Hepatitis C Direct-Acting Antivirals (Sofosbuvir-velpatasvir, Glecaprevir-pibrentasvir)
Modern oral medications that CURE hepatitis C in over 95% of patients with 8-12 weeks of treatment. Side effects are minimal — a revolutionary advance.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
Drug class
Direct-acting antivirals (DAAs) for hepatitis C
Examples
Sofosbuvir-velpatasvir (Epclusa) — pangenotypic, 12 weeks. Glecaprevir-pibrentasvir (Maviret) — pangenotypic, 8 weeks for most. Sofosbuvir-velpatasvir-voxilaprevir (Vosevi) — for prior treatment failures. Older: sofosbuvir-ledipasvir (Harvoni) — genotype 1 only.
How it works
DAAs target specific hepatitis C virus enzymes essential for viral replication. They directly stop the virus from making copies of itself. Modern combinations have 2-3 drugs targeting different parts of the virus, achieving cure rates of 95-99%. The era of interferon injections is over.
What it treats
- Chronic hepatitis C (all genotypes)
- Acute hepatitis C in some cases
- Treatment of HCV in cirrhosis (compensated and selected decompensated)
- Reinfection after prior cure (yes, you can be reinfected)
How to take it
Sofosbuvir-velpatasvir (Epclusa): 1 tablet daily for 12 weeks.
Glecaprevir-pibrentasvir (Maviret): 3 tablets together, once daily, with food, for 8 weeks (most patients) or 12-16 weeks in cirrhosis.
Very important: take EVERY dose without missing. Skipping doses can cause resistance.
Common side effects
- Headache (mild, transient)
- Fatigue
- Nausea
- Diarrhea
- Most patients tolerate treatment very well
Serious side effects — call your doctor
New jaundice or worsening of cirrhosis symptoms
Rare hepatic decompensation — stop and contact your doctor.
Severe rash, mouth ulcers, fever
Possible serious allergic reaction.
Interactions
IMPORTANT — many drug interactions. Common problematic combinations: amiodarone (cardiac arrest with sofosbuvir), strong CYP3A4 inducers (rifampin, carbamazepine, phenytoin, St. John's Wort), some statins, some antiretrovirals. ALWAYS review your full medication list with your doctor before starting.
Monitoring
Before starting: HCV RNA, genotype (newer drugs are pangenotypic), liver function, hepatitis B (must screen for occult HBV — risk of HBV reactivation), kidney function, drug interactions.
During treatment: typically no monitoring beyond clinical check-in.
After: HCV RNA at 12 weeks post-treatment to confirm cure (sustained virologic response = SVR).
When and how to stop
Don't stop early — even if feeling well or no detectable virus. Complete the full course. Stopping early causes treatment failure and resistance.
Pregnancy & breastfeeding
NOT recommended in pregnancy — limited safety data. Effective contraception during treatment and for some time after (varies by drug). If you become pregnant on treatment, contact your doctor.
In the Saudi context
Saudi MOH provides free DAA treatment for diagnosed hepatitis C patients through specialized clinics. Many private centers also treat. Saudi Arabia is on track for WHO global hepatitis C elimination by 2030.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- How long will my treatment be?
- What's my chance of cure?
- Will my insurance cover this?
- Can I get reinfected after cure?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026