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Zepatier
Zepatier (generic names: elbasvir and grazoprevir) is a combination antiviral medication used to treat chronic hepatitis C virus (HCV) infection. It is specifically indicated for patients with genotypes 1 and 4 of HCV. Zepatier works by inhibiting key proteins needed for the virus to replicate, helping to reduce the viral load and often leading to a cure. It is commonly used for both treatment-naïve and treatment-experienced patients, with or without compensated cirrhosis.
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Frequently Asked Questions
How long does it take for Zepatier to cure hepatitis C?
The treatment duration is typically 12 to 16 weeks, depending on the patient's genotype, treatment history, and viral mutations. Most patients achieve a sustained virologic response (SVR), meaning they are cured, after completing the prescribed course.
Can I drink alcohol while taking Zepatier?
No, it is advised to avoid alcohol while taking Zepatier, as alcohol can worsen liver damage in patients with hepatitis C.
What should I do if I miss a dose of Zepatier?
If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double up on doses.
Can Zepatier be used in patients with cirrhosis?
Yes, Zepatier can be used in patients with compensated cirrhosis (Child-Pugh Class A). However, it should not be used in patients with decompensated cirrhosis (Child-Pugh Class B or C).
Is Zepatier safe for long-term use?
Zepatier is intended for short-term use, typically for 12 to 16 weeks, to cure hepatitis C. Long-term use is not required or recommended beyond the prescribed treatment period.
Comprehensive Drug Guide
How Does Zepatier Work?
- Elbasvir: Inhibits the NS5A protein, which is critical for viral RNA replication.
- Grazoprevir: Inhibits the NS3/4A protease, an enzyme needed for viral replication and maturation. Together, these actions significantly reduce the viral load, often leading to the clearance of the virus.
Common Dosages
- Elbasvir 50 mg / Grazoprevir 100 mg
Typical Dosing
- The typical dosing for Zepatier is one tablet taken once daily, with or without food, for 12 to 16 weeks, depending on the patient's genotype and prior treatment history.
- Some patients may require a longer treatment duration based on the presence of certain viral mutations (e.g., NS5A resistance-associated variants).
Typical Dosing
FDA Approved Indications
- Chronic hepatitis C infection in patients with genotypes 1 and 4.
- It can be used in patients with or without compensated cirrhosis (Child-Pugh Class A).
Who Shouldn't Take Zepatier?
- Severe liver impairment (Child-Pugh Class B or C).
- Known hypersensitivity to elbasvir, grazoprevir, or any component of the formulation.
- Concurrent use of certain medications that strongly induce or inhibit CYP3A (e.g., rifampin, carbamazepine), as these can affect the metabolism of Zepatier.
Advice From The Pharmacist
- Take Zepatier exactly as prescribed: It is important to take it daily at the same time for the entire course of treatment to ensure effectiveness.
- Do not miss doses: Missing doses can reduce the effectiveness of the medication and increase the risk of developing resistance. If you miss a dose, take it as soon as you remember. If it’s close to the next dose, skip the missed dose and continue with your regular schedule.
- Avoid alcohol during treatment, as it can worsen liver function in patients with hepatitis C.
- You may need regular blood tests to monitor liver function and viral load during treatment.
Side Effects of Zepatier
Common Side Effects
- Fatigue
- Headache
- Nausea
- Elevated liver enzymes (ALT)
Uncommon/Severe Side Effects
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Hepatic decompensation in patients with advanced liver disease
- Hepatitis B reactivation in patients coinfected with hepatitis B and C
Risks and Warnings of Zepatier
- Liver Enzyme Elevation: Zepatier may cause an increase in ALT levels, which can indicate liver inflammation. Patients should have liver function monitored regularly during treatment.
- Hepatitis B Reactivation: Patients coinfected with hepatitis B and C should be monitored for signs of hepatitis B reactivation during and after treatment with Zepatier.
- Use in Severe Liver Disease: Zepatier is contraindicated in patients with moderate to severe liver impairment (Child-Pugh Class B or C) due to the risk of worsening liver function.
Interactions with Zepatier
Common Drug Interactions
- CYP3A inducers and inhibitors: Medications that strongly induce or inhibit the CYP3A enzyme can alter the effectiveness of Zepatier. Examples include:
- Rifampin (strong inducer): Decreases the effectiveness of Zepatier.
- Ketoconazole (strong inhibitor): Increases blood levels of Zepatier, potentially leading to toxicity.
- Statins: Zepatier can increase the risk of myopathy when taken with certain statins, such as atorvastatin or rosuvastatin. Your healthcare provider may adjust the statin dose or recommend an alternative.
Alternatives to Zepatier
- Harvoni (ledipasvir/sofosbuvir): A once-daily treatment for HCV genotypes 1, 4, 5, and 6.
- Epclusa (sofosbuvir/velpatasvir): A pan-genotypic regimen used to treat all HCV genotypes.
- Mavyret (glecaprevir/pibrentasvir): Another pan-genotypic option for hepatitis C, with a shorter treatment duration (8 weeks for most patients).
