Traditional dosage: One tablet daily containing 50 mg elbasvir and 100 mg grazoprevir. For treatment of chronic HCV genotype 1 or 4 infection in adults, use with or without ribavirin. (Zepatier combines a NS5A inhibitor, and a NS3/4A protease inhibitor.)
Drug interactions, precautions, & recommendations: Do not take with anticonvulsants (Phenytoin, Carbamazepine), antimycobacterials (Rifampin), immunosuppressants (Cyclosporine), St. John’s Wort, Efavirenz, atazanavir, darunavir, lopinavir, saquinavir, or tipranavir. Co-administration is not recommended with CYP3A inhibitors, ketoconazole, bosentan, tacrolimus, etravirine (Intelence), modafinil, and cobicistat containing drugs (Stribild, Genvoya). May increase concentrations of statins; use caution with atorvastatin, rosuvastatin, fluvastatin, lovastatin, simvastatin. You should be tested for current or prior hepatitis B infection before initiating Zepatier. HCV/HBV coinfected individuals should be monitored for HBV reactivation and hepatitis flare-up during and after treatment. Hepatic lab testing should occur prior to therapy, at treatment week 8, and as clinically indicated. Those receiving 16 week therapy, should receive additional hepatic lab testing at week 12. If ALT levels elevate, follow doctor recommendations. If administered with ribavirin, the warnings and precautions for ribavirin (Copegus, Rebetol) also apply.
The Federal Drug Administration issued the following label warning added for all hepatitis C (HCV) direct-acting antivirals (DAAs): Risk of hepatitis B virus (HBV) reactivation in patients connected with HCV and HBV has been reported, in some cases resulting in fulminant hepatitis, hepatic failure, and death.
Side effects: Most serious: elevation of liver enzymes, hepatitis B reactivation Other: fatigue, headache, nausea, anemia