Drug reference

Daclatasvir

Direct-acting antiviral (HCV NS5A inhibitor) · Antiviral

START

60 mg PO once daily with sofosbuvir

TYPICAL MAX

90 mg (with inducers — usually avoid); 30 mg with strong inhibitors

STOP IF

Symptomatic bradycardia (amiodarone) or hypersensitivity

WATCH

HBV status before start; cardiac monitoring if amiodarone unavoidable

CDSCO withdrawnSchedule HATC J05AP07

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · absorption
PEAK: 1.5h · Tmax
t½: 13h · t½
DURATION: 1d · once-daily

EXCRETION

Mainly faecal (~88%); ~7% renal

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Use only if benefit outweighs risk; ribavirin-containing regimens contraindicated in pregnancy.

FDA category + note

Top interactionssee all 12 →

Strong Cyp3a InducersContraindicatedTextbookG&G 14e · p1239, p1242
Strong Cyp3a4 InducersContraindicatedDatabaseKimi deep-research + Cla
ApalutamideSevereDatabaseDDInter
BerotralstatSevereDatabaseDDInter

Mechanism

Inhibits the hepatitis C virus NS5A protein, blocking viral RNA replication and virion assembly; used with sofosbuvir for pan-genotypic HCV cure.

Indications

Chronic hepatitis C (with sofosbuvir ± ribavirin)

Dosing

Adult: 60 mg PO once daily with sofosbuvir, typically 12 weeks (duration per genotype/cirrhosis).
Pediatric: Specialist; weight-based (limited).
Renal adjustment: No dose adjustment in any degree of renal impairment.
Hepatic adjustment: No dose adjustment for hepatic impairment.
Geriatric: No dose adjustment.
Max dose: 90 mg/day (with strong CYP3A4 inducers — generally avoid) or 30 mg with strong inhibitors

Pharmacokinetics

Onset

Viral suppression within days

Peak effect

~1–2 h (Tmax)

Duration

~24 h (once-daily)

Half-life

~12–15 h

Bioavailability

~67%

Protein binding

~99%

Metabolism

Hepatic CYP3A4; P-gp substrate

Excretion

Mainly faecal (~88%); ~7% renal

Contraindications

Co-administration with strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin, St John's wort)
Hypersensitivity

Side effects

Common

HeadacheFatigueNauseaDiarrhoea

Serious

Symptomatic bradycardia (with sofosbuvir + amiodarone)
Hepatitis B reactivation (if co-infected)
Hypersensitivity

Pregnancy & lactation

Pregnancy

Use only if benefit outweighs risk; ribavirin-containing regimens contraindicated in pregnancy.

Lactation

Limited data; weigh benefit/risk.

Drug interactions

Strong Cyp3a Inducers

Contraindicated

Textbook

Significantly reduced daclatasvir concentrations and efficacy.

Daclatasvir is contraindicated with strong CYP3A inducers (e.g., rifamycins, St. John’s wort, antiepileptics). Avoid combination.

Source: G&G 14e · p1239, p1242

Strong Cyp3a4 Inducers

Contraindicated

Database

Markedly reduced daclatasvir levels

Contraindicated; avoid

Source: Kimi deep-research + Cla

Apalutamide

Severe

Database