Administering a Soda Beverage With the Hepatitis C Treatment Sofosbuvir/Velpatasvir and the Proton-Pump Inhibitor Pantoprazole: A Case Report

Purpose: The manufacturer of sofosbuvir/velpatasvir recommends avoiding coadministration with proton pump inhibitors (PPI) due to decreased velpatasvir serum concentrations which could translate to an increased risk of HCV treatment failure. A recent open-label study in healthy adults reported overcoming this interaction through co-administration of velpatasvir and a PPI with soda, but there is no clinical outcome data in HCV-infected patients. Summary: A 64 year-old male with a past medical history significant for decompensated cirrhosis, chronic HCV infection, upper gastrointestinal bleed, anemia, esophagitis, and previous HCV treatment failures required HCV treatment. The patient’s medications included a PPI but no other significant DDI were present. The patient was instructed to take one sofosbuvir/velpatasvir tablet, soda, and pantoprazole 40 mg tablet at the same time once daily. Treatment was well tolerated, and clinical cure of HCV was achieved. Conclusion: Scenarios may arise during HCV treatment that necessitate coadministration of a PPI. Interfering with optimal absorption of HCV treatment could lead to development of resistance or treatment failure. Future studies should include this strategy for overcoming this common DDI. This case demonstrates sofosbuvir/velpatasvir administered orally with soda and a PPI is potentially safe and effective for treatment of chronic HCV infection.