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. Various drugs now help cure the infection more quickly and efficiently than 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 Food and Drug Administration (FDA) has approved, with details about each drug, including dosage and side effects.
There is a range of medications for hepatitis C because no single drug works for everyone.
Medications may vary depending on the amount of liver scarring a person has and the virus’s genotype.
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 seven genotypes. Doctors represent these types by using the numbers 1 to 7. The
Knowing which genotype a person has is crucial in getting the proper treatment.
For over 20 years, doctors have prescribed ribavirin for hepatitis infections. It works by stopping the spread of hepatitis C inside the body.
Ribavirin has many side effects, including:
Other facts about ribavirin include:
- Treatment duration depends on other drugs a person is taking.
- The dosage depends on the person’s body weight.
- A person will need their blood levels frequently checked while taking the medication to monitor efficiency and toxicity.
- Ribavirin may also cause congenital anomalies. Avoid ribavirin while pregnant or if trying to conceive.
Combination drugs tend to be effective for most or all hepatitis C genotypes.
Sofosbuvir and velpatasvir (Epclusa)
Doctors typically prescribe a combination of sofosbuvir and velpatasvir for people without cirrhosis. However, doctors may also prescribe it alongside ribavirin for people who have severe cirrhosis.
Facts about these drugs:
- The treatment time is 12 weeks.
- Dosage is fixed at 400 milligrams (mg) of sofosbuvir and 100 mg of velpatasvir once a day with or without food.
- Common side effects include:
Sofosbuvir, velpatasvir, and voxilaprevir (Vosevi)
This drug combination is similar to Epclusa but includes a drug called voxilaprevir.
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 voxilaprevir once per day with food.
- Common side effects include tiredness, headache, diarrhea, and nausea.
Doctors often recommend Vosevi for people with long-term hepatitis C infection when they’ve already received other treatments.
Glecaprevir and pibrentasvir (Mavyret)
Facts about the drug include:
- Treatment time is 8, 12, or 16 weeks and depends on the genotype and 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 headaches.
The following medications may be effective for genotype 1.
Elbasvir and grazoprevir (Zepatier)
Facts about Zepatier include:
- Treatment time is 12 or 16 weeks.
- Dosage is a fixed dose of 50 mg of elbasvir and 100 mg of grazoprevir once daily with or without food.
- Common side effects include a headache, fatigue, and nausea. If the person takes ribavirin, they may also experience shortness of breath, anemia, 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 genotype 1.
Ledipasvir and sofosbuvir (Harvoni)
The combination of ledipasvir and sofosbuvir is one of the newer treatments. It is the first single-dose daily tablet for genotype 1 hepatitis C. Doctors may also prescribe ribavirin alongside Harvoni.
Facts about Harvoni include:
- The treatment time is 8–24 weeks.
- Dosage is fixed at 90 mg of ledipasvir and 400 mg of sofosbuvir once daily.
- Common side effects include headaches and general fatigue.
When people take ribavirin, other side effects may include weakness and 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 medications to 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 of ritonavir, once daily. One 250 mg tablet of dasabuvir is taken twice daily with a meal.
- Common side effects of this group of drugs include nausea, itching, and trouble sleeping. If the person takes ribavirin, side effects include tiredness, nausea, fatigue, and skin reactions.
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 depends on a person’s body weight.
- Side effects include headaches 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 type 2, but the treatment time is 24 weeks.
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 genotypes 5 and 6 are often the same as for other types of hepatitis C. (These are mentioned in the relevant sections above.)
Direct-acting antivirals (DAAs) effectively cure chronic hepatitis C infections. These FDA-approved therapies offer many advantages and disadvantages:
- They provide fewer side effects. The adverse effects of earlier treatments exceed those of DAAs.
- The duration of treatment is less. The length of treatment is shorter, from 12–48 weeks to 8 weeks.
- A person takes fewer pills. Instead of taking multiple medications per day, it is a single pill per day.
- It is not an effective treatment for all. For example, DAAs are not as
effectivein treating hepatitis C for those with liver cancer or severe liver decompensation.
- Adherence and follow-up are crucial to its success. Taking the medication every day as directed for the length of therapy and strict follow-up visits with the doctor is required.
As experts learn more about hepatitis C and how to treat it, different medications that were once a preferred treatment may no longer be ideal. For example, some medications have severe adverse effects. When a new drug is available to treat a disease, a person can discontinue the previous medication. The new drug effectively treats the disorder without adverse effects.
Some discontinued hepatitis C medications include:
- telaprevir (Incivek)
- boceprevir (Victrelis)
- simeprevir (Olysio)
- daclatasvir (Daklinza)
There are many effective hepatitis C medications.
By working directly with a doctor, most people can find an effective treatment that helps manage symptoms. The doctor should know about any other medications the person is taking and 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 to their hepatitis C treatment should talk with their doctor about other options.