What Are the Side Effects of Epclusa?

It’s estimated over 2 million people in the U.S. live with chronic hepatitis C. This is a liver infection that’s caused by the hepatitis C virus. In some cases, the infection may get better on its own without any treatment. However, most people who are infected will eventually develop chronic hepatitis C. Untreated chronic hepatitis C can lead to cirrhosis (scarring of the liver) and liver cancer. 

There are currently no vaccines or preventive medications available to fight the hepatitis C virus. But, there are treatments available that have over a 90% success rate for curing the infection. One such example is Epclusa (sofosbuvir/velpatasvir). 

Epclusa is highly effective for treating chronic hepatitis C. But it’s important to know about some of the side effects before starting it. Read on to learn more about those side effects and ways to manage them.

What is Epclusa?

Epclusa is a combination antiviral medication that contains sofosbuvir and velpatasvir. In just 12 weeks (about 3 months), Epclusa can treat all six types of chronic hepatitis C infection in adults and children, ages 3 and older. 

Epclusa can be used by people without cirrhosis or with compensated cirrhosis (early-stage cirrhosis with no symptoms). For those with severe liver damage, Epclusa may be combined with another medication called ribavirin (Rebetol). 

Currently, Epclusa is available as a brand name and generic product. You can find it as oral tablets or pellets.

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How does it work for hepatitis C?

As mentioned earlier, hepatitis C infection is caused by the hepatitis C virus. Once the virus enters the body, it begins to replicate and grow. Epclusa lowers the amount of hepatitis C virus in the body by stopping it from making copies of itself.

Common side effects of Epclusa

Epclusa side effects vary depending on age and if it’s used alone or with ribavirin. They can also vary depending on other medical conditions you may have. Common side effects generally affect over 10% of people taking Epclusa.

The most common Epclusa side effects for adults and children, ages 6 and older, are headache and fatigue. Children under 6 years of age may vomit or spit up the medication.

If you’re taking Epclusa with ribavirin, side effects can also include:

• Tiredness

• Anemia (low amount of red blood cells)

• Nausea

• Headache

• Trouble sleeping

• Diarrhea

These are the most commonly reported side effects, but other ones are also possible.

Serious side effects of Epclusa

Before starting Epclusa, it’s important to let your healthcare provider know if you have a history of hepatitis B. Even though you’ll be tested for hepatitis B infection prior to starting treatment, this is helpful information to share. 

Epclusa can reactivate the hepatitis B virus during or after treatment. This can lead to very serious liver failure and even death. If you’re at risk for hepatitis B virus reactivation, your healthcare provider will monitor you during and after treatment for signs and symptoms of liver inflammation and damage.

Epclusa can also cause very serious problems for people taking amiodarone. Amiodarone is a medication used to treat certain heart rhythm conditions. 

When taken together, they can cause dangerously slow heart rate. This life-threatening side effect can raise your risk for death and may require you to have a heart pacemaker. Due to the severity of this interaction, it’s not recommended to take these medications together. 

In addition to amiodarone, other potentially serious drug interactions are also possible. To make sure Epclusa is a safe option for you, make sure your pharmacist and care team have a full list of medications and supplements that you take. 

When should I contact my healthcare provider about side effects from Epclusa?

Epclusa is generally well-tolerated. But it has some serious side effects that may require immediate medical attention. If you experience any of the side effects mentioned below, contact your healthcare provider right away.

If you’ve previously been infected with the hepatitis B virus, Epclusa can make that virus active again. In some cases, this can cause very serious and life-threatening damage to the liver. 

Symptoms of hepatitis B infection include:

• Fever

• Jaundice (yellowing of the skin or eyes)

• Dark urine

• Stomach pain

• Nausea

• Vomiting

• Tiredness 

• Loss of appetite

• Clay-colored stools

Earlier, we discussed that Epclusa shouldn’t be taken with amiodarone due to their effects on the heart. If you’re taking amiodarone and have to take Epclusa, it’s important to know the serious side effects associated with this combination. These side effects are related to an especially slow heart hate. 

Some of the those side effects include:

• Feeling like you’re going to pass out

• Dizziness

• Weakness

• Feeling extremely tired

• Feeling out of breath

• Chest pains

• Confusion

• Memory problems

What can I do to manage the side effects of Epclusa?

Most of the common side effects of Epclusa are mild and can be managed at home with some helpful tips.  

Headache is one of the most reported side effects of Epclusa. If you experience headaches while taking this medication, here are some ways to manage it:

• Keep hydrated by drinking plenty of water.

• Ask your healthcare provider about taking over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

• Make sure you’re fully rested and have adequate amounts of sleep.

Epclusa can cause fatigue. If you’re feeling more tired than normal while taking Epclusa, here are some ways to manage it:

• When your schedule allows, try to take short breaks or naps during the day as needed.

• Try to remain as physically active as you can. Go on short walks or do low-impact exercises to keep your energy up.

• Drink plenty of water and eat a healthy, balanced diet.

Some people may experience nausea or vomiting while taking Epclusa. Here are some ways to manage those symptoms:

• Avoid foods that are spicy, greasy, or too sweet.

• Avoid foods that have strong odors that may cause nausea.

• Try to eat smaller meals throughout the day.

• Eat saltine crackers or plain white toast if you’re feeling nauseous. 

You may find that it’s harder to fall or stay asleep while taking Epclusa. If you’re having trouble sleeping, here are some things to try:

• Talk to your healthcare provider about taking OTC medications like diphenhydramine (Benadryl) to help you fall asleep.

• Take a soothing, warm bath before bedtime.

• Avoid drinking caffeinated beverages for a couple of hours before bedtime.

• Try not to drink too much fluid before bed to avoid waking up during the night to go to the bathroom.

If at any point these side effects worsen, let your healthcare provider know. They may have different suggestions for ways to manage your side effects. They may also prescribe you medications to help treat some of them.

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Written by:

ThienLy Neal, PharmD

ThienLy Neal, PharmD, has over 10 years experience in the pharmacy field, including in such settings as retail, hospital, compounding, and managed care. She has led various clinical programs while focusing on medication adherence programs, specialty drug initiatives, and polypharmacy safety initiatives.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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