The most common Hepatitis C medications are direct-acting antivirals (DAAs). A typical treatment plan combines two or more DAAs together. In some cases, DAAs are also combined with ribavirin or interferons.

Hepatitis C is an infection caused by a virus of the same name (HCV) that causes liver inflammation that can lead to liver problems, including cancer.

People who have chronic hepatitis C require medication to treat it. These drugs can help ease symptoms, and in many cases, they can cure the condition.

Even if an HCV infection hasn’t caused symptoms yet, it’s still important to treat it. This is because medications can also lower the risk of complications from hepatitis C, such as dangerous liver problems.

HCV has different genetic variations (genotypes). The medication prescribed for hepatitis C depends on the genotype a person has. Genotype 1 is the most common type in the United States.

Here are the medications available to treat hepatitis C, plus some helpful information about what to expect during treatment.

Direct-acting antivirals (DAAs) are the most common treatment for hepatitis C. They’re usually taken as pills. These medications can cure Hepatitis C in up to 90 to 97 percent of cases. They work by helping to stop the hepatitis C virus from multiplying.

There are three types of DAAs used for hepatitis C:

  • NS3/4 protease inhibitors, which target an enzyme
  • NS5A inhibitors, which target a protein
  • NS5B polymerase inhibitors, which target an enzyme

Different DAA medications are taken in combination with each other to provide effective treatment. Some treatments are available as pills containing two or more different drugs.

Two other medications are available that are only used in people whose hepatitis is also being treated with DAAs:

  • ribavirin
  • interferons

Each of these medication types comes with different benefits, side effects, and risks. You should know that treatments to cure HCV are not approved for use during pregnancy, according to the Centers for Disease Control and Prevention (CDC). However, treatment can begin after the baby is born or after you have finished breastfeeding or chestfeeding.

We’ll look at each of these medication types in more detail below.

Ribavirin works by stopping viruses from replicating and spreading. It’s an oral medication that comes as a capsule, tablet, or liquid and is available in several strengths.

It’s always used in combination with other drugs to treat hepatitis C. The most common brand name of ribavirin is Rebetol.

Your doctor or pharmacist will give you instructions for taking ribavirin. It should be taken with food. Typically, it’s taken twice a day, once in the morning and once in the evening. It’s important to swallow the pills whole. If you are taking liquid ribavirin, shake the bottle well before every use.

Ribavirin can cause birth defects

Ribavirin may cause birth defects if it’s taken before or during pregnancy. If you or your partner are taking ribavirin, it’s important to avoid pregnancy while taking the drug. In addition, pregnant people should not have sexual intercourse with a person assigned male at birth who is taking ribavirin.

If you are planning to try to become pregnant, it is important to wait until after you have stopped taking ribavirin. People assigned female at birth must wait 9 months after stopping ribavirin before starting a pregnancy. People assigned male at birth must wait 6 months after stopping the drug before they attempt pregnancy with their partner.

Other side effects of ribavirin

Other side effects of ribavirin may include:

  • decreased red blood cells and anemia
  • nausea and vomiting
  • changes in your ability to taste
  • memory loss
  • trouble concentrating
  • difficulty sleeping
  • muscle pain
  • dermatitis
  • alopecia

Direct-acting antivirals (DAAs) are currently the standard of care for chronic HCV infection. These drugs work by attacking HCV directly.

This means they’re more targeted than older treatments such as interferons (see below).

Also, they do not affect as many systems in your body as interferons, so they may not cause as many side effects. Usually, the side effects of DAAs are only mild to moderate in severity.

Side effects of DAAs can include:

  • fatigue
  • headaches

Less common side effects include:

  • anemia
  • diarrhea
  • nausea
  • vomiting
  • slow heartbeat

All DAAs are oral drugs that you swallow. Follow your doctor’s or pharmacist’s instructions on how to take these medications. They can also tell you what side effects are possible and symptoms of any serious side effects to look out for.

Protease inhibitor antiviral medications (NS3/4A inhibitors)

Protease inhibitors work by preventing the spread of infection within the body by stopping viruses from multiplying.

Grazoprevir is a protease inhibitor for hepatitis C genotypes 1 and 4. It’s only available in combination with elbasvir and sold as grazoprevir/elbasvir.

The drug combination is sold under the brand name Zepatier.

NS5A inhibitors

The action of these drugs isn’t fully understood. They may work by stopping the virus from copying itself. They may also help prevent drug resistance (when a drug no longer works to treat a condition).

These drugs are used to treat all HCV genotypes. They’re used alone or in combination with other medications.

Examples of directed inhibitors include ledipasvir, a component of the combination drug Harvoni, and elbasvir, a component of the combination drug Zepatier.

Nucleotide/nucleoside and non-nucleoside polymerase inhibitors (NS5B inhibitors)

These drugs work by blocking an enzyme called NS5B. The hepatitis C virus needs this enzyme to replicate itself and survive.

Sofosbuvir (Sovaldi) is an example of an NS5B inhibitor.

All DAAs are given as combinations. Some combinations are made into single pills to make taking the medication easier. Brand names of current combination therapies include:

  • Harvoni
  • Zepatier
  • Epclusa
  • Vosevi
  • Mavyret

Harvoni, which contains ledipasvir and sofosbuvir, is used to treat HCV genotype 1. It was approved in 2014.

This medication is available as a tablet and as pellets. You should take this medication at the same time every day. If you take the pellet form, you can sprinkle the packet of pellets on a small amount of room temperature or cold foods that are non-acidic, like pudding or mashed potato. You must finish eating the combination within 30 minutes. Eat the pellets on soft food, so that you can avoid a bitter taste released by chewing them.

Zepatier contains elbasvir and grazoprevir. The FDA approved this drug in 2016 to treat HCV genotypes 1 and 4.

Zepatier is available as a tablet. You should take it at the same time every day.

Epclusa, which contains sofosbuvir and velpatasvir, was approved in 2016. It can be used in combination with ribavirin in people with moderate to severe cirrhosis. It’s available as a tablet or as pellets.

Epclusa was the first medication to treat all six HCV genotypes.

This medication should be taken once every day. If you are taking the pellet form, mix it with a small amount of a non-acidic soft food, like pudding or mashed potato. Swallow the mixture without chewing. You should finish eating the mixture within 15 minutes.

The FDA approved Vosevi in 2017 to treat any HCV genotype. It contains the drugs sofosbuvir, velpatasvir, and voxilaprevir.

Vosevi is intended for use in people whose HCV infection has been treated with sofosbuvir, but the treatment was not successful in treating hepatitis C.

This medication is typically taken once every day with food.

The FDA approved Mavyret in 2017 for use in the treatment of any HCV genotype. It contains glecaprevir and pibrentasvir.

Mavyret is the first treatment that can be administered for only 8 weeks in people without cirrhosis. Most of the other combination drugs must be administered for a minimum of 12 weeks.

This medication is available as tablets and pellets. If you’re prescribed tablets, you’ll typically take 3 pills at the same time every day. Mavyret tablets should be taken with food.

Mavyret pellets should be sprinkled onto a spoonful of soft, sticky, low-water food, like peanut butter, thick jam, or cream cheese. Swallow the mixture without chewing. Be sure to finish consuming the mixture within 15 minutes.

These days, interferons are not commonly used to treat HCV. The newer treatments listed above are typically used instead. This is because interferons can cause a lot of side effects, and they’re not as effective for treating chronic HCV infection. However, this medication type is sometimes used alongside DAAs.

Interferon is a protein. It helps your immune system develop an immune response to viruses, including HCV. Peginterferon alfa-2a (Pegasys) is a common brand-name interferon.

The more common side effects of interferons include:

  • anxiety
  • dry mouth
  • excessive fatigue
  • headache
  • mood changes or depression
  • weight loss
  • worsening hepatitis symptoms

Other more serious side effects can happen over time. These side effects may include:

  • autoimmune diseases (when your body mistakenly attacks itself)
  • reduced red blood cell levels (can lead to anemia)
  • reduced white blood cell levels (can lead to infections)
  • high blood pressure (can lead to a stroke or heart attack)
  • reduced thyroid function
  • changes in vision
  • liver disease
  • lung disease
  • inflammation of your bowel or pancreas
  • allergic reaction
  • slowed growth in children

Peginterferon alfa-2a is an injectable medication. Typically, it’s injected once a week into your abdomen or thigh.

As newer, more effective drugs have become available, some older HCV drugs have been discontinued. These include:

  • simeprevir (Olysio), for genotypes 1 and 4
  • paritaprevir, for genotype 1
  • ombitasvir-paritaprevir-ritonavir (Technivie)
  • dasabuvir-ombitasvir-paritaprevir-ritonavir (Viekira Pak)
  • ombitasvir (a component of the combination drug Viekira Pak)
  • dasabuvir sodium (a component of the combination drug Viekira Pak)
  • peginterferon alfa-2b (Sylatron)
  • daclatasvir (Daklinza)

Paritaprevir was a drug only available as part of the combination drugs Viekira Pak and Technivie.

Some brand names of ribavirin have also been discontinued. These include:

  • Ribasphere
  • Ribasphere RibaPak
  • Copegus
  • Moderiba

Hepatitis C, or HCV infection, can cause unpleasant symptoms and lead to serious health complications.

Your treatment for the condition will depend on:

  • your health
  • the HCV genotype you have
  • other factors

Different types of drugs used to treat hepatitis C work in different ways and can cause unique side effects.

For example, people with serious kidney disease can only use certain HCV treatments. If you have kidney disease, your doctor can talk with you about your options.

If you’ve ever had hepatitis B, talk with your doctor before starting HCV treatment. Treating HCV can sometimes cause a previous hepatitis B infection to come back.

Ask your doctor which medication might be a good fit for you. Together, you can find the most effective drug to treat your HCV infection with the fewest side effects.