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Glecaprevir Pibrentasvir

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Glecaprevir Pibrentasvir, Glecaprevir/Pibrentasvir, Mavyret

  • 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. General
    1. Initial therapy for any Genotype in patients without Cirrhosis (or with Class A compensated Cirrhosis)
    2. Salvage therapy for failed initial protocol for up to 16 weeks
  3. Genotypes
    1. Hepatitis CGenotype 1a
    2. Hepatitis CGenotype 1b
    3. Hepatitis CGenotype 2
    4. Hepatitis CGenotype 3
    5. Hepatitis CGenotype 4
    6. Hepatitis CGenotype 5 or 6
  • Contraindications
  1. See Hepatitis C Antiviral Regimen
  2. Advanced Cirrhosis with Child Pugh Class B or C (or CTP score >=7)
  3. No restriction based on Renal Function
  • Mechanism
  1. Glecaprevir is a NS3/4A Protease Inhibitor (...previrs)
  2. Pibrentasvir (Mavyret) is a NS5A Protein Inhibitor (...asvirs)
  • Dosing
  1. Take three tablets once daily for 8 weeks
  • Evaluation
  1. See Hepatitis C Antiviral Regimen for Pre and post-treatment protocols
  • Adverse Effects
  1. See Hepatitis C Antiviral Regimen
  2. Common (>10%)
    1. Headache
    2. Fatigue
  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. Safe drugs
    1. No significant interactions with Opioid Addiction therapy (Methadone, Buprenorphine)
    2. Proton Pump Inhibitors are safe to use with Mavyret
    3. Amiodarone is safe to use with Mavyret
  3. Contraindicated drugs (or limited dosing)
    1. Atazanavir
    2. Carbamazepine
    3. Cyclosporine (at doses >100 mg/day)
    4. Dabigatran
    5. Darunavir
    6. Digoxin (reduce dose to 50%)
    7. Efavirenz
    8. Ethinyl Estradiol
      1. Avoid use with Ethinyl Estradiol containing contraceptives
    9. Herbals
      1. St Johns Wort
    10. Lopinavir
    11. Phenobarbital
    12. Phenytoin
    13. Rifampin
    14. Ritonavir
    15. Statins
      1. Atorvastatin
      2. Lovastatin
      3. Simvastatin
      4. Limit Rosuvastatin to 5 to 10 mg/day
      5. Lower Pravastatin dose 50%
      6. Limit Fluvastatin and Pitavastatin to lowest effective dose
  • Monitoring
  1. See Hepatitis C Antiviral Regimen
  • Efficacy
  1. Hepatitis C clearance rate of >95% against all Genotypes
  • Resources
  1. Mavyret (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7bf99777-0401-9095-8645-16c6e907fcc0
  • References
  1. (2023) Presc Lett, Hepatitis C Treatment Overview, Resource #390902