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Hepatitis C

Information, Symptoms, Treatments and Resources

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Your Guide to Common Hepatitis C Treatments

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What you need to know about drugs for hep C, including the newest treatments

By Marijke Vroomen Durning, RN


Not too long ago, treating the liver infection called hepatitis C (or hep C, also known as HCV, for hepatitis C virus) meant taking drugs that caused debilitating side effects, such as dizziness, vomiting and muscle pain. This led many with hep C to either refuse treatment or stop it before the medications had a chance to fully treat the infection. Fortunately, research has resulted in more effective — and easier to tolerate — treatment options for HCV.

These drugs belong to a class of medications called direct-acting antivirals (DAAs). They tend to have few side effects compared to earlier treatments, and the ones they do have are less severe. This improvement means that patients may be more likely to stay on their medication for the full amount of time. “I’ve never had anyone stop treatment because of side effects [with the newer drugs],” says Carol Peters, NP, a nurse practitioner in the Liver Research Institute at Banner University Medical Center Tucson, AZ. And of course, sticking to a treatment plan increases the chances of ridding the body of HCV — that is, being cured of hep C. 


Innovations in Hep C Medications

The first innovation came in 1988 with the introduction of interferon, a long-acting antiviral drug that was injected similar to drugs given for chemotherapy. Then came another breakthrough on the treatment front: researchers added ribavirin (another antiviral medication) to the interferon therapy, and patients did better. These approaches still caused serious side effects, though.

When DAAs came on the scene in 2011, the cure rate rose to 70 to 80% — and this new treatment class seemed to improve patients’ willingness to stay on their medications, possibly because they were much more tolerable. Now, with the second generation of DAAs, the cure rates are as high as 95% — and the side effects are even more manageable. According to Hwan Yoo, MD, a liver specialist at Mercy Medical Center in Baltimore, MD, “Researchers are projecting that by 2030, which is shy of 15 years from now, hepatitis C will be a rare disease.”


Important Treatment Issues to Consider

Despite these innovations, treatment for hep C still has complexities that your specialist has to keep in mind, and that you should be aware of as you begin your treatment journey. First, not all hep C viruses are created equal. The disease has several types, or genotypes. Why is this important? Because not all medications work for all genotypes.

In addition, some drugs work better in patients who are treatment-naive (meaning they've never been treated with medications for hep C), while others are used if patients have been treated before but didn’t respond (meaning the treatment had no effect on the disease) or relapsed (meaning they developed the disease again, even though they at first responded to treatment).

Besides your hep C genotype and your possible past treatment experience, other issues your doctor has to consider when prescribing your medication include how well your liver is functioning, your current level of health (aside from hep C), and how long you’ve had the infection.


What to Expect from Hep C Treatments

Drug Name

Genotypes (GT) Treated

Success Rates* 

Special Notes

Common Side Effects**

Daclatasvir (Daklinza) plus sofosbuvir (Sovaldi)
GT 1 and 3 
89%
  • Taken by mouth
  • Can cause symptomatic heart rate slowing (bradycardia) in patients taking the antiarrythmic amiodarone 
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B

 

  •  Fatigue
  •  Headache
  •  Nausea
Sofosbuvir/velpatsir (Epclusa)
GT 1, 2, 3, 4, 5 and 6 
95 to 100%
  • Taken by mouth
  • Can cause symptomatic heart rate slowing (bradycardia) in patients taking the antiarrythmic amiodarone 
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B
  • Fatigue
  • Headache
  • Nausea
  • Insomnia
  • Lack of energy
  • Diarrhea
  • Rash 
Ledipasvir/sofosbuvir (Harvoni)

GT 1, 4, 5 and 6

93 to 96%
  • Taken by mouth
  • Can cause symptomatic heart rate slowing (bradycardia) in patients taking the antiarrythmic amiodarone 
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B
  • Fatigue
  • Headache
  • Nausea
  • Lack of energy
  • Cough
  • Shortness of breath
Simeprevir
(Olysio)

GT 1 and 4

GT 1, with other hep C drugs: 97%

GT 4, with other hep C drugs: 83%

  • Taken by mouth 
  • Used with other hep C drugs
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B
  • Itching
  • Nausea
  • Muscle pain
  • Rash, including photosensitivity of skin (i.e. easier to get a severe sunburn) 
Peginterferon alfa-2B
(Peg-Intron)

GT 1, 3, 4, 5 and 6 

When given with ribavirin:
  • GT 1: 45%
  • GT 2 or 3: 65 to 75%
  • GT 4: 25 to 70%
  • GT 5: 55%
  • GT 6: 60 to 90%
  • Taken via injection
  • Used with other hep C drugs
  • Bruising, pain, redness, swelling, itching, or irritation at the injection site
  • Change in the way things taste
  • Changes to your skin
  • Confusion
  • Constipation
  • Diarrhea
  • Difficulty concentrating
  • Difficulty falling asleep or staying asleep
  • Dizziness
  • Dry mouth
  • Feeling cold or hot all the time
  • Flushing
  • Hair loss or thinning
  • Headache
  • Heartburn
  • Itching
  • Loss of appetite
  • Nausea
  • Runny nose
  • Sweating
  • Vomiting
  • Weight loss
Pegylated interferon alfa-2A (Pegasys) Same as above Same as above Same as above

Same as above

Ribavirin (Rebetol, Copegus, Ribasphere, or RibaPak) GT 1, 2 and 3

GT 1: 45 to 70%

GT 2 or 3:
65 to 70%

  • Taken by mouth
  • Used with other hep C drugs
  • Fatigue
  • Headache
  • Muscle/joint aches
  • Nausea
  • Insomnia
  • Fevers
  • Depression
Sofosbuvir
(Sovaldi)

GT 1, 2, 3 and 4 

GT 1: 90%

GT 2: 93%

GT 3: 84%

GT 4: 96%

  • Taken by mouth
  • Used with other hep C drugs
  • Can cause symptomatic heart rate slowing (bradycardia) in patients taking the antiarrythmic amiodarone 
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B

With ribavirin:

  • Fatigue
  • Headache
  • Nausea
  • Insomnia

With ribavirin and pegylated interferon:

  • Fatigue
  • Headache
  • Nausea
  • Insomnia
  • Flu-like symptoms
Ombitasvir-paritaprevir-ritonavir  
(Technivie)

GT 4 

Without ribavarin: 91%

With ribavarin: 100%

  • Taken by mouth
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B
  • Lack of energy
  • Fatigue
  • Headache
  • Nausea
  • Insomnia
  • Itching, rash and other skin reactions
Ombitasvir-paritaprevir-ritonavir and dasabuvir 
(Viekira Pak™)

GT 1

89 to 99%  
  • Taken by mouth
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B

With ribavirin:

  • Fatigue
  • Nausea
  • Itching
  • Redness or rash
  • Sleep problems
  • Weakness

Without ribavirin:

  • Itching
  • Nausea
  • Sleep problems
Elbasvir/grazoprevir 
(Zepatier)

GT 1 and 4 

GT 1: 94 to 97%

GT 4: 97 to 100%

  • Taken by mouth 
  • May cause reactivation of hepatitis B; tell your provider if you have a history of hepatitis B
  • Fatigue
  • Headache
  • Nausea

*Success rates vary based on genotype and subtype, liver status, prior treatment status, combination of drugs, treatment length, and many other factors.

**These are only the most common side effects reported for these medications. You may experience a side effect that isn’t listed. Speak with your healthcare provider or pharmacist if you experience any side effects with these medications.

Reading this list of medicines and their side effects may make the process of treating hep C seem overwhelming. It’s important to keep in mind that most people don’t experience any side effects from the newer drugs. Following your treatment plan as prescribed is easier than it’s ever been. Learn what other things you can do to make your treatment a success and how to manage side effects if they do happen to you. 


Published on March 1, 2016. Updated on April 6, 2017.


Marijke Vroomen Durning, RN, has written articles for numerous healthcare sites and is the author of Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.

Fuse/Thinkstock
Reviewed by Shira R. Goldenholz, MD, MPH on March 13, 2017.
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