Sofosbuvir Velpatasvir Voxilaprevir

Aka: Sofosbuvir Velpatasvir Voxilaprevir, Velpatasvir/Voxilaprevir/Sofosbuvir, Vosevi

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II. Precautions

  1. See Hepatitis C Antiviral Regimen

III. Indications

  1. See Hepatitis C Antiviral Regimen
  2. Salvage therapy after failure of other regimens

IV. Contraindications

  1. See Hepatitis C Antiviral Regimen
  2. Advanced Cirrhosis with Child Pugh Class B or C (or CTP score >=7)

V. Mechanism

  1. Similar to Epclusa, with addition of Voxilaprevir
  2. Sofosbuvir is a NS5B Polymerase Inhibitor (...buvirs)
  3. Velpatasvir is a NS5A Protein Inhibitor (...asvirs)
  4. Voxilaprevir is a NS3/4A Protease Inhibitor (...previrs)

VI. Evaluation

  1. See Hepatitis C Antiviral Regimen for Pre and post-treatment protocols

VII. Adverse Effects

  1. See Hepatitis C Antiviral Regimen
  2. Common (>10%)
    1. Headache
    2. Fatigue
    3. Nausea
    4. Diarrhea
  3. Serious
    1. Liver injury or hepatic failure
      1. Do not use in Child Pugh Class B or C (or CTP score >=7)

VIII. Drug Interactions

  1. See Hepatitis C Antiviral Regimen
  2. Sofosbuvir (Sovaldi) Drug Interactions
    1. See Sofosbuvir
    2. Avoid potent P-Glycoprotein Inducers (reduce Sofosbuvir efficacy)
    3. Avoid Amiodarone (severe Bradycardia risk)
  3. Velpatasvir Drug Interactions
    1. See Epclusa
    2. Avoid Topetecan
    3. May raise Digoxin levels
    4. Antacids (reduce Velpatasvir absorption)
  4. Statins
    1. Avoid Rosuvastatin and Pitavastatin
    2. Limit Pravastatin to 40 mg daily
    3. Limit Atorvastatin to 10 mg daily
    4. Use lowest effective dose of other Statins
  5. Dabigatran
    1. P-gp inhibitors may effect levels
    2. Exercise caution with combination

IX. Monitoring

  1. See Hepatitis C Antiviral Regimen

X. Resources

  1. Vosevi (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=17ffc094-8ca7-45d2-80d8-fd043bc9a221

XI. References

  1. (2023) Presc Lett, Hepatitis C Treatment Overview, Resource #390902

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