Tab%2525252525252525252525252525252525252525252525252520voihep

# **Glecaprevir/Pibrentasvir (Mavyret)** ## Overview Glecaprevir/pibrentasvir is a combination, pan-genotypic, direct-acting antiviral (DAA) agent used for the treatment of chronic hepatitis C virus (HCV) infection. Glecaprevir is an NS3/4A protease inhibitor, and pibrentasvir is an NS5A inhibitor. ## Primary Indications * Treatment of chronic hepatitis C virus (HCV) infection without cirrhosis or with Child-Pugh A cirrhosis in patients 12 years of age and older or weighing at least 45 kg, across all HCV genotypes (1-6). ## Adult Dosing * **300 mg glecaprevir / 120 mg pibrentasvir orally once daily.** * Take with food. * Duration of therapy depends on prior treatment history and presence of cirrhosis: * **No cirrhosis:** 8 weeks. * **With cirrhosis (Child-Pugh A):** 12 weeks. * **Previously treated with HCV but failed treatment:** 16 weeks. ## Pediatric Dosing * **12 years of age and older OR weighing at least 45 kg:** * **300 mg glecaprevir / 120 mg pibrentasvir orally once daily.** * Take with food. * Duration of therapy as per adult recommendations. ## Dose Adjustments * **Hepatic Impairment:** * **Moderate hepatic impairment (Child-Pugh B):** Contraindicated. * **Severe hepatic impairment (Child-Pugh C):** Contraindicated. * **Renal Impairment:** No dose adjustment is required for any degree of renal impairment, including patients on dialysis. ## Contraindications * Moderate to severe hepatic impairment (Child-Pugh B or C). * Concomitant use with atazanavir or rifampin. ## Adverse Effects * Most common adverse effects (>10%): Headache, fatigue, nausea, diarrhea. * Serious adverse effects are rare but can include hepatotoxicity (especially in patients with underlying liver disease), and hypersensitivity reactions. ## Key Drug Interactions * **Strong CYP3A inhibitors:** Avoid concomitant use with atazanavir, as this can significantly increase glecaprevir/pibrentasvir plasma concentrations. * **Strong CYP3A inducers:** Avoid concomitant use with rifampin, as this can significantly decrease glecaprevir/pibrentasvir plasma concentrations. * **CYP1A2 substrates:** Glecaprevir is a weak inhibitor of CYP1A2. Caution may be warranted with narrow therapeutic index CYP1A2 substrates (e.g., theophylline). * **OATP1B1/1B3 inhibitors:** Due to potential for increased exposure to glecaprevir. * **Hormonal contraceptives:** Pibrentasvir can decrease the efficacy of hormonal contraceptives. Advise patients to use alternative or concomitant non-hormonal methods of contraception. ## Monitoring * Baseline assessment of liver function and viral load. * Monitor for signs and symptoms of hepatotoxicity and hypersensitivity reactions. * HCV RNA should be checked at the end of treatment or post-treatment to confirm sustained virologic response (SVR). ## Clinical Pearls * This regimen is pan-genotypic and can be used for any HCV genotype (1-6). * It is one of the shortest treatment durations available for HCV, with options for 8, 12, or 16 weeks. * Always take with food to ensure adequate absorption. * Be aware of potential drug interactions, particularly with CYP3A inhibitors/inducers and hormonal contraceptives. *** *This information is intended for healthcare professionals and does not replace a thorough review of the most current prescribing information, including the full prescribing information and boxed warnings, and consultation with other healthcare professionals.*