Tab%252525252525252525252525252525252525252525252525252525252520voihep

## Overview Tabvoihep is a combination product containing sofosbuvir and velpatasvir, used for the treatment of chronic hepatitis C virus (HCV) infection. Sofosbuvir is a nucleotide analog inhibitor of the HCV NS5B polymerase. Velpatasvir is an inhibitor of the HCV NS5A protein. ## Primary Indications Treatment of chronic hepatitis C virus (HCV) infection: * Genotype 1, 2, 3, 4, 5, or 6 without cirrhosis or with compensated cirrhosis. * Genotype 1, 2, 3, 4, 5, or 6 with decompensated cirrhosis (in combination with ribavirin). ## Adult Dosing One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) orally once daily. * Treatment duration is typically 12 weeks for patients without cirrhosis or with compensated cirrhosis. * Treatment duration is 12 weeks in combination with ribavirin for patients with decompensated cirrhosis. Consult specific guidelines or product information for ribavirin dosing. ## Pediatric Dosing Not established. ## Dose Adjustments No dose adjustment is necessary for patients with mild, moderate, or severe renal impairment (eGFR < 30 mL/min/1.73 m²). However, data is limited in this population, and caution is advised. No dose adjustment is necessary for patients with mild or moderate hepatic impairment (Child-Pugh A or B). In patients with severe hepatic impairment (Child-Pugh C), sofosbuvir/velpatasvir is not recommended without ribavirin. If used with ribavirin in severe hepatic impairment, dose adjustment of ribavirin may be necessary based on local protocol. ## Contraindications * Concomitant use with strong P-glycoprotein (P-gp) inducers such as rifampin, St. John's wort, and carbamazepine, as they may significantly decrease sofosbuvir and velpatasvir plasma concentrations. ## Adverse Effects The most common adverse effects include headache and fatigue. Less common but serious adverse effects may include: * Hepatitis B virus (HBV) reactivation in patients coinfected with HBV. * Bradycardia, especially when used with amiodarone or other drugs that cause bradycardia. * Rash. ## Key Drug Interactions * **Amiodarone:** Increased risk of severe symptomatic bradycardia. * **Strong P-gp inducers (e.g., Rifampin, St. John's Wort, Carbamazepine):** Significant decrease in sofosbuvir and velpatasvir concentrations. Avoid concomitant use. * **Antacids (Aluminum/Magnesium Hydroxide):** May decrease velpatasvir exposure. Separate administration by at least 4 hours. * **Certain Antiretrovirals (e.g., Tenofovir Disoproxil Fumarate):** Increased tenofovir exposure. Monitor renal function. * **Other direct-acting antivirals (DAAs):** Potential for drug-drug interactions. Consult specific product information. ## Monitoring * HCV RNA levels to assess treatment response. * Liver function tests. * Hepatitis B serological markers in patients coinfected with HBV. * Heart rate and rhythm in patients taking amiodarone or other medications known to cause bradycardia. * Renal function if co-administered with certain antiretrovirals. ## Clinical Pearls * Always test for HBV infection before initiating therapy. * Consider treatment duration based on HCV genotype, prior treatment history, and presence/severity of cirrhosis. * Ensure patients are not taking St. John's wort or other strong P-gp inducers. * Counsel patients on the potential for HBV reactivation and the importance of follow-up. **Disclaimer:** This information is intended for clinical pharmacist use. Always refer to the most current prescribing information and institutional protocols for definitive guidance.