Hep C drugs: cash flow, interactions and raising awareness

New pharmacy training to understand and dispense the new direct acting antiviral oral regimens for Hepatitis C will be available in May, but pharmacists need to learn as much as they can about the new drugs as there has already been significant uptake, a panel of experts told pharmacy media today.

Debbie Rigby, Professor Lisa Nissen and Chris Campbell have developed the CPD accredited education package designed specifically for community pharmacy.

Rigby highlighted the fact that there are significant interactions with the new class of drugs – for example Harvoni, Sofosbuvir and Daklinza all interact with amiodorone, causing potential symptomatic bradycardia and death. Harvoni interacts with acid reducers.

Harvoni is contraindicated with rosuvastatin – a potentially frequent possibility given that Prof Nissen says 80% of people in Australia with Hepatitis C are aged 40-plus.

The experts urged pharmacists to visit www.hep-druginteractions.org to keep abreast of potential interactions with not just prescription drugs, but also OTCs and any complementary medicines patients may be on, such as turmeric or St John’s Wort. Patients can also use the site and app.

“It’s fair to say that GPs have limited knowledge of these drugs,” Rigby said, so pharmacists need to be on top of these potential problems and to be able to discuss with patients, GPs and specialists the possibility of stopping rosuvastatin for the (on average) 12 week treatment duration with new DAAs, for example.

“For most people on statins you can stop that for 12 weeks, that’s a way to manage the interaction,” she says.

Campbell said that in an earlier APP session on the new Hepatitis C drugs, the majority of questions from pharmacists had centred around their significant cost, cash flow issues and GST implications.

Pharmacists need to be across the cash flow issues and whether (as well as over what time frame) they are able to purchase the medicines from their wholesaler, he said.

For these two reasons, as well as the role for pharmacy in improving adherence, it is vital for pharmacists to stay in close contact with patients’ GPs, liver clinics and other specialists.

Pharmacists have a key role to play in raising awareness, Rigby says, particularly of the short treatment time (compared to earlier generation drugs), the much smaller side-effect profile, and the far greater probability of being cured of Hepatitis C.

“Many of them will have been turned off by the peg-interferon and how terrible it made them feel as well as the fact that it didn’t always work,” Rigby says. “We should be increasing the awareness of patients with Hepatitis C that these are highly effective drugs and the majority of people will get a cure.”

Common DAA side-effects include headache and some insomnia as patients’ viral status improves and they have more energy.

Campbell said it is important to educate all pharmacy staff about the importance of not perpetuating stigma.

“Sussan Ley, the Health Minister, described this as a ‘watershed’ moment, and it is,” Rigby says. “Now we have drugs that could have the potential in the next 25 years to eradicate Hepatitis C from the world.”


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  1. Russell Smith

    Seems that just to start off this fix the world scenario we should certainlly ask about the most common side effects of these medications –
    Such as – how many hundreds of thousands of mainly older Aussies have had to pay for them by missing out on, say, Panadol Osteo, and how many pharmacists are having personally to subsidise these medications – over to you Minister – with regard to side effects – how much have you personally put in?

    • Drugby

      Look around you – 1 in 100 adults in Australia have chronic hep C infection and 80% are over the age of 45 years. And the new DAAs have good evidence of efficacy – cures 95-100% of people with hep C with a 12 week course. Yes they are expensive, but they are also cost-effective as the sequelae to no treatment is very expensive (hospital admissions, cirrhosis, liver transplants).
      The evidence for paracetamol SR is not as good, and guidelines are shifting on the benefits for treating osteoarthritis. How many packets of Panadol Osteo are sitting in people’s cupboards at home?? In my experience, most people only take it 2 bd so the benefits of sustained release are lost.

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