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# Tab "voihep" (Sofosbuvir/Velpatasvir)
## Overview
Sofosbuvir/velpatasvir is a fixed-dose combination antiviral medication used to treat chronic hepatitis C virus (HCV) infection. It is a direct-acting antiviral (DAA) that targets different stages of the HCV replication cycle.
## Primary Indications
* Chronic Hepatitis C virus (HCV) genotypes 1, 2, 3, 4, 5, and 6.
* Used in combination with other agents for treatment-naive and treatment-experienced patients, including those with cirrhosis.
## Adult Dosing
* **Recommended Dose:** One tablet (400 mg sofosbuvir/100 mg velpatasvir) orally once daily.
* **Duration of Therapy:** Varies based on HCV genotype, prior treatment history, and presence of cirrhosis. Common durations are 8, 12, or 24 weeks. Specific duration should be determined by local protocol or treatment guidelines.
* **Maximum Dose:** Not applicable for the fixed-dose tablet.
## Pediatric Dosing
* Approved for children aged 6 years and older, and weighing at least 17 kg. Dosing is weight-based and depends on the HCV genotype. Consult specific pediatric guidelines for exact dosing.
## Dose Adjustments
* No dose adjustment is required for sofosbuvir/velpatasvir based on renal or hepatic impairment. However, caution is advised in severe renal impairment (CrCl < 30 mL/min) or decompensated cirrhosis when used with ribavirin or other agents.
## Contraindications
* Concomitant use with strong P-glycoprotein (P-gp) inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort).
## Adverse Effects
Common adverse effects include headache and fatigue. Less common but serious adverse effects are rare.
## Key Drug Interactions
* **Potent P-gp inducers:** Concurrent use significantly reduces sofosbuvir and velpatasvir concentrations, leading to loss of efficacy. Avoid.
* **Antacids:** Separate administration by at least 4 hours.
* **Rifampin, Carbamazepine, Phenytoin, St. John's Wort:** Avoid due to decreased drug concentrations.
* **Efavirenz:** May decrease velpatasvir concentrations. Monitor for virologic response.
* **Rosuvastatin:** Increased rosuvastatin concentrations. Limit rosuvastatin dose to 5 mg daily.
* **Other DAAs:** Interactions can occur; consult specific combination guidelines.
## Monitoring
* Baseline HCV genotype testing.
* Liver function tests.
* Viral load (HCV RNA) to assess treatment response.
* Renal function.
* Monitor for potential adverse effects.
## Clinical Pearls
* Sofosbuvir/velpatasvir is a pan-genotypic regimen for HCV genotypes 1-6.
* It can be used in patients with and without cirrhosis.
* Always administer with or without food.
* Ensure adequate contraception when used with ribavirin due to teratogenicity.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and guidelines for complete details before making any treatment decisions.*
