Blackmond Nicholas, Kanke Joshua D, Loh Tiffany, Weitzman Raymond
Internal Medicine, Gary Burnstein Community Health Clinic, Pontiac, USA.
Pharmacy, College Pharmacy, Colorado Springs, USA.
Cureus. 2022 May 31;14(5):e25530. doi: 10.7759/cureus.25530. eCollection 2022 May.
Currently, there is limited data evaluating the coadministration of first-generation anticonvulsants for epilepsy treatment and direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection. There is a potential risk of suboptimal DAA serum concentrations that could potentially lead to HCV treatment failure. In this report, we describe the case of an uninsured, non-Hispanic Black male in his mid-40s with a history of generalized epilepsy that was managed with phenytoin 100mg twice a day and divalproex 500mg extended-release once daily. He was diagnosed with an acute hepatitis C viral infection with a genotype of 1a. Due to the viral genotype, treatment naivety, and lack of cirrhosis the recommended treatment is to start glecaprevir/pibrentasvir, but the concomitant use of phenytoin and glecaprevir/pibrentasvir is not recommended due to a drug-drug interaction that could lead to subtherapeutic DAA levels and possible treatment failure. Through shared decision-making and close follow-up, we slowly weaned the patient off phenytoin, replaced it with levetiracetam, and started glecaprevir/pibrentasvir. We successfully eradicated the patient's HCV infection, and no breakthrough seizures were reported. Although an unprecedented case and with the limited data evaluating the coadministration of DAAs and treatment of acute HCV infection, we were able to successfully treat and achieve full remission of the HCV infection. By virtue of this case report, we hope to encourage others to report similar cases and spread awareness regarding the difficulties in management.
目前，评估用于癫痫治疗的第一代抗惊厥药与用于治疗丙型肝炎病毒（HCV）感染的直接作用抗病毒药物（DAA）联合使用的相关数据有限。存在DAA血清浓度未达最佳水平的潜在风险，这可能会导致HCV治疗失败。在本报告中，我们描述了一名45岁左右未参保的非西班牙裔黑人男性的病例，他有全身性癫痫病史，每天服用两次100mg苯妥英钠和一次500mg丙戊酸缓释片进行治疗。他被诊断为急性丙型肝炎病毒感染，基因型为1a。由于病毒基因型、初治状态以及无肝硬化，推荐的治疗方案是开始使用格卡瑞韦/哌仑他韦，但由于药物相互作用可能导致DAA水平低于治疗剂量并可能导致治疗失败，不建议同时使用苯妥英钠和格卡瑞韦/哌仑他韦。通过共同决策和密切随访，我们逐渐让患者停用苯妥英钠，换用左乙拉西坦，并开始使用格卡瑞韦/哌仑他韦。我们成功根除了患者的HCV感染，且未报告有突破性癫痫发作。尽管这是一个前所未有的病例，且评估DAA联合使用和急性HCV感染治疗的相关数据有限，但我们成功治疗并实现了HCV感染的完全缓解。通过这份病例报告，我们希望鼓励其他人报告类似病例，并提高对管理困难的认识。
