Direct-acting antiviral (NS5B inhibitor)
Sofosbuvir
Brand names: Sovaldi
Adult dose
Dose: 400mg PO OD as part of combination regimen
Route: PO
Frequency: OD
Dose adjustments
Renal
Avoid if eGFR <30 (older guidance); newer evidence supports use
Clinical pearls
- Hepatitis C — combine with daclatasvir/ledipasvir/velpatasvir per genotype
- Screen for HBV before (reactivation risk)
Contraindications
- Concurrent amiodarone (severe bradycardia)
- Hypersensitivity
- Severe renal impairment
Side effects
- Fatigue
- Headache
- Nausea
- Bradycardia (with amiodarone)
- HBV reactivation
Interactions
- Amiodarone (avoid)
- Strong P-gp/CYP3A4 inducers (rifampicin, St John's wort)
Monitoring
- LFTs
- HCV RNA
- HBV DNA
Reference: BNF; NICE TA330; BHIVA/EASL; https://bnf.nice.org.uk/drugs/sofosbuvir/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023