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Sofosbuvir-Velpatasvir
Sofosbuvir-Velpatasvir (brand name: Epclusa) is a combination antiviral medication used to treat chronic hepatitis C virus (HCV) infection in adults. It is effective across all major genotypes (1-6) of HCV, making it a pan-genotypic treatment. Sofosbuvir is a nucleotide polymerase inhibitor, while velpatasvir is an NS5A inhibitor. Together, they block different stages of the viral replication process, helping to clear the infection. Sofosbuvir-Velpatasvir is often used with or without ribavirin depending on the severity of liver disease.
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Frequently Asked Questions
How effective is Sofosbuvir-Velpatasvir in treating hepatitis C?
Sofosbuvir-Velpatasvir has a high cure rate, with studies showing that over 95% of patients achieve a sustained virologic response (SVR), meaning the virus is undetectable 12 weeks after completing treatment.
Can I drink alcohol while taking Sofosbuvir-Velpatasvir?
It is strongly recommended to avoid alcohol while being treated for hepatitis C, as alcohol can cause further liver damage, which may affect the treatment's success.
What should I do if I miss a dose of Sofosbuvir-Velpatasvir?
If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for the missed one.
Can Sofosbuvir-Velpatasvir cure hepatitis C?
Yes, Sofosbuvir-Velpatasvir is considered a cure for hepatitis C if taken as prescribed and patients achieve SVR, indicating the virus is no longer detectable in the body.
Do I need to follow a specific diet while on Sofosbuvir-Velpatasvir?
There are no specific dietary restrictions with Sofosbuvir-Velpatasvir, but maintaining a healthy diet and avoiding alcohol is recommended to support liver health during treatment.
Comprehensive Drug Guide
How Does Sofosbuvir-Velpatasvir Work?
- Sofosbuvir: Inhibits the NS5B polymerase, an enzyme the virus needs to replicate its RNA, preventing the virus from multiplying.
- Velpatasvir: Inhibits the NS5A protein, which is essential for viral replication and assembly.
Common Dosages
- 400 mg sofosbuvir / 100 mg velpatasvir tablets
Typical Dosing
- The recommended dosage is one tablet taken once daily for 12 weeks. In patients with decompensated cirrhosis, ribavirin may be added to the regimen.
Typical Dosing
FDA Approved Indications
- Chronic hepatitis C virus (HCV) infection in genotypes 1 through 6, with or without cirrhosis.
- Compensated or decompensated cirrhosis (with the addition of ribavirin in some cases).
Who Shouldn't Take Sofosbuvir-Velpatasvir?
- Severe hypersensitivity to sofosbuvir, velpatasvir, or any of the components of the tablet.
- Concomitant use with rifampin, carbamazepine, or St. John’s Wort, as these drugs can significantly reduce the effectiveness of Sofosbuvir-Velpatasvir.
Advice From The Pharmacist
- Take Sofosbuvir-Velpatasvir exactly as prescribed, preferably at the same time each day. Do not skip doses or stop taking the medication without consulting your healthcare provider.
- Sofosbuvir-Velpatasvir can be taken with or without food.
- Avoid using any medications or supplements that may interact with Sofosbuvir-Velpatasvir, especially antacids, proton pump inhibitors, or H2-receptor antagonists, as these can reduce the absorption of velpatasvir.
- Routine liver function tests and viral load tests will be done during and after treatment to monitor the success of therapy.
Side Effects of Sofosbuvir-Velpatasvir
Common Side Effects
- Headache
- Fatigue
- Nausea
- Insomnia
Uncommon/Severe Side Effects
- Bradycardia (slow heart rate), especially when used with amiodarone
- Severe allergic reactions, such as rash, swelling, or difficulty breathing.
Risks and Warnings of Sofosbuvir-Velpatasvir
- Bradycardia Risk with Amiodarone: Patients taking both Sofosbuvir-Velpatasvir and amiodarone may experience severe, life-threatening bradycardia. This combination should be avoided unless absolutely necessary, and patients should be monitored closely.
- Hepatitis B Reactivation: Patients co-infected with hepatitis B virus (HBV) should be closely monitored, as there is a risk of HBV reactivation during or after treatment with Sofosbuvir-Velpatasvir.
- Drug Interactions: Sofosbuvir-Velpatasvir interacts with a range of medications that can either reduce its effectiveness or increase the risk of side effects. Always inform your doctor of all medications you are taking.
Interactions with Sofosbuvir-Velpatasvir
Common Drug Interactions
- Antacids: Taking antacids (like Tums) within 4 hours of Sofosbuvir-Velpatasvir can reduce velpatasvir’s effectiveness. It is recommended to space them apart.
- Proton Pump Inhibitors (PPIs): If taking PPIs (e.g., omeprazole), they should be taken simultaneously with Sofosbuvir-Velpatasvir on an empty stomach.
- Rifampin, carbamazepine, and St. John’s Wort: These can significantly reduce the effectiveness of Sofosbuvir-Velpatasvir and should be avoided.
Alternatives to Sofosbuvir-Velpatasvir
- Harvoni (ledipasvir/sofosbuvir): Another combination antiviral used to treat HCV but limited to genotypes 1, 4, 5, and 6.
- Zepatier (elbasvir/grazoprevir): An antiviral used to treat HCV, particularly in genotypes 1 and 4.
- Mavyret (glecaprevir/pibrentasvir): Another pan-genotypic HCV treatment that may be used for shorter treatment durations in some cases.
- Ribavirin: Sometimes used in combination with Sofosbuvir-Velpatasvir for patients with decompensated cirrhosis.
