Tab%2520voihep

# Voihep (Sofosbuvir/Velpatasvir) ## Overview Voihep is a fixed-dose combination of sofosbuvir (a nucleotide analog NS5B polymerase inhibitor) and velpatasvir (an NS5A inhibitor). It is a pangenotypic direct-acting antiviral (DAA) used for the treatment of chronic hepatitis C virus (HCV) infection. ## Primary Indications Treatment of chronic HCV genotype 1, 2, 3, 4, 5, or 6 infection in adults and pediatric patients ≥3 years of age. May be used in patients with or without compensated cirrhosis; for patients with decompensated cirrhosis, it is used in combination with ribavirin. ## Adult Dosing Standard dose: 400 mg sofosbuvir/100 mg velpatasvir orally once daily for 12 weeks. Decompensated cirrhosis: 400 mg/100 mg orally once daily for 12 weeks **in combination with weight-based ribavirin**. ## Pediatric Dosing Patients ≥3 years of age: Dosing is based on body weight. * <17 kg: 150 mg/37.5 mg once daily. * 17 kg to <30 kg: 200 mg/50 mg once daily. * ≥30 kg: 400 mg/100 mg (adult tablet) once daily. Total treatment duration: 12 weeks. ## Dose Adjustments * Renal Impairment: No dosage adjustment required for mild, moderate, or severe renal impairment (eGFR <30 mL/min/1.73m²) or patients on hemodialysis. * Hepatic Impairment: No adjustment for Child-Pugh A, B, or C. In Child-Pugh B or C, administer with ribavirin. ## Contraindications * Hypersensitivity to the active ingredients. * When co-administered with ribavirin, the contraindications to ribavirin (e.g., pregnancy, severe renal impairment, hemoglobinopathies) also apply. ## Adverse Effects Common: Headache, fatigue, nausea. Serious: Symptomatic bradycardia when initiated with amiodarone; potential for hepatitis B virus (HBV) reactivation in HBV/HCV co-infected patients. ## Key Drug Interactions * **Acid-Reducing Agents:** PPIs should be limited or avoided. If necessary, limit to 20 mg omeprazole (or equivalent) taken 4 hours before Voihep. H2RAs: Take simultaneously or 12 hours apart from Voihep. Antacids: Take 4 hours apart. * **P-gp/CYP Inducers:** Rifampin, St. John’s Wort, and anticonvulsants (carbamazepine, phenytoin) are contraindicated as they decrease drug concentrations. * **Amiodarone:** Concomitant use is discouraged due to risks of severe, symptomatic bradycardia. ## Monitoring * Baseline: HCV RNA, HBsAg, anti-HBc, renal function, and liver function tests (LFTs). * During Therapy: Monitor for signs of hepatic decompensation or HBV reactivation (if HBsAg+). * Post-Treatment: Sustained Virologic Response (SVR) at 12 weeks post-treatment (HCV RNA). ## Clinical Pearls * Administer consistently with or without food. * Assess for bradycardia if amiodarone must be initiated during Voihep therapy; cardiac monitoring is required. * Confirm HBV status prior to initiation, as DAAs carry a black box warning for HBV reactivation. *** *Disclaimer: This information is for educational purposes only. Clinical protocols may vary by institution. Always consult the latest FDA-approved prescribing information and local infectious disease guidelines before prescribing or administering medication.*