Epclusa vs. Harvoni: What You Should Know

If you’re looking into hepatitis C* treatments, your doctor may tell you about Epclusa (velpatasvir and sofosbuvir) and Harvoni (ledipasvir and sofosbuvir).

Both of these drugs are treatment options for hepatitis C. This infection can lead to cirrhosis (liver scarring) and liver cancer, so it’s important to get it treated.

Epclusa and Harvoni are both tablets taken by mouth once daily, usually for 12 weeks. They’re brand-name prescription medications that are available in generic versions as well.

Epclusa and Harvoni work in a similar way to treat hepatitis C, but these drugs do have some key differences. Keep reading to learn more.

Note: For more information about these drugs, see the in-depth articles on Epclusa and Harvoni.

* Hepatitis C is a liver infection caused by the hepatitis C virus.

Epclusa and Harvoni each contain two active ingredients combined in one tablet:

• Epclusa contains velpatasvir and sofosbuvir
• Harvoni contains ledipasvir and sofosbuvir

These active ingredients all belong to the same drug class, called antivirals. (A drug class is a group of medications that work in a similar way.)

Epclusa and Harvoni are both used to treat hepatitis C. This is a liver infection caused by the hepatitis C virus (HCV). There are six different genotypes (strains) of HCV.

• Epclusa can be used in people with any of the six genotypes of HCV, whether or not they have cirrhosis* (liver scarring).

• Harvoni can be used in people with genotypes 1, 4, 5, and 6. For each of these genotypes, there are specific circumstances in which Harvoni can be used. It depends on whether the person has cirrhosis, as well as other factors.

For more details, see the prescribing information for Epclusa and Harvoni. Also, see the “Epclusa vs. Harvoni” section of this article.

* People with severe cirrhosis will need to take ribavirin with Epclusa to treat hepatitis C.

Epclusa or Harvoni and children

Epclusa is used in children with hepatitis C who weigh at least 37 pounds (lb), or 17 kilograms (kg), or who are at least 6 years old. This drug can be used in children who have any of the six genotypes of HCV and who:

• have no cirrhosis or mild cirrhosis
• have severe cirrhosis, when used with ribavirin

Harvoni, on the other hand, is used in adults and children who are at least 12 years old or who weigh at least 77 lb (35 kg).

Like all medications, Epclusa and Harvoni may cause side effects. The most common side effects are usually mild. They may be easy to manage or go away on their own. However, serious side effects are possible.

The sections below describe how the side effects of Epclusa and Harvoni compare. And for more information about possible side effects, see these in-depth articles on Epclusa and Harvoni.

Mild side effects

Epclusa and Harvoni may cause mild side effects in some people. The chart below lists examples of mild side effects that can occur with these drugs.

* This mild side effect occurred in studies of people taking ribavirin along with Epclusa.
† This mild side effect occurred in studies of people taking ribavirin along with Harvoni.

This chart may not include all mild side effects of these drugs. For more information about mild side effects of each medication, see Epclusa’s fact sheet and Harvoni’s patient information sheet.

Serious side effects

The chart below lists possible serious side effects in people taking Epclusa or Harvoni.

* Epclusa and Harvoni both have a boxed warning for this side effect. To learn more, see the “What are the warnings of Epclusa and Harvoni?” section below.
† An allergic reaction is possible after using Epclusa or Harvoni. However, this side effect wasn’t reported in studies.
‡ This side effect has been reported by the manufacturer of Harvoni. In rare cases, it occurred in people taking sofosbuvir (one of the drugs in Harvoni) when used with ribavirin or pegylated interferon/ribavirin. Although suicidal thoughts or actions weren’t reported in studies of Epclusa, there may be a risk for this side effect because Epclusa also contains sofosbuvir.

If you have questions about your risk for serious side effects from either drug, talk with your doctor.

Whether you have health insurance or not, cost may be a factor when you’re considering these drugs. But keep in mind that what you’ll pay for either drug will depend on your treatment plan and health insurance, and the pharmacy you use.

Epclusa and Harvoni are both brand-name drugs. These drugs also have generic forms. You’ll usually pay more for brand-name drugs than for generics. If you’re interested in using the generic form of either drug, talk with your doctor.

Both Epclusa and Harvoni come as tablets that are taken by mouth once per day. They’re both used as short-term treatments.

Epclusa comes as a tablet that contains 100 milligrams (mg) of velpatasvir and 400 mg of sofosbuvir. It’s also available as a tablet that contains 50 mg of velpatasvir and 200 mg of sofosbuvir. Epclusa is used for 12 weeks.

Harvoni comes as a tablet. These are available in two strengths: 90 mg of ledipasvir with 400 mg of sofosbuvir, and 45 mg of ledipasvir with 200 mg of sofosbuvir.

In addition, Harvoni also comes as pellets, which can be easier to swallow. These pellets may be swallowed on their own or mixed with nonacidic soft foods, such as mashed potatoes, pudding, or ice cream.

The typical length of Harvoni treatment is 12 weeks. However, some people may take it for either 8 weeks or 24 weeks, depending on their hepatitis C virus genotype and other factors. If you use Harvoni, your doctor will determine how long your treatment should last.

You may wonder if Epclusa or Harvoni would be effective at treating your condition.

Studies have found both drugs to be highly effective at treating hepatitis C. And hepatitis C treatment guidelines recommend both drugs as first-choice treatment options.

To learn about how each drug performed in clinical studies, see the prescribing information for Epclusa and Harvoni. The manufacturer websites for Epclusa and Harvoni also provide information about each drug’s effectiveness.

Epclusa and Harvoni may not be right for you if you have certain medical conditions or other factors that affect your health. Before using either drug, talk with your doctor about your health history.

Boxed warning: Reactivation of hepatitis B virus

Epclusa and Harvoni both have a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

If you’ve had both hepatitis B and hepatitis C, using Epclusa or Harvoni could cause the hepatitis B virus (HBV) to reactivate. This means that the infection flares up and causes symptoms again. In some cases, HBV reactivation may lead to liver failure or death.

Your doctor will test you for hepatitis B before you start treatment with Epclusa or Harvoni. If you have the infection, you may need to take medication to treat it before you use either of these drugs.

Other warnings

In addition to boxed warnings, Epclusa and Harvoni have other warnings.

Before using Epclusa or Harvoni, talk with your doctor if any of the following conditions or health factors apply to you:

• if you’ve had an allergic reaction to either drug or any of its ingredients
• if you’re pregnant or breastfeeding
• if you take amiodarone, a heart medication
• if you take medications that interact with Epclusa or Harvoni
• if you have kidney problems or are on dialysis
• if you have HIV

To learn more about these drugs and their warnings, see the in-depth articles on Epclusa and Harvoni.

The short answer: It’s not likely.

Details: Epclusa and Harvoni are very similar medications. They even contain one of the same active ingredients (sofosbuvir).

Once you start using Epclusa or Harvoni, you’ll stick with the same drug for your entire treatment. Because the drugs are so similar, there wouldn’t be a reason to switch from one to the other.

For instance, it’s rare to have a severe allergic reaction to one of these drugs. If this occurs, there wouldn’t be any benefit in switching to the other drug because they share an active ingredient.

If you experience a severe allergic reaction or another serious side effect from either Epclusa or Harvoni, you and your doctor will discuss your treatment options. These likely won’t include switching to the other drug.

Reminder: You shouldn’t switch drugs or stop your current treatment unless your doctor recommends it.

If you have hepatitis C, Epclusa or Harvoni may be treatment options for you.

Epclusa and Harvoni work in a similar way, and both come as tablets that are taken by mouth once daily.

However, these drugs have some differences, in terms of who can use them.

• Epclusa can be used in people with any of the six genotypes of the hepatitis C virus (HCV), whether or not they have cirrhosis* (liver scarring).

• Harvoni can be used in people with genotypes 1, 4, 5, and 6. For each of these genotypes, there are specific circumstances in which Harvoni can be used. It depends on whether the person has cirrhosis, as well as other factors.

* People with severe cirrhosis will need to take ribavirin with Epclusa to treat hepatitis C.

Epclusa is used for 12 weeks. Harvoni is also typically used for 12 weeks, but some people may take it for either 8 weeks or 24 weeks. This will depend on their HCV genotype and other factors.

To learn more about these treatment options, talk with your doctor. They can determine if one of these drugs may be right for you.

Here are some questions you may want to ask your doctor:

• How will I know if Epclusa or Harvoni reactivates my hepatitis B virus?
• Does having HIV raise my risk for side effects from either of these drugs?
• After I complete my treatment with Epclusa or Harvoni, am I at risk for getting hepatitis C again?
• Which HCV genotype do I have, and how long would I be able to take Harvoni?

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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.