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# **Sofosbuvir/Velpatasvir (Epclusa)** ## Overview Sofosbuvir/velpatasvir is a fixed-dose combination antiviral medication used for the treatment of chronic hepatitis C virus (HCV) infection. It targets multiple stages of the HCV replication cycle. ## Primary Indications Treatment of chronic genotype 1, 2, 3, 4, 5, or 6 HCV infection in adults. ## Adult Dosing **Recommended dose:** One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) orally once daily. **Duration of therapy:** 12 weeks. For patients with decompensated cirrhosis, duration is 24 weeks. ## Pediatric Dosing Not recommended for pediatric patients. Safety and efficacy have not been established. ## Dose Adjustments No dose adjustment is required for patients with mild, moderate, or severe renal impairment. Use with caution in severe renal impairment or end-stage renal disease due to lack of data. No dose adjustment is required for patients with mild or moderate hepatic impairment. Use with caution in patients with severe hepatic impairment. ## Contraindications * Hypersensitivity to sofosbuvir, velpatasvir, or any component of the formulation. * Concomitant use with strong P-glycoprotein (P-gp) inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort). ## Adverse Effects Most common adverse effects include headache and fatigue. Nausea may also occur. ## Key Drug Interactions * **Rifampin, carbamazepine, phenytoin, St. John's wort:** Potent P-gp inducers that significantly decrease sofosbuvir and velpatasvir concentrations, leading to loss of efficacy. Avoid concomitant use. * **Antacids:** May decrease velpatasvir concentration. Separate administration by at least 4 hours. * **Antiretroviral agents (e.g., efavirenz, ritonavir-boosted protease inhibitors):** May decrease velpatasvir concentration. Clinical significance may vary; monitor for virologic response. ## Monitoring * HCV RNA levels to assess treatment efficacy. * Liver function tests periodically. * Renal function, especially in patients with pre-existing renal impairment. ## Clinical Pearls * Sofosbuvir/velpatasvir can be taken with or without food. * Ensure patients are tested for HCV genotype prior to initiation. * Testing for baseline HCV RNA is recommended. * Treatment duration may be extended to 24 weeks for patients with decompensated cirrhosis. *** *Disclaimer: This information is intended for healthcare professionals and should not replace professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*