Sofosbuvir / Velpatasvir

How it works

Sofosbuvir inhibits the hepatitis C NS5B RNA-dependent RNA polymerase to block viral RNA replication, while velpatasvir inhibits the NS5A protein essential for viral replication and assembly, together suppressing the virus across genotypes.

Prescribing in practice

• Co-administration with amiodarone can cause severe symptomatic bradycardia and should be avoided, and reactivation of hepatitis B can occur, so screen for hepatitis B before treatment.
• Velpatasvir absorption depends on gastric acidity, so acid-reducing drugs such as proton pump inhibitors must be managed carefully, and potent enzyme inducers like certain anticonvulsants and rifampicin markedly reduce efficacy.
• Velpatasvir is a P-glycoprotein and BCRP inhibitor that can raise levels of substrates such as some statins, requiring interaction review.

Monitoring

Assess hepatitis B status and liver function before treatment and confirm sustained virological response after completing the course.

Counselling the patient

• Take the tablet once daily with or without food and complete the full course.
• Tell the team about all other medicines, including heart-rhythm drugs and indigestion remedies.
• Report a slow or irregular heartbeat, fainting or marked tiredness.

Evidence & guidelines

Sofosbuvir/velpatasvir achieves high sustained virological response rates across genotypes in the ASTRAL trials and is recommended in NICE hepatitis C guidance.