If you’ve been diagnosed with hepatitis C, you may know that this disease is caused by a virus that infects your liver. You may also know that it was once very hard to cure. Today, new drug combinations can cure most patients with hepatitis C.
In 2014, the Food and Drug Administration (FDA) approved two medications to treat hepatitis C: Harvoni and Viekira Pak. These medications are combination drugs, which means they contain more than one drug. The drugs contained in Harvoni and Viekira Pak are different. As a result, Harvoni and Viekira Pak can have different effects.
As more people use these drugs, we learn more about them and their effects. Here’s what we know about Harvoni and Viekira Pak today. Review this information with your doctor to see if one of these drugs is a good option for you.
What drugs are in these combination treatments?
Harvoni is used to treat chronic hepatitis C (CHC) genotype 1 in adults. It contains two drugs in one film-coated tablet.
Drugs in the tablet
The tablet contains ledipasvir (90 mg). This is an NS5A inhibitor. It blocks the formation of a protein that helps the virus copy itself. It also contains sofosbuvir (400 mg). This is a polymerase inhibitor. It prevents the building blocks of the virus from coming together.
The typical daily dosage is one tablet once per day. Treatment typically lasts 12–24 weeks. The length of your treatment depends on whether you have cirrhosis (scarring of the liver).
You can take this medication with or without food. This medication is available only in the strength combination listed above. You should not cut or crush this tablet.
Viekira Pak is used to treat three types of hepatitis C: genotype 1, genotype 1a, and genotype 1b. Viekira Pak consists of two film-coated tablets that contain different drugs. You need to take both tablets.
Drugs in the tablet
Tablet 1 contains:
- Ombitasvir (12.5 mg). This is an NS5A inhibitor. It blocks the formation of a protein that helps the virus copy itself.
- Paritaprevir (75 mg). This is a protease inhibitor. It helps stop the building of small parts that make up the virus.
- Ritonavir (50 mg). This drug helps make paritaprevir last longer in your body. This action makes paritaprevir more effective.
Tablet 2 contains:
- Dasabuvir (250 mg). This is a polymerase inhibitor. It prevents the building blocks of the virus from coming together.
The typical dosage is two tablets of Tablet 1 taken every morning. You’ll also take one tablet of Tablet 2 twice per day. Treatment typically lasts 12–24 weeks. The length of treatment depends on whether you have cirrhosis (scarring of the liver).
You should take both tablets with a meal. This medication is available only in the strength combination listed above. You should not cut or crush these tablets.
Cost, availability, and insurance
All hepatitis C drugs require special approval from insurance companies. Only specialty pharmacies dispense them. They are also very expensive.
Harvoni costs about $37,800 for every 4 weeks of treatment. That means the average 12-week treatment could cost about $113,400.
Viekira Pak costs about $33,000 for every 4 weeks of treatment. That means the average 12-week treatment could cost about $99,000.
The costs of these drugs may vary depending on the agreement between your insurance company and the drug manufacturer. Not all insurance companies cover the cost of the drugs. Sometimes, insurance companies only cover the drug cost if your hepatitis C is at a certain stage. If the drug cost isn’t covered, some manufacturers offer patient assistance programs to help pay for the medication.
Both Harvoni and Viekira Pak can cause side effects. Fortunately, side effects are typically mild.
The more common side effects of Harvoni include:
- trouble sleeping
The more common side effects of Viekira Pak include:
- trouble sleeping
A drug interaction is when one drug changes the way another works. Interactions can be harmful or prevent a drug from working well. Like many drugs, both Harvoni and Viekira Pak have many possible drug interactions.
Before you start either drug, be sure to tell your doctor about all prescription and over-the-counter (OTC) drugs you take. This includes supplements, such as St. John’s wort. Your doctor and pharmacist will check carefully for any interactions with Harvoni or Viekira Pak.
Some of the drugs that interact with Harvoni include:
- Antacids, including OTC products (such as aluminum and magnesium hydroxide) and drugs such as famotidine or omeprazole
- Antiseizure drugs such as carbamazepine, phenytoin, phenobarbital, or oxcarbazepine
- Cholesterol-lowering drugs such as rosuvastatin
- Drugs to treat tuberculosis such as rifampin, rifabutin, or rifapentine
- Heart drugs such as amiodarone or digoxin
- HIV drugs such as tenofovir
- Simeprevir, which is also used to treat hepatitis C
- St. John’s wort
Some of the drugs that interact with Viekira Pak include:
- Antacids such as omeprazole
- Antifungal drugs such as ketoconazole or voriconazole
- Anxiety drugs such as alprazolam
- Asthma drugs such as salmeterol
- Cholesterol-lowering drugs such as rosuvastatin or pravastatin
- Heart drugs such as amlodipine, amiodarone, mexiletine, and many others
- HIV drugs such as darunavir, rilpivirine, and lopinavir
- Immunosuppressants such as cyclosporine or tacrolimus
- Mood stabilizers such as quetiapine
- Nasal steroids such as fluticasone
- Pain drugs such as buprenorphine/naloxone
What if you have another medical condition?
Your overall health can affect your choice of treatment for hepatitis C. Be sure to share all of your medical records with your doctor before you consider using Harvoni or Viekira Pak. If you have any of the conditions listed below, it’s especially important to discuss them with your doctor.
Both Harvoni and Viekira Pak (when taken without a drug called ribavirin) are category B pregnancy drugs. This means that there haven’t been enough studies done in pregnant women to confirm whether these drugs are safe to use during pregnancy. These drugs have been tested in pregnant rats, but the results of lab studies can’t always be applied to humans.
You should take one of these drugs only if you feel the benefits to you and your unborn child outweigh the risks to your pregnancy. Your doctor can help you make a decision that’s right for you.
If you decide to use one of these medications while pregnant, you may be able to enroll in a pregnancy registry. The registry would track the results of your treatment. That data could help other women make decisions in the future.
Note: Harvoni and Viekira Pak may each be used in combination with a drug called ribavirin. If you take Harvoni or Viekira Pak with ribavirin, do not get pregnant. The drug combination could cause birth defects in your unborn child.
If you take Harvoni and have mild kidney disease, your dosage should stay the same. If you have severe kidney disease and are on dialysis, you may not be able to take Harvoni. Talk with your doctor about whether it’s safe for you. Be sure to share all medical records about your kidney health with your doctor.
If you take Viekira Pak and have mild kidney disease, your dosage should stay the same. Your dosage will likely also stay the same if you have severe kidney disease. Still, be sure to share all medical records about your kidney health with your doctor before starting Viekira Pak.
You should not need any change to your Harvoni dosage, even if you have severe liver disease. Still, be sure to share all medical records about your liver health with your doctor before starting Harvoni.
If you have mild liver disease, you will probably be able to take Viekira Pak. But if you have severe liver disease, Viekira Pak is not recommended. Talk with your doctor about whether this drug is safe for you. Be sure to share all medical records about your liver health with your doctor.
Viekira Pak is used to treat several types of hepatitis C patients. For those who have never been treated before, the cure rate is about 95 percent. For those with cirrhosis or who have been treated before with other drugs, Viekira Pak is used with ribavirin. The cure rate for this usage can be 80–90 percent or higher.
The cure rate for Harvoni is about 95 percent.
Which drug should you take?
You’ll need to keep several factors in mind when you and your doctor decide if one of these drugs is a good treatment option for you.
Both of these drug combinations can have a very high success rate in curing hepatitis C.
Viekira Pak can be used to treat several genotypes of hepatitis C, while Harvoni treats just genotype 1. Your doctor will consider your genotype when deciding which treatment is the best choice for you. (Note: Harvoni has recently been approved to treat genotypes 4, 5, and 6. Your doctor can tell you more.)
Other drugs needed
If you take Harvoni, you may not need to take anything else to treat your hepatitis C. But if you take Viekira Pak, you may need to take ribavirin also. Ribavirin has its own risks and side effects, including a risk of anemia (low red blood cell count).
If you have severe liver disease, you may be able to take Harvoni. However, Viekira Pak is not recommended with severe liver disease.
If you take a number of other drugs, you’ll need to consider whether Harvoni or Viekira Pak would interact with them. Your doctor may need to change your dosages of your other drugs or switch you to other medications.
Pharmacist’s takeaway advice
There are many new hepatitis C drugs on the market today. Harvoni and Viekira Pak are two promising options. Each person is different, so talk with your doctor about your current and past health concerns and how these drugs might affect you. Together, you and your doctor can decide if one of these drugs is a good choice to treat your hepatitis C.