Sofosbuvir with velpatasvir

How it works

Sofosbuvir is a nucleotide inhibitor of the HCV NS5B RNA-dependent RNA polymerase and velpatasvir inhibits the NS5A protein essential for viral replication and assembly, giving combined suppression of HCV replication.

Prescribing in practice

• Co-administration with amiodarone has been associated with serious symptomatic bradycardia and should generally be avoided; screen for this and other interactions before starting.
• Velpatasvir absorption is reduced by gastric acid-suppressing drugs, so the timing and use of antacids, H2-receptor antagonists and proton pump inhibitors must be managed per the SPC, and potent enzyme inducers such as rifampicin or St John's wort markedly lower drug levels.
• Patients should be screened for hepatitis B before treatment because of the risk of HBV reactivation during HCV direct-acting antiviral therapy.

Monitoring

Monitor for treatment response by HCV viral load and assess hepatic status, with hepatitis B reactivation surveillance in co-infected or previously exposed patients.

Counselling the patient

• Take one tablet once daily for the full prescribed course to give the best chance of cure.
• Tell us about all your medicines, including indigestion remedies and herbal products such as St John's wort.
• Avoid missing doses, and report any fainting or very slow heartbeat, particularly if you take heart-rhythm medicines.

Evidence & guidelines

Sofosbuvir with velpatasvir achieves high sustained virological response rates across HCV genotypes and is recommended by NICE for chronic hepatitis C.