Epclusa vs. Zepatier for Hepatitis C: Important Differences and Potential Risks.

Key takeaways

Epclusa (sofosbuvir/velpatasvir) and Zepatier (elbasvir/grazoprevir) are both antiviral medications used to treat hepatitis C, but they have some key differences. Epclusa treats all six types of hepatitis C, while Zepatier is only effective for genotypes 1 and 4. Epclusa can be used in both adults and children aged 3 and older, whereas Zepatier is primarily for those ages 12 and older. Zepatier is a good option for people with kidney problems, including those on hemodialysis, and it doesn't interact with stomach acid medications, unlike Epclusa. However, Zepatier cannot be used in people with cirrhosis or moderate to severe liver problems, and it requires resistance testing for hepatitis C type 1 before starting therapy. Both medications have similar common side effects like headache and fatigue, but Epclusa has additional risks such as slow heart rate when taken with amiodarone and potential reactivation of hepatitis B.

Epclusa

(sofosbuvir / velpatasvir)

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Zepatier

(elbasvir / grazoprevir)

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Summary for Epclusa

Prescription only

Epclusa (sofosbuvir / velpatasvir) is a combination medication containing two antiviral medications, sofosbuvir and velpatasvir, that's used to treat chronic hepatitis C in adults and children.

Indications for Epclusa

Chronic hepatitis C infection

Pros and Cons for Epclusa

Pros

Treats all 6 types of hepatitis C
Most people only have to take one pill once a day for 12 weeks
Can be taken with or without food
Most common side effects are usually mild, such as fatigue and headache

Cons

Interacts with many medications including those used for heartburn
Not a good option for people taking amiodarone (Pacerone) because the combination can cause slow heart rate
Some people with severe liver problems who have chronic hepatitis C may need to take it with another antiviral medication called ribavirin
Can reactivate the hepatitis B virus if you have a history of hepatitis B infection

Common Side Effects for Epclusa

Headache
Fatigue

Warnings for Epclusa

Hepatitis B reactivation
Slow heart rate
Ribavirin risks
Interactions with other medications

Summary for Zepatier

Prescription only

Zepatier (elbasvir / grazoprevir) is a combination medication containing two antiviral medications, elbasvir and grazoprevir. It's one of the first choice treatment options for hepatitis C genotypes 1 and 4.

Indications for Zepatier

Hepatitis C infection genotype 1 and 4

Pros and Cons for Zepatier

Pros

1 tablet once a day is a full regimen for some people and can cure hepatitis C
Doesn't interact with stomach acid medications like Epclusa and Harvoni
Can be taken by people with kidney problems, even those on hemodialysis
Usually has mild side effects
Good option for people taking amiodarone, since it doesn't contain sofosbuvir which can cause slow heartbeat

Cons

Doesn't treat all the types of hepatitis C like other antiviral combos such as Epclusa or Mavyret
People with hepatitis C type 1 need to have resistance testing before starting therapy
Can't be used in people with cirrhosis or moderate to severe liver problems
Some people who have hepatitis B and C have had their hepatitis B come back after taking hepatitis C treatment
Some people need to take Zepatier (elbasvir / grazoprevir) with an antiviral medication called ribavirin, which can have a lot of side effects