Velpatasvir

Velpatasvir is an antiviral medication used to treat chronic hepatitis C virus (HCV) infection. It is a direct-acting NS5A inhibitor and is combined with sofosbuvir in a fixed-dose tablet (100 mg velpatasvir / 400 mg sofosbuvir) sold under the brand name Epclusa. The combination is pan-genotypic, meaning it is active against HCV genotypes 1 through 6.

Mechanism and use: Velpatasvir inhibits NS5A, a viral protein essential for HCV replication and assembly. When used with sofosbuvir, an NS5B polymerase inhibitor, the regimen provides potent antiviral activity and high rates of sustained virologic response, which is the goal of therapy.

Indications and regimen: Velpatasvir/sofosbuvir is approved for adults and certain pediatric patients with chronic HCV infection, including those with compensated cirrhosis. The standard dosing is once daily, taken with food, for 12 weeks in most patients. Some patients may receive shorter or alternative regimens based on prior treatment history, genotype, and cirrhosis status, per clinical guidelines.

Administration and interactions: The tablet is taken orally with a meal to optimize absorption. Absorption of velpatasvir can be reduced by certain antacids and proton pump inhibitors; if acid-suppressing therapy is necessary, specific dosing instructions should be followed. A known drug interaction is with amiodarone, which may cause bradycardia in some cases; caution is advised in patients who require both medications. Velpatasvir is not recommended for patients with decompensated cirrhosis; in such cases, alternative regimens are used.

Safety: Common adverse effects include headache and fatigue. Serious adverse events are uncommon but can occur, particularly in individuals with advanced liver disease. As with all HCV therapies, treatment decisions should consider liver function, comorbidities, and potential drug interactions.