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

Key takeaways

Harvoni (ledipasvir/sofosbuvir) and Zepatier (elbasvir/grazoprevir) are both antiviral combination medications used to treat hepatitis C, but they have some key differences. Harvoni is effective against hepatitis C genotypes 1, 4, 5, and 6, while Zepatier is only used for genotypes 1 and 4. Harvoni can be used in children as young as 3 years old and is available in a generic form, which can make it more affordable. On the other hand, Zepatier is a good option for people with kidney problems, including those on hemodialysis, and does not interact with stomach acid-lowering medications. However, Zepatier requires resistance testing for people with genotype 1 before starting therapy and cannot be used in individuals with cirrhosis or moderate to severe liver problems. Both medications have similar common side effects, such as headache, fatigue, and nausea. Additionally, Harvoni interacts with more medications, including some HIV antiretrovirals and heart medications like amiodarone, which can cause slow heart rate.

Harvoni

(ledipasvir / sofosbuvir)

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Zepatier

(elbasvir / grazoprevir)

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Summary for Harvoni

Prescription only

Harvoni (ledipasvir / sofosbuvir) is a combination medication containing two antiviral medications, ledipasvir and sofosbuvir (Sovaldi). It is a first-choice treatment option for hepatitis C for certain types of people.

Indications for Harvoni

Hepatitis C infection genotype 1, 4, 5, and 6

Pros and Cons for Harvoni

Pros

Taking the medication for 6 months or less is very effective against hepatitis C
Few side effects; most common are stomachache, tiredness, and headache
Can be used in children age 3 years or older
Available as a generic, which can be more affordable
Available as an oral pellet for people who can't swallow the tablet or need their dose lowered

Cons

Heartburn and stomach acid-lowering medications can lower the amount of Harvoni (ledipasvir / sofosbuvir) in your body
Not a good option for people taking amiodarone, because the combination can cause slow heart rate
Doesn't treat all the types of hepatitis C like other antiviral combos, such as Epclusa or Mavyret
Interacts with some HIV antiretroviral medications
Some people who have hepatitis B and C have had their hepatitis B come back after taking hepatitis C treatment

Common Side Effects for Harvoni

Headache (14%)
Fatigue or tiredness (13%)
Nausea (7%)

Warnings for Harvoni

HEPATITIS B REACTIVATION
SLOW HEART RATE
RIBAVIRIN RISKS

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