What are the best hepatitis C drugs?

Drugs
Treatment for hepatitis C involves using medications to control symptoms of the infection, as well as drugs that help cure the infection itself. Using medications may improve the outcome of the disorder by helping to prevent severe complications from chronic liver damage.

In the past, there were not many medical treatments available to treat hepatitis C. Today, there is a variety of drugs available that can help cure the infection more quickly and efficiently than ever before.

Treatment is essential even if the person is not showing signs or symptoms of hepatitis C. This article lists the hepatitis C medications that the U.S. Food and Drug Administration (FDA) has approved, along with details about each drug, including dosage and side effects.

Understanding hepatitis C genotypes

pharmacist looking at box of medication
The genotype of hepatitis C that a person has will affect the medication available to them.

There is a range of different medications for hepatitis C because there is no single drug that works for everyone.

Medications may vary depending on the amount of liver scarring a person has and the genotype of the virus they have.

A genotype refers to the genes that make up the hepatitis C virus. All genotypes cause similar liver damage, but the long-term effects may differ.

Hepatitis C has six genotypes. Doctors represent these types by using the numbers 1 through 6. The most common genotype is type 1 hepatitis C. There are also sub-groups within these groups, such as hepatitis 1a and 1b.

Knowing which genotype a person has is crucial in choosing the right treatment.


Ribavirin (Copegus and Rebetol)

Ribavirin is one of the older drugs that doctors prescribe for hepatitis infections.

It is a general-use antiviral drug that is not specific to a particular hepatitis genotype. Doctors usually prescribe it alongside other combinations of drugs to treat various types of chronic hepatitis C infections.

Facts about ribavirin include:

  • Treatment duration depends on other drugs a person is taking.
  • Dosage depends on the person’s body weight.
  • Side effects include nausea and vomiting, difficulty sleeping, and cognitive problems, such as trouble concentrating or memory loss
  • Ribavirin may also cause congenital disabilities. Avoid ribavirin while pregnant or if trying to conceive.


Combination medications for all genotypes

Combination drugs tend to be effective for most or all hepatitis C genotypes:

Daclatasvir and sofosbuvir (Daklinza)

Daclatasvir is one of the newer drugs for hepatitis C.

Doctors use this drug in combination with another drug called sofosbuvir (Sovaldi) to treat hepatitis C genotype 1. Doctors may also prescribe ribavirin.

Facts about these drugs include:

  • Treatment time is 12 weeks.
  • Dosage is 60 milligrams (mg) of daclatasvir and 400 mg of sofosbuvir once a day.
  • Common side effects include a headache, general fatigue, and tiredness.

Sofosbuvir and velpatasvir (Epclusa)

Doctors typically prescribe a combination of sofosbuvir and velpatasvir for people without cirrhosis. Doctors may also prescribe it alongside ribavirin for people who have severe cirrhosis.

Facts about these drugs:

  • Treatment time is 12 weeks.
  • Dosage is fixed at 400 mg of sofosbuvir and 100 mg of velpatasvir once a day with or without food.
  • Common side effects include general fatigue, a headache, and gastrointestinal issues, such as nausea or diarrhea.

Sofosbuvir, velpatasvir, and voxilapresvir (Vosevi)

This drug combination is similar to Epclusa but also includes a drug called voxilapresvir.

Facts about Vosevi include:

  • Treatment time is 12 weeks for people without cirrhosis or compensated cirrhosis (a scarred but functioning liver).
  • Dosage is fixed at 400 mg of sofosbuvir, 100 mg of velpatasvir, and 100 mg of voxilapresvir once per day with food.
  • Common side effects include tiredness, a headache, diarrhea, and nausea.

Doctors often recommend Vosevi for people who have had previous treatment for hepatitis C that did not work.

Glecaprevir and pibrentasvir (Mavyret)

young woman with headache sitting in front of laptop
Headaches may be a side effect of glecaprevir and pibrentasvir.

Doctors may prescribe glecaprevir and pibrentasvir in a fixed-dose combination.

The medication may be helpful for all adults with any chronic hepatitis C genotype.

Facts about the drug include:

  • Treatment time is 8, 12, or 16 weeks. This depends on the genotype, as well as other issues such as previous treatment for hepatitis C or having cirrhosis.
  • Dosage is a fixed dose of 100 mg of glecaprevir and 40 mg of pibrentasvir, taken as three oral tablets daily with food.
  • The most common side effects include fatigue and a headache.


Medications for genotype 1

The following medications may be effective for genotype 1:

Elbasvir and grazoprevir (Zepatier)

The FDA approved this combination of elbasvir and grazoprevir in early 2016. Doctors may also prescribe ribavirin alongside Zepatier.

Facts about Zepatier include:

  • Treatment time is 12 or 16 weeks.
  • Dosage is a fixed dose of 50 mg of elbasvir and 100mg of grazoprevir once daily with or without food.
  • Common side effects include a headache, fatigue, and nausea. If the person also takes ribavirin, they may also experience shortness of breath, anemia, or rashes and itching.

Doctors may also prescribe Zepatier alongside ribavirin for genotype 4 hepatitis C. The treatment time, dosage and side effects are the same as for genotype 1.

Simeprevir (Olysio) and sofosbuvir

The combination of simeprevir with sofosbuvir may also help treat people with hepatitis C genotype 1. Doctors will sometimes also prescribe ribavirin alongside these drugs.

Facts about these drugs include:

  • Treatment time is 12 or 24 weeks.
  • Dosage is 150 mg of simeprevir and 400 mg of sofosbuvir once per day.

Common side effects at 12 weeks include:

  • fatigue
  • a headache
  • nausea
  • insomnia
  • rash
  • itching
  • sensitivity to light

Additional side effects during 24-week treatment may include diarrhea and dizziness.

Ledipasvir and sofosbuvir (Harvoni)

The combination of ledipasvir and sofosbuvir is one of the newer treatments and is the first single-dose daily tablet for genotype 1 hepatitis C. Doctors may also prescribe ribavirin alongside Harvoni.

Facts about Harvoni include:

  • Treatment time is 12 weeks.
  • Dosage is fixed at 90 mg of ledipasvir and 400 mg of sofosbuvir once per day.
  • Common side effects include a headache and general fatigue.

When people also take ribavirin, other side effects may include weakness and a cough.

Doctors also prescribe Harvoni to treat genotype 4. In this instance, the doctor may include ribavirin in the prescription.

People with genotype 5 and 6 hepatitis C may also receive Harvoni to treat the infection.

In all these cases, treatment time, dosage, and side effects remain the same as for genotype 1.

Ombitasvir, paritaprevir, and ritonavir tablets co-packaged with dasabuvir tablets (Viekira Pak)

This is a relatively new group of medicines that treat genotype 1 hepatitis.

Facts about the drug pack include:

  • Treatment time is 12 or 24 weeks.
  • Dosage is a pack of tablets containing 12.5 mg of ombitasvir, 75 mg of paritaprevir, and 50 mg ritonavir, taken once daily in the morning, and one 250 mg tablet of dasabuvir taken twice daily with a meal.
  • Common side effects of this group of drugs include nausea, itching, and trouble sleeping. If the person also takes ribavirin, side effects include tiredness, nausea, fatigue, and skin reactions.

Medications for genotype 2

The following medications may be effective for genotype 2:

Sofosbuvir and ribavirin

Doctors typically recommend the combination of sofosbuvir and ribavirin to treat genotype 2 hepatitis C.

Facts about these drugs include:

  • Treatment time is 12 or 16 weeks.
  • Dosage is 400 mg of sofosbuvir, once a day with or without food. The dosage of ribavirin varies depending on body weight.
  • Side effects include a headache and fatigue.

Doctors may also prescribe this combination of drugs for genotype 3 and genotype 4 hepatitis C. The dosage and side effects are the same as for type 2, but the treatment time for 24 weeks.


Medications for genotype 3

Daclatasvir and sofosbuvir

The combination of daclatasvir and sofosbuvir may also work for people with genotype 3. Doctors may also prescribe ribavirin alongside these drugs.

Facts about these drugs include:

  • Treatment time is 12 weeks.
  • Dosage is 60 mg daclatasvir and 400 mg sofosbuvir once a day.
  • The most common side effects are a headache and fatigue.

Medications for genotype 4

The following medications may be effective for genotype 4:

Ombitasvir, paritaprevir, and ritonavir (Technivie)

woman sleeping with face to wall
Ombitasvir, paritaprevir, and ritonavir can cause sleep problems.

Doctors may prescribe this combination of drugs to treat hepatitis C genotype 4. They may also prescribe ribavirin.

  • Facts about Technivie include:
  • Treatment time is 12 weeks.
  • Dosage is a fixed-dose combination of 12.5 mg ombitasvir, 75 mg paritaprevir, and 50 mg ritonavir taken once daily.
  • Common side effects include weakness, tiredness, nausea, and sleep problems.


Medications for genotype 5 and 6

Medications for genotypes 5 and 6 are often the same as for other types of hepatitis C . These have been included in the appropriate sections, above.


Takeaway

There are many effective hepatitis C medications.

By working directly with their doctor, most people can find an effective treatment that helps manage symptoms. It is essential that the doctor knows about any other medications the person is taking, as well as any side effects they experience.

People should note that almost all hepatitis C medications have very high cure rates. One of the keys to successful treatment is completing the drug regimen and following the doctor’s advice.

Anyone who experiences a severe reaction from their hepatitis C treatment should talk to their doctor about other options.

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