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Hepatitis C — SCE Infectious Diseases MCQ

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HardHepatitisHepatitis CSCE Infectious Diseases

A patient with genotype 1 chronic hepatitis C is selected for ledipasvir/sofosbuvir. Epilepsy is controlled with carbamazepine and previous unsupervised withdrawal caused status epilepticus. What is the best plan?

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Correct answer: B — Replace carbamazepine with neurology input before starting DAA therapy

Carbamazepine is a strong intestinal P-glycoprotein inducer that substantially lowers ledipasvir and sofosbuvir exposure, risking virological failure; co-administration is contraindicated in the UK SmPC. Because abrupt withdrawal has caused status epilepticus, the correct response is coordinated substitution of the anticonvulsant before starting the DAA, not dose separation or empirical DAA escalation.

Reference: Ledipasvir/sofosbuvir SmPC: https://www.medicines.org.uk/emc/product/11849/smpc