Treatment

HCV Medications: Precautionary Measures

Many hepatitis C medications have important considerations that you should be aware of before starting a course of treatment for your HCV infection.  Some considerations are specific to a particular drug, while others are more general in nature.

Before starting treatment, it’s important to tell your healthcare provider if you:

  • Have other medical conditions, including liver problems not due to HCV
  • Take other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements.  They may affect how well your hepatitis C treatment works, and your hepatitis C treatment may affect the way other medicines work.
  • Are breastfeeding or plan to breastfeed; it’s not known if some of the hepatitis C medications pass into your breast milk.
  • Are pregnant or plan to become pregnant; it’s not known if some of the hepatitis C medications will harm your unborn baby.

Below we’ve listed some important considerations you should be aware of related to specific medications.  This is not a comprehensive list and does not take the place of talking with your healthcare provider.

Ribavirin

  • Ribavirin can cause birth defects and must not be taken by pregnant women or the male partners of pregnant women.
  • Extreme care must be taken to avoid pregnancy during treatment and for six months following treatment in both female patients and female partners of male patients who are taking ribavirin.
  • You and your partner should use two forms of birth control during this period.  For example, a man could use a condom and a woman could use a diaphragm or birth control pills.

Olysio (simprevir) 

  • Simprevir – a protease inhibitor – cannot be used with any hormonal birth control because the protease inhibitors stop hormonal birth control from working well.  These include:
    • Birth control pills
    • Uterine implants
    • Depo-Provera injections
    • Vaginal rings

When taking a protease inhibitor, you would need to use two non-hormonal forms of birth control, like a condom and diaphragm plus spermicidal jelly.

  • Increased chance of sunburn (photosensitivity): This has been observed with simprevir combination therapy.  Use sun protective measures, limit sun exposure and avoid tanning devices during treatment with simprevir.
  • Simprevir should not be taken alone; it is used in combination with other antiviral drugs. It’s important to review the considerations related to other HCV medications you’re taking in combination with simprevir.

Sovaldi (sofosbuvir)

  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, at the same time as Sovaldi.  It can lead to dangerous slowing of the heart rate.
  • If you take any medications for seizures, let your doctor know.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with sofosbuvir as this can decrease its effectiveness.
  • Sofosbuvir should not be taken alone; it is used in combination with other antiviral drugs. It’s important to review the considerations related to other HCV medications you’re taking in combination with sofosbuvir.

Harvoni (ledipasvir/sofosbuvir)

  • Taking other drugs containing sofosbuvir, including Sovaldi, is not recommended.
  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, at the same time as Harvoni.  It can lead to dangerous slowing of the heart rate.
  • If you take any medications for seizures, let your doctor know.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with Harvoni as this can decrease its effectiveness.
  • Drugs that reduce the amount of acid your stomach produces may affect the levels of Harvoni in your blood.  There are two types of acid-reducing medications: protein pump inhibitors like omeprazole (Prilosec), and H2 blockers such as famotidine (Pepcid), ranitidine (Zantac) and cimetidine (Tagamet).  If you’re taking an acid-reducing medication, talk with your doctor about proper dosing and timing of when to take it while being treated with Harvoni.
  • If you take an antacid that contains aluminum (such as Amphojel) or magnesium hydroxide (such as Phillips’ Milk of Magnesia), take it fours hours before or fours hours after you take Harvoni.

Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets)

  • Viekira can cause an increase in your liver function blood test results, especially if you use ethinyl estradiol-containing medicines, such as some birth control products (for example, Lo Loestrin FE, Norinyl, Ortho Tri-Cyclen Lo, etc.) and hormone replacement therapy (Fem HRT).
  • You must stop using these products before you start treatment with Viekira.  You’ll need to use another method of birth control during treatment and for about 2 weeks after treatment ends.  Your healthcare provider will tell you when you may begin taking ethinyl estradiol-containing medicines.
  • If you take any medications for seizures, let your doctor know.
  • If you’ve had a liver transplant and take the medicines tacrolimus (Prograf) or cyclosporine (Gengraf, Neoral, Sandimmune), your healthcare provider should check your blood levels and, if needed, may change your dose of these medicines or how often you take them, both during and after treatment.

Peg-interferon

  • Peg-interferon often causes flu-like symptoms like headache, fever, and body aches.  Since you may not feel well for a time, consideration should be given to your work schedule and the ability to care for yourself or get assistance when needed.
  • Tell your healthcare provider if you have a history of psychiatric illness – particularly depression – as peg-interferon can cause malaise, mood changes and depression.  Your healthcare provider may consider prescribing antidepressant medications that can help alleviate this situation.
  • Peg-interferon can cause low red blood cell count (anemia), low white blood cell count (leukopenia) and low platelet count (thrombocytopenia).  As such, you will likely need frequent blood tests so your healthcare provider can closely monitor your blood counts to make sure they don’t fall below a certain level.


This page has been updated and medically reviewed April 2015.