Direct-acting antiviral (NS5A + NS3/4A protease inhibitor)

Elbasvir with grazoprevir

Brand names: Zepatier

Adult dose

Dose: 1 tablet (50/100mg) OD for 12 weeks (extend to 16 weeks ± ribavirin per genotype/resistance)

Route: Oral

Frequency: OD

Clinical pearls

NICE TA413: chronic HCV genotype 1 and 4
NHS England HCV elimination programme — operational delivery network prescribing
EASL HCV guidelines; ribavirin add-on for selected resistance/cirrhosis groups
Pre-treatment NS5A resistance testing in genotype 1a

Contraindications

Decompensated hepatic impairment (Child-Pugh B/C)
Concurrent strong OATP1B inhibitors, rifampicin, efavirenz, etravirine
Pregnancy with ribavirin
Hypersensitivity

Side effects

Fatigue
Headache
ALT elevation
Nausea
Anaemia (with ribavirin)

Interactions

Carbamazepine, phenytoin, rifampicin (avoid)
Cyclosporin
Tacrolimus
Statins

Monitoring

LFTs (week 8)
HCV RNA at end of treatment and 12 weeks (SVR12)

Reference: BNF; NICE TA413; EASL HCV; NHS England HCV ODN; SmPC; https://bnf.nice.org.uk/drugs/elbasvir-with-grazoprevir/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways