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Elbasvir Grazoprevir

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Elbasvir Grazoprevir, Elbasvir/Grazoprevir, Zepatier

  • See Also
  1. Hepatitis C Antiviral Regimen
  2. Hepatitis C
  • Precautions
  1. See Hepatitis C Antiviral Regimen
  • Indications
  1. See Hepatitis C Antiviral Regimen
  2. Hepatitis C Genotype 1a (alternative agent)
  3. Hepatitis C Genotype 1b
  4. Hepatitis C Genotype 4
  5. Advantages
    1. Priced lower than other Genotype I regimens
    2. May be used despite GFR <30 ml/min
  • Contraindications
  1. See Hepatitis C Antiviral Regimen
  2. Child Pugh Class B or C (or CTP score >=7)
  • Mechanism
  1. Elbasvir is a NS5A Protein Inhibitor (...asvirs)
  2. Grazoprevir is a NS3/4A Protease Inhibitor (...previrs)
  • Dosing
  1. Take once daily for 12 weeks
  • Evaluation
  1. See Hepatitis C Antiviral Regimen for Pre and post-treatment protocols
  • Efficacy
  1. As effective as other agents used in Genotype 1 Hepatitis C infections
  • Adverse Effects
  1. See Hepatitis C Antiviral Regimen
  2. Common (>5%)
    1. Fatigue
    2. Headache
    3. Nausea
  3. Serious
    1. Liver injury or hepatic failure
      1. Do not use in Child Pugh Class B or C
  • Drug Interactions
  1. See Hepatitis C Antiviral Regimen
  2. Statins
    1. Atorvastatin (avoid dose >20 mg daily)
    2. Rosuvastatin (avoid dose >10 mg daily)
    3. Use lowest adequate dose of Fluvastatin, Lovastatin or Simvastatin
    4. Monitor for Statin-Induced Myopathy
  3. Avoid with strong and moderate CYP3A inducers
    1. Bosentan
    2. Carbamazepine
    3. Efavirenz
    4. Etravirine
    5. Modafinil
    6. Nafcillin
    7. Phenytoin
    8. Rifampin
    9. St. Johns Wort
  4. Avoid with strong CYP3A Inhibitors
    1. Cobicistat
    2. Ketoconazole
  5. Avoid with OATP1B1/3 Inhibitors
    1. Atazanavir
    2. Cyclosporine
    3. Darunavir
    4. Lopinavir
    5. Saquinavir
    6. Tipranavir
  • Monitoring
  1. See Hepatitis C Antiviral Regimen
  2. Recheck Liver Function Tests at 8 weeks
    1. If using a 16 week course, also recheck at 12 weeks
  • Resources
  1. Zepatier (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=164dc02a-9180-426a-b8b5-04ab39d2bbd4
  • References
  1. (2023) Presc Lett, Hepatitis C Treatment Overview, Resource #390902