Epclusa Interactions: Alcohol, Medications, and Others

Certain health conditions or other factors could raise your risk of harm if you take Epclusa. In such cases, your doctor may not prescribe Epclusa for you. These are known as contraindications. Epclusa has one contraindication, which is described below.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Epclusa or any of its ingredients, your doctor likely won’t prescribe Epclusa. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

There is no known interaction between Epclusa and alcohol. However, drinking large amounts of alcohol can worsen hepatitis C, which Epclusa is used to treat.

If you drink alcohol, talk with your doctor to learn how much (if any) may be safe to consume with your condition and treatment plan.

Before you start taking Epclusa, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Epclusa interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Epclusa?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The table below lists drugs that may interact with Epclusa. Keep in mind that this table does not include all drugs that may interact with Epclusa. For more information about some of these interactions, see the “Drug interactions explained” section below.

Learn more about certain drug interactions that can occur with Epclusa.

Interaction with acid-reducing medications

Epclusa interacts with acid-reducing drugs. Some of these drugs may be prescribed by a doctor, while others are available over the counter (OTC). They’re usually taken to relieve acid reflux or heartburn.

Examples of acid-reducing medications include:

• famotidine (Pepcid)
• omeprazole (Prilosec)
• aluminum hydroxide/magnesium hydroxide (Maalox)

What could happen

Velpatasvir, one of the active ingredients* in Epclusa, dissolves better in a more acidic environment. And acid-reducing medications make your stomach less acidic.

Because of this, taking Epclusa with acid-reducing drugs can make it more difficult for Epclusa to dissolve in your stomach. This may reduce the amount of medication that your body absorbs, which may make Epclusa less effective.

* An active ingredient is what makes a drug work.

What you can do

Whether you can help prevent an interaction between Epclusa and an acid-reducing drug depends on the specific drug you take.

For example, antacids such as aluminum hydroxide/magnesium hydroxide (Maalox) can be taken with Epclusa if you separate the doses by at least 4 hours.

If you take famotidine or another H2-blocker drug (the group of drugs famotidine belongs to), you can take it at the same time as Epclusa or 12 hours apart from your Epclusa dose. Regardless of how you take famotidine, you should not take more than 40 milligrams (mg) of famotidine twice per day while taking Epclusa. (If you take an H2-blocker besides famotidine, your doctor may prescribe a lower dose of that drug as well.)

Taking omeprazole or another proton-pump inhibitor (the group of drugs omeprazole belongs to) with Epclusa is not recommended. But if your doctor determines that you must take a proton pump inhibitor during your Epclusa treatment, they’ll likely recommend that you take Epclusa with food 4 hours before you take omeprazole. They’ll likely prescribe omeprazole at a dose no higher than 20 mg (or the equivalent dose of another proton pump inhibitor).

Talk with your doctor or pharmacist before you take any OTC medication to reduce acid. They can recommend the best time of day to take Epclusa to reduce your risk of interactions.

Interaction with statins

Epclusa can interact with statins, which are used to treat high cholesterol.

Examples of statins include:

• atorvastatin (Lipitor)
• rosuvastatin (Crestor)
• simvastatin (Zocor)

What could happen

Epclusa can prevent your body from breaking down statins properly. This could cause the statin to build up in your body, which may increase your risk of side effects from the statin. Examples of these side effects include muscle pain and muscle breakdown.

What you can do

Before you start taking Epclusa, let your doctor know if you take medications to lower cholesterol. If you take a statin, they may lower your statin dosage during your Epclusa treatment. This is to reduce the risk of side effects from the statin.

If you take a statin with Epclusa, tell your doctor if you have muscle pain during your treatment. They’ll check for signs of muscle breakdown. If they discover that you have muscle breakdown, they’ll likely lower your statin dosage or have you stop taking it during your Epclusa treatment.

Interaction with certain seizure medications

Epclusa interacts with some seizure medications. Examples include:

• phenytoin (Dilantin)
• carbamazepine (Tegretol, others)
• phenobarbital (Sezaby)

What could happen

Taking certain seizure medications with Epclusa can decrease the level of Epclusa in your body. This can make Epclusa less effective.

What you can do

Before you start taking Epclusa, tell your doctor if you take a seizure medication. If you must take seizure medications that interact with Epclusa, your doctor will likely recommend a different treatment option for hepatitis C.

Epclusa may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Epclusa.

Does Epclusa interact with supplements?

Before you start taking Epclusa, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Epclusa interactions with herbs

Epclusa can interact with the herb St. John’s wort, which some people use to help with symptoms of depression. Taking St. John’s wort with Epclusa can reduce the level of Epclusa in your body. This can make Epclusa less effective.

If you take St. John’s wort, talk with your doctor before starting Epclusa treatment. They’ll likely recommend that you stop taking St. John’s wort while you take Epclusa.

Epclusa interactions and vitamins

There are currently no reports of Epclusa interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Epclusa.

Does Epclusa interact with food?

Epclusa can interact with grapefruit or grapefruit juice. Consuming grapefruit products with Epclusa may cause the drug to build up in your body, which can raise your risk of side effects.

If you or your child takes the pellet form of Epclusa, you should not mix it with acidic foods. You can swallow the pellets by themselves or sprinkle them on nonacidic food, such as pudding or ice cream.

If you have questions about eating certain foods during your Epclusa treatment, talk with your doctor.

Does Epclusa interact with vaccines?

There are currently no reports of Epclusa interacting with vaccines. If you have questions about getting specific vaccines during your Epclusa treatment, talk with your doctor.

Does Epclusa interact with lab tests?

There aren’t any lab tests known to interact with Epclusa. If you’re concerned about having lab tests during your Epclusa treatment, talk with your doctor.

Does Epclusa interact with cannabis or CBD?

There are currently no reports of Epclusa interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Epclusa.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Epclusa. Before taking Epclusa, talk with your doctor about your health history. They’ll determine whether Epclusa is right for you.

Health conditions or other factors that might interact with Epclusa include:

Hepatitis B. If you’ve had hepatitis B virus (HBV) before, taking Epclusa can cause it to reactivate (flare up and cause symptoms). In fact, Epclusa has a boxed warning for this risk. Before you start taking Epclusa, let your doctor know if you have or have had HBV. If your HBV is not treated, your doctor will likely prescribe treatment for it along with Epclusa.

Diabetes. Hepatitis C treatment, including Epclusa, may result in changes in your liver function. If you have diabetes, this could cause low blood sugar. Before you start Epclusa treatment, talk with your doctor if you have diabetes or take medication to help manage your blood sugar. They’ll likely have you monitor your blood sugar more closely while you’re taking Epclusa.

If your blood sugar becomes too low, your doctor may lower the dosage of your diabetes medication or have you temporarily stop taking it.

HIV. If you have HIV, let your doctor know before you take Epclusa. You should also tell them about any HIV drugs you take. Certain medications used to treat HIV can make Epclusa less effective.

If you take HIV medications that interact with Epclusa, your doctor may recommend a treatment option other than Epclusa for your hepatitis C.

Pregnancy. It’s not known whether it’s safe to take Epclusa during pregnancy. But it’s important to note that ribavirin is sometimes prescribed with Epclusa to treat hepatitis C. Ribavirin is not safe to use during pregnancy.

You should not take Epclusa with ribavirin if you’re pregnant or planning to become pregnant. Let your doctor know right away if you or your partner become pregnant while taking Epclusa with ribavirin.

Breastfeeding. It’s not known whether Epclusa is safe to take while breastfeeding. If you’re breastfeeding or planning to do so, talk with your doctor before taking Epclusa.

Allergic reaction. If you’ve had an allergic reaction to Epclusa or any of its ingredients, your doctor will likely not prescribe Epclusa. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Taking certain steps can help you avoid interactions with Epclusa. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Epclusa treatment.

It’s also important to understand Epclusa’s label and other paperwork that may come with the drug. Colored stickers that describe interactions may be on the label. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Epclusa, ask your pharmacist to print a copy for you.)

If you have trouble reading or understanding this information, your doctor or pharmacist can help.

Taking Epclusa exactly as prescribed can also help prevent interactions.

If you still have questions about Epclusa and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Do I need to space out when I take my medications throughout the day to avoid interactions?
• Do I need to tell you if I start taking another medication or supplement during my Epclusa treatment?
• Could I still take Epclusa even if it interacts with a health condition I have?

To learn more about Epclusa, see these articles:

• All About Epclusa
• Dosage Details for Epclusa
• Mavyret vs. Epclusa: How These Drugs Compare
• Epclusa and Cost: What You Need to Know
• Epclusa vs. Harvoni: What You Should Know

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.