SNFGE SNFGE
 
Thématique :
- Foie
- Hépatites virales
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gastroenterology
  2015/11  
 
  2015 Nov;149(6):1378-1380.e1  
  doi: 10.1053/j.gastro.2015.07.051  
 
  Extreme Bradycardia After First Doses of Sofosbuvir and Daclatasvir in Patients Receiving Amiodarone: 2 Cases Including a Rechallenge  
 
  Renet S, Chaumais MC, Antonini T, Zhao A, Thomas L, Savoure A, Samuel D, Duclos-Vallée JC, Algalarrondo V  
  http://www.ncbi.nlm.nih.gov/pubmed/26253303  
 
 

Sofosbuvir and daclatasvir are direct-acting antiviral drugs used to treat chronic hepatitis C virus infection. In 2015, the Food and Drug Administration and European Medical Agency warned that bradycardia could occur when amiodarone was administered in combination with sofosbuvir, but no case reports had been published. We report extreme bradycardia within 2 hrs after intake of sofosbuvir and daclatasvir by 2 patients receiving amiodarone. The first patient had a cardiac asystole 30 min after receiving sofosbuvir and daclatasvir. Amiodarone, sofosbuvir, and daclatasvir treatment were stopped; after 10 days, the cardiac evaluation was normal and patient was discharged. The second patient was taking amiodarone and propranolol; 2 hrs after receiving sofosbuvir and daclatasvir, he had an extreme sinus node dysfunction (heart rate of 27beats/min). Amiodarone and propranolol were stopped, but the patient continued receiving sofosbuvir and daclatasvir for 3 days and sinus bradycardia was recorded each day, 2 hrs after intake of these drugs. When he stopped taking the drugs, no bradycardia was observed. Administration of sofosbuvir and daclatasvir on day 13 induced bradycardia 2 hrs after intake. However, no bradycardia occurred following a rechallenge 8 weeks after the patient stopped taking amiodarone. These observations indicate that patients treated with amiodarone should be continuously monitored within the first 48 hrs following the initiation of sofosbuvir and daclatasvir.

 
Question posée
 
Peut-on prescrire le sofosbuvir en association avec le daclatasvir chez les patients traités par cordarone ?
 
Question posée
 
Non.
 
Commentaires

Le traitement du VHC n’est pas une urgence, on a le temps de discuter avec le cardiologue pour modifier le traitement et débuter le sofosbuvir plusieurs semaines après l’arrêt de la cordarone chez un patient bien équilibré avec son nouveau traitement.

 
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