Medication Regimens According to HCV Genotype

The good news is that there are now more medications available to treat Hepatitis C than ever before.  Based on you medical history, physical exam, laboratory and other test results, your healthcare provider will suggest which medications are right for you, as well as determine the length of time you need to be treated.  This decision will depend upon a number of factors including:

  • Your Hepatitis C virus (HCV) genotype
  • Whether or not you have cirrhosis, and if it’s mild (compensated) or severe (decompensated)
  • If you’ve received treatment before and which medications were used
  • If you’re waiting for or you’ve already had a liver transplant
  • Other health conditions you may have

Treatment regimens are usually 12 or 24 weeks, but sometimes longer, depending on your particular circumstances.

What follows is a basic outline of recommended treatment protocols organized by HCV genotype.  HCV genotypes are 1 (1a and 1b), 2, 3, 4, 5, and 6.  About 75% of the people with HCV in the U.S. have either genotype 1a or 1b.  Between 10% – 20% of people with HCV in the U.S. have either genotype 2 or 3.

Use this information as a starting point to talk with your healthcare provider about which treatment protocol is best for you.  Keep in mind that these are general guidelines and they do not cover alternative treatment protocols or special situations.  It’s important to follow your healthcare provider’s instructions regarding what, when, how and for how long to take your medication(s), as this will depend upon your specific circumstances.


HCV GENOTYPE 1

  • Daklinza (daclatasvir) with Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage: Daclatasvir 60 mg with sofosbuvir 400 mg once a day.
    • Length of treatment is 12 weeks.
    • The most common side effects are fatigue and headache.
  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Harvoni (ledipasvir/sofosbuvir); sometimes given with ribavirin. 
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • In clinical trials, the most common side effects observed with Harvoni treatment for 8, 12, or 24 weeks were fatigue and headache.
    • When Harvoni was given with ribavirin the most common side effects observed were weakness, headache and cough.
  • Olysio (simprevir) plus Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage of simeprevir: One 150-mg capsule once a day with food.
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • In clinical trials, the most common side effects observed during 12 weeks of treatment with simprevir/sofosbuvir combination therapy were fatigue, headache, nausea, insomnia, itching, rash and photosensitivity.  During 24 weeks of treatment, dizziness and diarrhea were also observed.
  • Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets); given with ribavirin if genotype 1a.
    • Recommended dosage: Two ombitasvir 12.5 mg/paritaprevir 75 mg/ritonavir 50 mg tablets once daily (in the morning) and one dasabuvir 250 mg tablet twice daily (morning and evening) with a meal.
    • Length of treatment is usually 12 or 24 weeks.
    • The common side effects for Viekira Pak without ribavirin include nausea, itching, and sleep problems.  If taken with ribavirin side effects include tiredness, nausea, itching, sleep problems, feeling weak and skin reactions such as redness or rash.
  • Viekira XR (ombitasvir, paritaprevir, ritonavir, dasabuvir tablet); given with ribavirin if genotype 1a.  Viekira XR is a once-daily, extended release formulation that contains the same ingredients as Viekira Pak, which is dosed twice a day.
    • Recommended dosage: Three tablets once daily with a meal.
    • If you also need ribavirin, this is an additional medication that will be taken twice a day.
    • Length of treatment is 12 weeks (patients without cirrhosis) or 24 weeks (patients with compensated cirrhosis).
    • The common side effects for Viekira without ribavirin include nausea, itching, and sleep problems.  If taken with ribavirin side effects include tiredness, nausea, itching, sleep problems, feeling weak and skin reactions such as redness or rash.
  • Zepatier (elbasvir/grazoprevir): sometimes given with ribavirin.
    • Recommended dosage: One tablet (elbasvir 50 mg/grazoprevir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12-weeks for the vast majority of people, although a 16-week course has been approved for a certain subset of patients.
    • The most common side effects of Zepatier without ribavirin include fatigue, headache and nausea.  If taken with ribavirin, common side effects include low red blood counts (anemia), headache, fatigue, shortness of breath, and rash or itching.

HCV GENOTYPE 2

  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is usually 12 or 16 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.

HCV GENOTYPE 3

  • Daklinza (daclatasvir) with Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage: Daclatasvir 60 mg with sofosbuvir 400 mg once a day.
    • Length of treatment is 12 weeks.
    • The most common side effects are fatigue and headache
  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment with sofosbuvir/ribavirin combination therapy is usually 24 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.

HCV GENOTYPE 4

  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Harvoni (ledipasvir/sofosbuvir); sometimes given with ribavirin. 
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects of Harvoni are fatigue and headache.
    • When co-administered with ribavirin the most common side effects are weakness, headache and cough.
  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir:   One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is usually 24 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.
  • Technivie (ombitasvir/paritaprevir/ritonavir) plus ribavarin
    • Recommended dosage of Technivie: One tablet once daily with a meal.
    • Ribavarin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is 12 weeks.
    • The common side effects for Technivie with ribavirin include fatigue, nausea, sleep problems, feeling weak, itching and other skin reactions such as redness or rash.
  • Zepatier (elbasvir/grazoprevir): sometimes given with ribavirin.
    • Recommended dosage: One tablet (elbasvir 50 mg/grazoprevir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12-weeks for the vast majority of people, although a 16-week course has been approved for a certain subset of patients.
    • The most common side effects of Zepatier without ribavirin include fatigue, headache and nausea.  If taken with ribavirin, common side effects include low red blood counts (anemia), headache, fatigue, shortness of breath, and rash or itching.

HCV GENOTYPE 5

  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Harvoni (ledipasvir/sofosbuvir)
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects are fatigue and headache.

HCV GENOTYPE 6

  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Harvoni (ledipasvir/sofosbuvir)
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects are fatigue and headache.

After you and your doctor decide on a treatment regimen, it’s important to take these medications exactly as prescribed.  That means taking the correct dose of each drug for the full duration that your doctor prescribes them.  Adhering to your medication regimen is an important factor in treatment success.

Discuss any side effects you experience with your doctor.  He or she may be able to treat them by giving you other medicines to treat the side effects.  If you experience serious side effects or complications from other health conditions, contact your doctor before stopping any of your Hepatitis C medications.  Your doctor will determine if you need to stop or change treatment.

This page has been updated and medically reviewed October 2016.