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Epclusa
Epclusa (generic name: sofosbuvir and velpatasvir) is an antiviral medication used to treat chronic hepatitis C in adults and children aged 3 years and older. It is a combination drug containing sofosbuvir, a nucleotide analog polymerase inhibitor, and velpatasvir, a NS5A inhibitor. Together, these drugs work by targeting two different proteins the hepatitis C virus (HCV) needs to replicate, helping to clear the virus from the body. Epclusa is effective against all six major HCV genotypes.
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Frequently Asked Questions
How long does it take for Epclusa to cure hepatitis C?
Treatment with Epclusa typically lasts for 12 weeks, and most patients are considered cured after completing the full course if their viral load becomes undetectable.
Can Epclusa be used in people with liver cirrhosis?
Yes, Epclusa can be used in patients with compensated or decompensated cirrhosis, though additional medications like ribavirin may be required.
Can I take Epclusa with antacids?
No, antacids can interfere with the absorption of Epclusa. If needed, take them at least four hours apart.
Can Epclusa cause liver problems?
In patients with severe liver disease, Epclusa can lead to complications. Your healthcare provider will monitor your liver function during treatment.
Does Epclusa interact with other medications?
Yes, Epclusa can interact with drugs like rifampin, St. John's Wort, and amiodarone, potentially reducing its effectiveness or causing serious side effects.
Comprehensive Drug Guide
How Does Epclusa Work?
- Sofosbuvir blocks the action of NS5B polymerase, an enzyme the virus uses to copy its RNA.
- Velpatasvir inhibits NS5A, a protein necessary for viral replication and assembly. Together, these actions prevent the virus from multiplying, allowing the immune system to clear the infection.
Common Dosages
- 400 mg sofosbuvir / 100 mg velpatasvir tablets.
Typical Dosing
- The typical dosing for Epclusa is one tablet daily for 12 weeks, regardless of the hepatitis C genotype or liver disease stage. Treatment may be extended or combined with other medications depending on the patient's condition.
Typical Dosing
FDA Approved Indications
- Chronic hepatitis C infection in patients with genotypes 1-6, with or without cirrhosis.
- HCV infection in patients with compensated cirrhosis or decompensated cirrhosis when combined with ribavirin.
Who Shouldn't Take Epclusa?
- Severe liver disease (unless used with additional therapy)
- Concurrent use of rifampin or St. John's Wort, which may reduce the effectiveness of the drug.
Advice From The Pharmacist
- Take Epclusa exactly as prescribed, with or without food. Missing doses can lead to treatment failure.
- Avoid taking antacids or proton pump inhibitors within four hours of taking Epclusa, as they can reduce the drug’s effectiveness.
- Routine blood tests may be needed to monitor liver function and viral load during treatment.
- Notify your healthcare provider if you are pregnant or planning to become pregnant, as Epclusa combined with ribavirin can harm the fetus.
Side Effects of Epclusa
Common Side Effects
- Headache
- Fatigue
- Nausea
Uncommon/Severe Side Effects
- Severe liver problems
- Hepatitis B reactivation in co-infected patients
- Allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Epclusa
- Hepatitis B Reactivation: Patients with a history of hepatitis B may experience reactivation of the virus during treatment with Epclusa, which can lead to serious liver damage. Your healthcare provider will screen for HBV before starting therapy.
- Liver Failure: For patients with advanced liver disease, close monitoring is required, especially if taking Epclusa with ribavirin.
- Drug Interactions: Epclusa may interact with certain medications like rifampin, St. John's Wort, and antacids, reducing its effectiveness.
Interactions with Epclusa
Common Drug Interactions
- Rifampin: Reduces the levels of sofosbuvir and velpatasvir, making Epclusa less effective.
- Antacids and proton pump inhibitors: Can interfere with the absorption of Epclusa.
- Amiodarone: Co-administration with Epclusa can cause a slow heart rate, potentially leading to a fatal condition called bradycardia.
Alternatives to Epclusa
- Harvoni (ledipasvir/sofosbuvir): Another direct-acting antiviral for chronic hepatitis C.
- Mavyret (glecaprevir/pibrentasvir): A combination drug used for shorter treatment durations for hepatitis C.
- Zepatier (elbasvir/grazoprevir): A treatment option for certain genotypes of HCV infection.
