Mavyret
Mavyret (glecaprevir / pibrentasvir) is a combination medication containing two antivirals, glecaprevir and pibrentasvir. It's a first-choice option that's used to treat many forms of hepatitis C infection. If you've never taken hepatitis C treatment before, you'll need to take Mavyret (glecaprevir / pibrentasvir) for 8 weeks. But if you're already been treated for hepatitis C before you start this medication, your Mavyret (glecaprevir / pibrentasvir) treatment duration might be longer. The most common, short-term side effects include headache, tiredness, and nausea.
What is Mavyret (glecaprevir / pibrentasvir)?
What is Mavyret (glecaprevir / pibrentasvir) used for?
Chronic (long-term) hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection in certain people age 3 years and older
Hepatitis C genotype 1 infection in people age 3 years and older who were previously treated with an NS5A inhibitor or an HCV protease inhibitor (not both)
How Mavyret (glecaprevir / pibrentasvir) works
Mavyret (glecaprevir / pibrentasvir) contains two antiviral medications that work together to stop the hepatitis C virus (HCV) from making copies of itself in the body. The two medications are glecaprevir (a protease inhibitor) and pibrentasvir (an NS5A inhibitor). They work by attacking two different proteins in the virus.
Using two medications that work in different ways can prevent HCV resistance, which is when the virus develops a defense against antivirals. As a result, the medications no longer work to fight the virus.
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What are the side effects of Mavyret (glecaprevir / pibrentasvir)?
Common Side Effects
- Headache (13%)
- Fatigue or tiredness (11%)
- Nausea (8%)
Other Side Effects
- Diarrhea
- Rash
- Stomach pain
Serious Side Effects
- Liver failure caused by hepatitis B virus reactivation: nausea, stomach pain, yellowing of your skin or whites of your eyes
Source: FDA
More on Mavyret (glecaprevir / pibrentasvir) side effects
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Mavyret (glecaprevir / pibrentasvir)
Pros
Works against six types of hepatitis C
Only need to take once a day
Only have to take it for 8 weeks for some people
Available as oral pellets for children who have a hard time swallowing tablets
Can take with antacids and other heartburn medications, unlike other treatment options
Cons
Brand name only
Need to take multiple tablets or use multiple oral pellet packets at one time
Can reactivate hepatitis B in people who have a history of hepatitis B infection
Not a good option for people who have severe liver problems
Can interact with certain medications, including HIV medications, statins, antiseizure medications, and blood thinners
Pharmacist tips for Mavyret (glecaprevir / pibrentasvir)
Take Mavyret (glecaprevir / pibrentasvir) at the same time every day with food. This will keep the medication levels where they need to be to fight HCV.
Remember to take all tablets or pellet packets once a day. This is not the same as taking 1 tablet or packet multiple times a day.
If you've never been treated for HCV (treatment-naive), your treatment length is typically 8 weeks. If you don't fall in this category, your treatment will probably be longer, usually 12 or 16 weeks. Confirm with your provider before stopping Mavyret (glecaprevir / pibrentasvir). Stopping the medication too early can allow hepatitis C to come back.
The oral pellets are a nice option for children. Sprinkle all pellets for the dose onto a small amount of soft food that can be swallowed without chewing, such as peanut butter, yogurt, or thick jam. Don't use liquids or liquidy foods because the medication can dissolve and not work as well. Swallow the mixture of pellets and food within 15 minutes of preparation. Don't crush or chew the pellets.
Frequently asked questions about Mavyret (glecaprevir / pibrentasvir)
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What are the risks and warnings for Mavyret (glecaprevir / pibrentasvir)?
Mavyret (glecaprevir / pibrentasvir) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Hepatitis B reactivation
Risk factors: History of hepatitis B infection
Some people who have both hepatitis B and C infections have had their hepatitis B reactivate or flare up while getting treated for hepatitis C. These people typically aren't taking hepatitis B medications at the time of reactivation. Hepatitis B reactivation can cause mild-to-severe liver problems if not caught early and treated. Your provider might check for hepatitis B before you start Mavyret (glecaprevir / pibrentasvir). Still, let your provider know if you've ever had hepatitis B or been treated for it in the past.
Worsening liver health
Risk factors: History of liver problems
Some people have experienced severe liver problems, including liver failure, while taking hepatitis C medications such as Mavyret (glecaprevir / pibrentasvir). This is more common in people who already have liver problems. And worsening liver problems typically happen within the first 4 weeks of treatment with Mavyret (glecaprevir / pibrentasvir). Before starting this medication, your provider will check your liver health. Mavyret (glecaprevir / pibrentasvir) can't be used if you have severe liver problems. People with mild-to-moderate liver problems can use Mavyret (glecaprevir / pibrentasvir), but your provider might keep a closer eye on your liver health. Let your provider know if you notice symptoms of worsening liver health, such as yellowing of your skin or whites of your eyes, stomach bloating, or changes in behavior or thinking.
Taking medications that make Mavyret (glecaprevir / pibrentasvir) not work as well
Mavyret (glecaprevir / pibrentasvir) interacts with other medications. Some interactions are more serious than others. Medications, such as rifampin (Rifadin), carbamazepine (Tegretol), those containing efavirenz, and St. John's wort, can lower the amount of Mavyret (glecaprevir / pibrentasvir) in your body. This can make Mavyret (glecaprevir / pibrentasvir) less effective (not work as well) for your HCV infection. For this reason, it's not recommended to take these medications with Mavyret (glecaprevir / pibrentasvir). It's important to let your provider and pharmacist know about all the medications you're currently taking, including vitamins, herbal supplements, and over-the-counter medications.
Mavyret (glecaprevir / pibrentasvir) dosage forms
Typical dosing for Mavyret (glecaprevir / pibrentasvir)
Each tablet contains 100 mg of glecaprevir and 40 mg of pibrentasvir. The packets of oral pellets containing 50 mg of glecaprevir and 20 mg pibrentasvir are recommended for younger children.
Adults, children age 12 years or older, and children who weigh at least 99 pounds: The recommended dose is 3 tablets by mouth once a day with food. The total daily dose is 300 mg of glecaprevir and 120 mg of pibrentasvir.
Children age 3 to 12 years old: The dose is based on your child's body weight. The provider will determine the right dose for your child. In general, the recommended dose ranges from 3 to 5 packets of oral pellets by mouth once a day with food.
The treatment duration ranges from 8 to 16 weeks, depending on your previous HCV treatment regimens and your liver health.
How much does Mavyret (glecaprevir / pibrentasvir) cost?
Mavyret (glecaprevir / pibrentasvir) contraindications
Moderate-to-severe liver problems
Taking atazanavir (Reyataz) or rifampin (Rifadin) at the same time as Mavyret (glecaprevir / pibrentasvir)
What are alternatives to Mavyret (glecaprevir / pibrentasvir)?
Chronic (long-term) hepatitis C genotype 1, 2, 3, 4, 5, or 6 infection in certain people age 3 years and older
Hepatitis C genotype 1 infection in people age 3 years and older who were previously treated with an NS5A inhibitor or an HCV protease inhibitor (not both)
Hepatitis C infection genotype 1, 4, 5, and 6
Chronic hepatitis C infection
What is the latest news about Mavyret (glecaprevir / pibrentasvir)?
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References
Best studies we foundAbbVie Inc. (2021). Mavyret® (glecaprevir and pibrentasvir) tablets, for oral use; oral pellets [package insert].
AbbVie Inc. (2021). Patient information: Mavyret® (glecaprevir and pibrentasvir) tablets, for oral use; oral pellets.
AbbVie Inc. (n.d.). Powerful cure rates in just 8 weeks.
American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. (2022). HCV resistance primer.
American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. (2023). Monitoring patients who are starting HCV treatment, are on treatment, or have completed therapy.
American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. (n.d.). HCV guidance: Recommendations for testing, managing, and treating hepatitis C.
Andrews, R. R. (2018). Family physicians can manage adults with hepatitis C. American Family Physician.
Centers for Disease Control and Prevention. (2023). Hepatitis C questions and answers for the public.
Chatel-Chaix, L., et al. (2010). Hepatitis C virus NS3/4A protease inhibitors: A light at the end of the tunnel. Viruses.
National Center for Complementary and Integrative Health. (2020). St. John’s wort.
National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Hepatitis C.
Urbanowicz, A., et al. (2019). Modulation of the immune system in chronic hepatitis C and during antiviral interferon-free therapy. Archivum Immunologiae et Therapiae Experimentalis.
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