Mavyret vs. Epclusa: What You Should Know

If you have hepatitis C, your doctor may prescribe an antiviral medication, such as Mavyret (glecaprevir and pibrentasvir) or Epclusa (velpatasvir and sofosbuvir). Hepatitis C is an infection caused by the hepatitis C virus (HCV).

Mavyret and Epclusa are both combination prescription drugs used to help cure hepatitis C.

Although Mavyret and Epclusa are similar, they have differences, too. Keep reading to learn how these drugs compare.

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

Mavyret and Epclusa are both in the class of drugs called antivirals. (Classes are drugs grouped together by how they work.)

They’re also both combination medications:

• Mavyret contains the active drugs glecaprevir and pibrentasvir.
• Epclusa contains the active drugs velpatasvir and sofosbuvir.

Mavyret and Epclusa are both prescribed to treat chronic hepatitis C in adults and in some children. “Chronic” means long term. (For information on the use of these drugs in children, see the “Mavyret and children” and “Epclusa and children” sections below.)

For this use, hepatitis C must be caused by specific genotypes of the hepatitis C virus (HCV). Each hepatitis C genotype has its own genetic makeup.

Mavyret and Epclusa are both used to treat hepatitis C caused by:

• HCV genotypes 1 to 6 in adults who have mild cirrhosis (liver scarring) or no cirrhosis

Mavyret is also used to treat hepatitis C caused by:

• HCV genotype 1 in adults whose condition has been treated, but not cured, with a different medication

Epclusa is also used with the drug ribavirin to treat hepatitis C caused by:

• HCV genotypes 1 to 6 in adults who have severe cirrhosis

See this article for details about Mavyret’s use for hepatitis C. You can also see this article for details about Epclusa’s use for hepatitis C.

Mavyret and children

Mavyret is used in children ages 3 years and older. This drug treats hepatitis C caused by:

• HCV genotype 1 in children whose condition has been treated, but not cured, with a different medication

Epclusa and children

Epclusa is used in children ages 3 years and older. This drug treats hepatitis C caused by:

• HCV genotypes 1 to 6 in children who have mild cirrhosis or no cirrhosis
• HCV genotypes 1 to 6 in children who have severe cirrhosis, when used with ribavirin

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, health insurance, and the pharmacy you use.

Mavyret and Epclusa are both brand-name drugs. Mavyret isn’t available in generic form. However, Epclusa tablets are available in generic form in one strength: 400 milligrams (mg) of sofosbuvir and 100 mg of velpatasvir. Generic drugs are exact copies of the brand-name product but usually cost less.

If you’d prefer to use a generic drug to treat hepatitis C, ask your doctor if the generic form of Epclusa, or a different generic hepatitis C treatment, is right for you.

Get answers to some frequently asked questions about Mavyret and Epclusa.

Do Mavyret or Epclusa interact with any other drugs?

Yes. Mavyret and Epclusa can interact with other drugs.

For example, both Mavyret and Epclusa interact with the following drugs:

• digoxin (Lanoxin, Digitek) for heart failure
• certain antiviral drugs for HIV, such as efavirenz (Sustiva)
• statins for lowering cholesterol, such as atorvastatin (Lipitor) or rosuvastatin (Crestor)
• certain seizure drugs, such as phenytoin (Dilantin) and carbamazepine (Tegretol)

Also, Mavyret interacts with the following drugs:

• dabigatran (Pradaxa) for preventing blood clots
• birth control pills with the hormone ethinyl estradiol
• cyclosporine (Sandimmune) to suppress the immune system

And Epclusa interacts with the following drugs:

• amiodarone (Pacerone, Nexterone) for heart arrythmias
• other seizure drugs, such as phenobarbital, or oxcarbazepine (Trileptal)
• antacids, such as calcium carbonate (Tums), histamine 2 blockers (Pepcid), and proton pump inhibitors (Nexium)

Mavyret and Epclusa may interact with certain herbs or supplements, too. For example, you shouldn’t take either medication with the herb St. John’s wort.

These aren’t all of the interactions possible with these drugs. For more information, see these in-depth articles on Mavyret and Epclusa. You can also talk with your doctor and pharmacist. In fact, you should talk with them before you use either drug. Telling them about any medications, vitamins, and herbs you use can help prevent interactions.

Can I take Mavyret or Epclusa if I have HIV and hepatitis C?

Yes, it’s possible. If you have both HIV and hepatitis C, you may be able to take Mavyret or Epclusa to treat your hepatitis C. Having HIV doesn’t change how either drug works in your body to help cure hepatitis C.

HIV treatment guidelines from the Department of Health and Human Services recommend that people with HIV as well as hepatitis C be treated for both conditions. Hepatitis C treatment can improve your liver and your overall health.

If you have HIV and hepatitis C, talk with your doctor about whether Mavyret or Epclusa might be a treatment option.

What can happen if I miss a dose of Mavyret or Epclusa?

If you miss a dose of Mavyret or Epclusa, the level of drug in your blood may get too low. A low drug level may make Mavyret or Epclusa less effective at treating hepatitis C.

Missing doses of either drug increases the chance that your hepatitis C won’t be cured.

Try your best to take either drug every day at about the same time. You’ll want to do this for the length of time prescribed by your doctor. Here are some tips to help you remember your medication:

• Ask a friend, co-worker, or loved one to remind you.
• Set a daily reminder on your smartphone or computer.
• Make a medication calendar and post it somewhere you’ll see it every day, such as on your refrigerator.
• Fill a weekly or monthly pill organizer and place it by your toothbrush or on your bedstand.

If Mavyret or Epclusa cures my hepatitis C, can I have hepatitis C again?

Yes, it’s possible to have hepatitis C again after your condition is cured as a result of Mavyret or Epclusa treatment. This can happen in a couple of ways: relapse or re-exposure to the hepatitis C virus (HCV).

For your hepatitis C to be considered cured, you must have a sustained virologic response. This means tests can no longer detect HCV in your body. In rare cases, you could have a relapse if HCV is still present in your body. With a relapse, HCV becomes detectable and could start causing symptoms of hepatitis C again.

After your hepatitis C has been cured, there is a chance of contracting HCV again by being re-exposed to the virus. Taking certain precautions can help you avoid having hepatitis C again.

Could having certain health issues result in my doctor prescribing one drug over the other?

Yes. Your doctor may prescribe one drug over the other based on your health history and other factors. These may include:

• Past hepatitis C treatments. They may choose one drug over the other based on any hepatitis C treatments you’ve tried before.
• Liver function. If you have liver disease, Epclusa may be a better treatment choice for you.
• Severe scarring of your liver. Mavyret isn’t used for treating hepatitis C if you have severe cirrhosis. However, Epclusa can be used with the drug ribavirin for this purpose.

Mavyret and Epclusa both come as tablets and as pellets. You take the tablets or pellets by swallowing them whole. The pellets can be prescribed for people who have trouble swallowing pills, and for children.

You should not crush, split, or chew Mavyret tablets or pellets. Doing so may make Mavyret less effective. It’s unknown if breaking up Epclusa tablets to take is safe, but you should not chew Epclusa pellets.

To treat hepatitis C with Mavyret, adults and children ages 12 years and older take three tablets together with food once each day. You’ll take Mavyret for 8, 12, or 16 weeks, depending on your condition and past treatments. The dosage for children ages 3 years to less than 12 years is below under “Mavyret dosage for children.”

The dosage for Epclusa depends on whether you’re an adult or child. Adults take one Epclusa tablet with or without food once each day for 12 weeks. For children’s dosage, see “Epclusa dosage in children” below.

When Epclusa is prescribed with the drug ribavirin, the Epclusa dosage is typically the same as when the drug is taken alone.

Mavyret dosage for children

For treating hepatitis C in children ages 3 years to under 12 years, Mavyret’s dosage is based on weight. Children younger than 12 years or under a certain body weight are prescribed pellets instead of tablets. Mavyret pellets are taken once per day after mixing with food.

You should sprinkle Mavyret pellets onto food that will stick to a spoon, such as cream cheese or peanut butter. The pellets should be swallowed within 15 minutes after mixing with food.

Epclusa dosage for children

The dose of Epclusa for children varies based on their weight. They take the dose their doctor prescribes once each day, with or without food, for 12 weeks. This is regardless of whether they take Epclusa alone or with ribavirin.

Children younger than 6 years are prescribed Epclusa pellets instead of tablets. The pellets should be sprinkled onto non-acidic food, such as pudding or ice cream. And the pellets should be swallowed without chewing within 15 minutes after mixing them with food.

Most people who’ve taken Mavyret or Epclusa have had mild side effects. These are usually manageable and tend to go away with time.

But in rare cases, people have had serious side effects with both drugs. Some serious side effects, such as hepatitis B reactivation, could happen after you’ve finished Mavyret or Epclusa treatment. Both drugs have a boxed warning about the risk of reactivation of hepatitis B virus. (See the “What are the warnings of Mavyret and Epclusa?” section below.)

Keep reading to learn about both mild and serious side effects with these drugs.

For more information about the possible side effects of each drug, see the side effects articles for Mavyret and Epclusa.

Mild side effects

Mavyret and Epclusa may cause mild side effects in some people. The chart below lists examples of mild side effects that have been reported with these drugs.

* This mild side effect may be a symptom of hepatitis C itself or of a serious side effect, such as reactivation of the hepatitis B virus (HBV). See the “What are the warnings of Mavyret and Epclusa?” section below for details.
† This mild side effect occurred in studies of people taking Epclusa with the drug ribavirin.

This chart may not include all mild side effects of these drugs. For more information on mild side effects of the two drugs, see Mavyret’s prescribing information and Epclusa’s prescribing information.

Serious side effects

In addition to the mild side effects described above, serious side effects may occur in people using Mavyret or Epclusa. See the chart below for a list of possible side effects.

* Both Mavyret and Epclusa have a boxed warning for risk of hepatitis B reactivation. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “What are the warnings of Mavyret and Epclusa?” section below.

Talk with your doctor about your medical history and risks for serious side effects with these drugs.

You may wonder how effective Mavyret and Epclusa are at treating hepatitis C. In studies of Mavyret and Epclusa, both were highly effective at curing chronic hepatitis C caused by certain genotypes of the hepatitis C virus (HCV). Each hepatitis C genotype has its own genetic makeup.

According to the latest treatment guidelines from American Association for the Study of Liver Diseases, both drugs can be first-choice treatments for hepatitis C in people who:

• have HCV that’s genotype 1 to 6
• don’t have cirrhosis (liver scarring), or have mild cirrhosis, and
• haven’t been treated for hepatitis C in the past

If you’d like to read more about how each drug performed in studies, see the prescribing information for Mavyret and Epclusa.

Mavyret and Epclusa may not be right for you if you have certain medical conditions or other factors that affect your health. Here, these are referred to as warnings. The two drugs share some of the same warnings, but they also have different ones. Some of these warnings are mentioned below.

Before you start using Mavyret or Epclusa, be sure to talk with your doctor to see if these warnings apply to you.

Boxed warning: Hepatitis B reactivation

Mavyret and Epclusa 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.

Hepatitis B reactivation. If you’ve had hepatitis B in the past, using Mavyret or Epclusa could make the hepatitis B virus (HBV) reactivate in your body. This means HBV could flare up again. In rare cases, flare-ups can cause serious or fatal liver failure.

Before you start to take either drug, tell your doctor if you’ve had hepatitis B. They may test you for HBV prior to taking Mavyret or Epclusa. If you have HBV, you may need hepatitis B treatment before starting Mavyret or Epclusa. Your doctor may also watch you closely during and after treatment with either drug.

Other warnings

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

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

• Warnings for Mavyret:
  • if you take the HIV drugs atazanavir (Reyataz) or efavirenz (Sustiva)
• Warnings for Epclusa:
  • if you have severe kidney disease, including if you’re receiving dialysis
  • if you take the heart arrythmia drug amiodarone (Pacerone, Nexterone)
  • if you can’t take the antiviral drug ribavirin, but would require combination treatment of Epclusa and ribavirin to treat hepatitis C in certain situations
• Warnings for both Mavyret and Epclusa:
  • if you’ve had an allergic reaction to either drug or any of its ingredients
  • if you’re pregnant or breastfeeding, or planning to become pregnant or breastfeed
  • if you take the herb St. John’s wort
  • if you take the seizure drug carbamazepine (Tegretol)
  • if you take the antibiotic drug rifampin (Rifadin)
  • if you’ve received a liver transplant
  • if you have HIV
  • if you have liver disease besides hepatitis C

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

The short answer: Probably not.

Details: Mavyret and Epclusa treatment involve short-term regimens. They need to be taken every day to help cure hepatitis C. Although they work in similar ways and are used for similar types of hepatitis C, they aren’t exactly the same. For example, they aren’t necessarily used for the same length of time.

Unless you have a serious side effect with either drug, you’ll need to stay on the exact regimen as prescribed by your doctor. This means taking the same drug for the amount of time they recommend and not skipping doses. Doing this will increase the likelihood that your hepatitis C will be cured.

At the end of your treatment period, your doctor will test you for the hepatitis C virus (HCV). If the test can still detect HCV in your body, they’ll prescribe a new hepatitis C treatment.

If Epclusa didn’t cure your hepatitis C, your doctor may prescribe Mavyret. But this depends on many factors, such as your condition, type of hepatitis C, and past treatment.

If Mavyret didn’t cure the hepatitis C condition, Epclusa isn’t a second treatment option. In this case, other treatments are better options.

Reminder: To increase the chance of hepatitis C being cured, you need to take Mavyret or Epclusa exactly as prescribed. Don’t miss doses, switch drugs, or stop your current treatment unless your doctor recommends it.

Taking Mavyret or Epclusa may cure your hepatitis C. When taken exactly as prescribed, both drugs are highly effective at curing this disease.

Depending on your condition, you may only have to take Mavyret for 8 weeks compared with 12 weeks for Epclusa. However, your doctor may prescribe Epclusa if you have severe liver disease.

Talk with your doctor about the best choice for you. They can answer your questions so that you feel confident about your hepatitis C treatment. Ask about any concerns, such as:

• Do I have any health factors that make Mavyret or Epclusa a better fit?
• What should I do if I miss a dose of either Mavyret or Epclusa? Would I have to start treatment over?
• Are there any financial resources that would make one treatment cheaper than the other?
• If I’m a good candidate for both drugs, are there reasons why one would be prescribed over the other?
• Does one of these drugs have a higher rate of relapse associated with it?

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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.