Epclusa interactions: Alcohol, medications, and other factors

Before you start treatment with Epclusa, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Epclusa interacts with supplements, herbs, or vitamins, see the “Epclusa and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Epclusa. Keep in mind that this table doesn’t include all drugs that may interact with Epclusa. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about Epclusa’s side effects, see this article.
† For details about this interaction, see the “Drug interactions in depth” section below.

There aren’t any known interactions between Epclusa and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Epclusa treatment.

This is because alcohol can also worsen hepatitis C, which Epclusa is used to treat. Drinking alcohol while taking the drug may also worsen some of Epclusa’s side effects. For example, you may experience worsened nausea, headache, or fatigue.

If you have questions about limiting or avoiding alcohol while taking Epclusa, talk with your doctor.

Here’s a closer look at certain drug interactions of Epclusa.

Certain antacids

Antacids are used to ease symptoms of conditions such as indigestion and heartburn.

Interaction result: Taking Epclusa with antacids can make Epclusa less effective.

Interaction explained: Antacids lower the pH (acid level) in your stomach, which affects your body’s ability to absorb Epclusa. This can lead to lower levels of Epclusa in your system making it less effective at treating hepatitis C.

Examples of antacids: Here are some antacids that may interact with Epclusa:

• calcium carbonate (TUMS)
• aluminum hydroxide/magnesium hydroxide (Maalox)

Steps you or your doctor may take: Due to this risk, you should take Epclusa at least 4 hours before or 4 hours after taking an antacid. This may help prevent your antacid treatment from affecting the level of Epclusa.

Before taking an antacid with Epclusa, talk with your doctor or pharmacist. They can advise you on the best way to take both treatments.

To learn more about taking Epclusa with certain antacids, talk with your doctor or pharmacist.

H2 blockers

H2 blockers are also used to ease symptoms of conditions such as indigestion and heartburn.

Interaction result: Taking Epclusa with an H2 blocker can make Epclusa less effective.

Interaction explained: H2 blockers may affect your body’s ability to absorb Epclusa. This can lower the level of Epclusa in your body. As a result, the drug may be less effective at treating hepatitis C.

Examples of H2 blocker drugs: Here are some H2 blockers that may interact with Epclusa:

• cimetidine (Tagamet HB)
• famotidine (Pepcid AC)
• nizatidine (Axid AR)

Steps you or your doctor may take: Due to this risk, you should take Epclusa at least 12 hours before or 12 hours after taking an H2 blocker. Doing so may help prevent the H2 blocker from affecting the level of Epclusa.

Your doctor may also suggest taking a lower dose of the H2 blocker to further reduce this risk. They can help you determine a safe dosage to take with Epclusa.

To learn more about taking Epclusa with H2 blockers, talk with your doctor or pharmacist.

Diabetes medications

Diabetes medications are prescribed to help manage blood sugar levels in people with type 1 or type 2 diabetes.

Interaction result: Taking Epclusa with diabetes medications can increase the risk of low blood sugar.

Interaction explained: There’s a possible link between hepatitis C and diabetes. Specifically, hepatitis C may raise blood sugar levels and increase one’s risk of diabetes. By treating hepatitis C, Epclusa could lower blood sugar levels. People taking diabetes medications with Epclusa could develop very low blood sugar levels.

Examples of diabetes drugs: Here are some diabetes medications that may interact with Epclusa:

• metformin (Fortamet, Glumetza)
• pioglitazone (Actos)
• semaglutide (Ozempic, Rybelsus)

Steps you or your doctor may take: Before starting Epclusa treatment, tell your doctor if you take any diabetes medications. They may prescribe a lower dosage of the diabetes drug to help reduce the risk of low blood sugar with Epclusa.

If you take Epclusa with a diabetes medication, watch for symptoms of low blood sugar. Examples include headache, dizziness, sweating, and shaking.

To ease symptoms of low blood sugar, your doctor may recommend eating at least 15 grams (g) of carbohydrates. This may include fruit juice, hard candies, or glucose (sugar) tablets. Keep in mind that sugar-free candies and diet sodas will not treat low blood sugar.

Severely low blood sugar may be life threatening or cause loss of consciousness. If you have severely low blood sugar, you or a bystander should call 911 or a local emergency number immediately.

To learn more about taking Epclusa with diabetes medications, talk with your doctor or pharmacist.

Epclusa may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Epclusa.

Epclusa interactions with supplements

Before you start treatment with Epclusa, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Epclusa interactions with herbs

Epclusa may interact with St. John’s wort, which is an herbal supplement that may be used for depression and other conditions.

St. John’s wort may speed up the activity of an enzyme (a type of protein) in your body that helps break down Epclusa. This can cause Epclusa to break down too quickly, leading to a low level of Epclusa. If the level of Epclusa is too low, the drug may not work to treat hepatitis C.

Due to this risk, doctors will typically advise you to avoid taking St. John’s wort with Epclusa. They may be able to suggest a treatment option other than St. John’s wort.

Epclusa and vitamins

There are no reports of interactions between Epclusa and vitamins. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Epclusa.

Epclusa interactions with food

Epclusa may interact with grapefruit and grapefruit juice.

Grapefruit products may slow down the activity of an enzyme in your body that helps break down Epclusa. This can cause Epclusa to break down too slowly, leading to a high level of Epclusa in your system. A high level of the drug in your system may increase your risk of side effects from Epclusa.

Due to this risk, your doctor may advise you to limit or avoid grapefruit products while taking Epclusa.

It’s also important to avoid sprinkling Epclusa oral pellets on acidic foods such as cheese and fruit. The pellets should be sprinkled onto nonacidic foods, such as ice cream and pudding. To learn more about taking Epclusa, see this article.

If you have additional questions about foods to avoid while taking Epclusa, talk with your doctor.

Epclusa and vaccines

There aren’t any known interactions between Epclusa and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Epclusa and lab tests

Epclusa isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

EPCLUSA AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Epclusa. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with Epclusa. The impact of cannabis may affect how well you stick to your Epclusa treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Epclusa. Before you take this drug, be sure to talk with your doctor about your health history. Epclusa may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Epclusa include:

• Allergic reaction: If you’ve had an allergic reaction to Epclusa or any of its ingredients, your doctor will likely not prescribe Epclusa. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It’s not known whether it’s safe to use Epclusa while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Epclusa may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before using Epclusa. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: There haven’t been enough clinical trials to determine whether Epclusa is safe to use while pregnant. If you’re pregnant or planning to become pregnant, tell your doctor before starting Epclusa. They can advise you on the right treatment plan for you.
• Risk of reactivation of HBV: Epclusa has a boxed warning about the risk of HBV reactivation. For details, see the boxed warning at the top of this article.

Note: Epclusa has no known contraindication* with ribavirin. However, ribavirin does have known contraindications to medical conditions other than hepatitis C. Doctors may prescribe ribavirin with Epclusa for hepatitis C in certain situations, but not for people with contraindications to ribavirin. Your doctor can review your medical history and recommend whether to prescribe ribavirin with Epclusa.

* A factor or condition that could prevent your doctor from prescribing a drug due to the risk of harm.

You can take certain steps to help prevent interactions with Epclusa. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Epclusa label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Epclusa doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Epclusa by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Epclusa. These resources might help:

• Overview of Epclusa: For a general overview of Epclusa, you can see this article.
• Side effects: If you’re interested in the side effects of Epclusa, see this article. Another option is to refer to the Epclusa prescribing information.
• Dosage specifics: To learn about the dosage of Epclusa, see this article.
• Drug comparison: Find out how Epclusa compares with Harvoni and Mavyret.
• Cost: If you’d like to learn about Epclusa and cost, see this article.
• Facts about hepatitis C: To learn about Epclusa treatment for hepatitis C, see this article.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.