Hepatitis C virus (HCV) infection causes liver inflammation that can lead to liver problems, including cancer. People who have chronic hepatitis C need medication to treat it. These drugs can help ease symptoms.
Even if an HCV infection hasn’t caused symptoms yet, it’s still important to treat it. This is because drugs 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 with their treatment.
Ribavirin works by stopping viruses from replicating and spreading. It’s an oral medication that comes as a capsule or tablet 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.
Ribavirin may cause birth defects if it’s taken during pregnancy. It can also cause birth defects if a child is conceived while the father is receiving treatment with this drug.
Other side effects may include:
- nausea and vomiting
- changes in your ability to taste
- memory loss
- trouble concentrating
- difficulty sleeping
- muscle pain
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 don’t affect as many systems in your body as interferons, so they may not cause as many side effects. All DAAs are oral drugs.
Side effects of DAAs can include:
- slow heartbeat
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.
Protease inhibitors (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 a protein called NS5B. The hepatitis C virus needs this protein 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, which contains ledipasvir and sofosbuvir, is used to treat HCV genotype 1. It was approved in 2014.
Zepatier contains elbasvir and grazoprevir. The FDA approved this drug in 2016 to treat HCV genotypes 1 and 4.
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.
Epclusa was the first medication to treat all six HCV genotypes.
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 who’ve been treated with sofosbuvir, which didn’t work to treat hepatitis C.
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.
Interferons were the standard treatment for hepatitis C for many years, but now, 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.
Interferon is a protein that your body makes. It helps your immune system develop an immune response to viruses, including HCV. A common brand-name interferon is peginterferon alfa-2a (Pegasys).
Interferons were part of combination treatments for genotype 1 HCV, but they could also be used for genotypes 2 and 3. The more common side effects of interferons include:
- dry mouth
- excessive fatigue
- 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 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
- 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 RibaPak
HCV infection, or hepatitis C, 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.
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.