Ledipasvir with sofosbuvir

How it works

Ledipasvir inhibits the HCV NS5A protein required for viral replication and assembly, while sofosbuvir is a nucleotide NS5B polymerase inhibitor that terminates viral RNA synthesis.

Prescribing in practice

• Co-administration with amiodarone has caused serious symptomatic bradycardia and is not recommended; check for hepatitis B status before starting because of the risk of HBV reactivation.
• Ledipasvir absorption depends on gastric acidity, so acid-suppressing drugs such as proton pump inhibitors require careful timing and dose consideration.
• It interacts with potent P-glycoprotein inducers (for example rifampicin and St John's wort), which reduce antiviral levels and should be avoided.

Monitoring

Assess hepatitis B serology before treatment, monitor for HBV reactivation, and confirm sustained virological response after completing the course.

Counselling the patient

• Take the tablet once daily and complete the full course for the best chance of cure.
• Tell your clinician about all medicines, including antacids and herbal products like St John's wort.
• Report dizziness, fainting or a very slow heartbeat, especially if you take heart-rhythm medicines.

Evidence & guidelines

High sustained virological response rates were demonstrated in the ION programme of phase 3 trials; NICE recommends direct-acting antivirals for chronic hepatitis C.