Updated: 3/10/2019

Hepatitis C Drugs

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Snapshot
  • A 54-year-old man presents to his primary care physician with fatigue and issues with sleep. His symptoms are associated with nausea and abdominal discomfort. A few days ago, he noted dark urine but denies any dysuria. He said that in the past he experienced severe right upper quadrant pain and jaundice approximately 8 years ago, requiring treatment which he does not remember the specifics. Social history is remarkable for intravenous drug use and had required a transfusion over a decade ago. Laboratory testing is remarkable for slightly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level. He has a reactive HCV antibody and positive HCV RNA test. He is started on sofosbuvir-ledipasvir for chronic HCV infection.
Introduction
  • Note that none of these medications are used as monotherapy
Hepatitis C Drugs
Medications
Comments
Ledipasvir
  • Mechanism of action
    • hepatitis C virus (HCV) NS5A protein inhibitor
      • NS5A is an HCV viral phosphoprotein that is necessary for viral replication
  • Clinical use
    • HCV chronic infection
  • Adverse effects
    • headache
    • weakness
    • fatigue
Ribavirin
  • Mechanism of action
    • inosine monophosphate dehydrogenase competitive inhibitor
      • impairs viral DNA and RNA replication
  • Clinical use
    • HCV chronic infection
  • Adverse effects
    • hemolytic anemia
    • severe teratogen
Simeprevir
  • Mechanism of action
    • HCV protease (NS3/4A) inhibitor
      • NS3/4A is also essential for viral replication
      • this is a specifically targeted antiviral therapy for HCV
  • Clinical use
    • HCV chronic infection
  • Adverse effects
    • photosensitivity reactions
    • rash
Sofosbuvir
  • Mechanism of action
    • inhibits HCV RNA-dependent RNA polymerase (NS5B), which is also essential for viral replication
  • Clinical use
    • HCV chronic infection
  • Adverse effects
    • headache
    • fatigue
    • nausea
 
 

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