Indications
Glecaprevir is an antiviral medicine used, always together with Pibrentasvir in a single tablet, to treat long-term (chronic) hepatitis C virus infection in adults and older children. It works against all six main types (genotypes) of the virus and can be used in people with or without compensated cirrhosis (liver scarring with the liver still working), and in people with kidney disease, including those on dialysis.
How It Works
Glecaprevir blocks an enzyme of the hepatitis C virus called the NS3/4A protease. The virus needs this enzyme to cut its long chain of proteins into the working parts it needs to copy itself. With the enzyme blocked, the virus cannot multiply. Pibrentasvir attacks a different viral protein (NS5A), and using both together cures the infection in most people and makes resistance less likely.
Dosage and Administration
This medicine is prescribed and monitored by a doctor experienced in treating hepatitis C. The usual adult dose is three tablets (each containing Glecaprevir 100 mg and Pibrentasvir 40 mg) taken together once a day with food, giving 300 mg of Glecaprevir and 120 mg of Pibrentasvir daily. Treatment usually lasts 8 weeks, but may be 12 or 16 weeks depending on liver scarring, past treatment and the virus type. Swallow the tablets whole; do not chew, split or crush them. Take every dose as prescribed and do not stop early.
Interactions
- Must not be used with Atazanavir or Rifampicin.
- Carbamazepine, Phenytoin, Phenobarbital, Efavirenz and St John’s Wort can lower its levels and stop it working.
- Birth control pills containing Ethinylestradiol increase the risk of liver enzyme rises and are not recommended during treatment.
- It can raise blood levels of Atorvastatin, Simvastatin, Lovastatin, Rosuvastatin, Dabigatran, Digoxin and Ciclosporin, so doses may need changing or the medicine may need to be avoided.
- People on Warfarin need closer INR checks, and people with diabetes may need lower doses of diabetes medicines as the liver improves.
- Always give your doctor a full list of your medicines, including herbal products.
Contraindications
- Moderate or severe liver failure (Child-Pugh B or C), or a past episode of liver failure with jaundice, fluid in the belly or confusion.
- Use together with Atazanavir or Rifampicin.
- Allergy to either active substance or any ingredient.
Side Effects
Most people tolerate treatment well. Common effects are headache, tiredness, nausea and diarrhoea. Itching can occur, mainly in people with kidney disease. Raised bilirubin on blood tests is sometimes seen.
Get urgent medical help if you have yellowing of the skin or eyes, dark urine, swelling of the belly, confusion or extreme sleepiness, vomiting blood, or signs of a severe allergic reaction such as swelling of the face or throat and difficulty breathing.
Pregnancy and Lactation
There is little experience in pregnancy. Treatment is usually delayed until after pregnancy, so tell your doctor if you are pregnant or planning a pregnancy. It is not known whether it passes into breast milk; your doctor will weigh the benefits of breastfeeding against any risk.
Precautions and Warnings
- Hepatitis B can flare up, sometimes seriously, during or after hepatitis C treatment. You will be tested for hepatitis B before starting.
- People with cirrhosis need regular checks for worsening liver function during treatment.
- Not recommended for those who have already failed treatment with a similar NS3/4A protease inhibitor plus NS5A inhibitor combination, unless a specialist advises.
- Clearing the virus does not protect you from catching hepatitis C again; avoid sharing needles, razors and toothbrushes.
Overdose
There is little experience with overdose. If too many tablets are taken, contact a doctor or hospital so that you can be watched for side effects. Dialysis does not remove the medicine.
Therapeutic Class
Direct-acting antiviral for hepatitis C (NS3/4A protease inhibitor).
Storage
Store below 30°C in a dry place, in the original pack to protect from moisture, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.