Full List of HCV/Hepatitis C Drugs

Treating Hepatitis C Virus Infection

Hepatitis C virus (HCV) infection is a disease that causes liver inflammation. The hepatitis C virus is extremely contagious. While some cases of hepatitis C virus infection are acute (short-term), most patients have long-lasting (chronic) cases. The Centers for Disease Control and Prevention (CDC) estimates that up to 85 percent of people infected with HCV develop chronic disease. If you have HCV infection, genetic testing will help your doctor find the right treatment because the treatments are very specific.
In the last year or two new treatments for HCV infection have become available. These treatments have been much more successful at treating the disease. Additionally, many treatments are currently in development. Some treatments can cure HCV infection, so it’s important to work closely with your doctor to select the best treatment.

Medications to treat HCV infection are essential for:

• preventing liver disease (cirrhosis)
• relieving symptoms
• decreasing the risk for liver cancer
• preventing liver failure

It’s important to note that not all people with HCV infection experience symptoms. Sometimes it takes many years for symptoms occur. If a test reveals HCV infection, it’s important to start medication as soon as possible. Your doctor will prescribe more than one medication for treatment.

Interferons

Interferons are proteins that are usually present in the body. They help fight infections. Interferon medications help the immune system fight off the HCV to prevent complications. These include:

• peginterferon alfa-2a (Pegasys)
• peginterferon alfa-2b (PegIntron, Sylatron)
• interferon alfa-2b (Intron A)

All of these drugs are injected. They are part of a combination treatment. Patients usually take these shots on a weekly basis. It’s also important to note that there are no generic versions of these medications available. The peginterferons consist of interferon combined with another compound that makes the drug last longer in the body. This combination also helps reduce side effects.

Here is a breakdown of dosage information:

• The recommended dose for peginterferon alfa-2a is 180-mcg shots per week. It may be given to people aged 5 years and older.
• The recommended peginterferon alfa-2b dosage for treatment of severe HCV is 3 mcg per week for 8 weeks and then 1.5 mcg per week for five years. These injections may be given to people aged 3 years and older.
• Interferon alfa-2b is given in shots of 3 million units, three times per week. These injections may be given to people aged 1 year and older. Interferon alfa-2b has more intense side effects, so it’s not often used.

All interferons have the same side effect risks, including:

• anxiety
• dry mouth
• excessive fatigue
• headache
• mood changes
• weight loss
• worsening hepatitis symptoms

Protease Inhibitor Antiviral Medications

Protease inhibitors are oral medications that work by preventing the spread of infection. They stop viruses from multiplying in the body. Protease inhibitors for HCV infection include:

• telaprevir (Incivek)
• boceprevir (Victrelis)
• paritaprevir (This is a protease inhibitor but it’s only available within the Viekira Pak, as part of a combination used to treat HCV infection.)

These medications are not taken alone. They’re only used in conjunction with other HCV infection therapies. Telaprevir is taken twice per day, while boceprevir is taken three times per day. Both medications should be taken with food.
The most common side effects are:

• anemia
• diarrhea
• fatigue
• headaches
• nausea
• vomiting

Nucleoside Analogue Antiviral Medications

Nucleoside analogue antiviral medications also prevent viruses from spreading. This class of drugs stops nucleosides from forming in infected cells. Ribavirin is the type of nucleoside analogue used to treat HCV infection.
Ribavirin is most commonly used with an interferon to treat HCV infection. In some cases, it may also be used as a triple therapy with an interferon and a protease inhibitor. Like interferons and protease inhibitors, ribavirin is not a stand-alone treatment for HCV infection.
Ribavirin is available in several dose forms and strengths. Various forms include capsules, tablets, and oral solution. All of these forms are not available in every brand. Brands names of ribavirin include:

• Copegus
• Moderiba
• Rebetol
• Ribasphere
• Ribasphere RibaPak
• Virazole

Ribavirin poses the risk of birth defects if taken while pregnant. This risk may transfer from a male to his female partner during conception. It can also cause stunted growth in pediatric patients. People with a history of heart disease should talk to their doctor about the risks of using ribavirin.

Polymerase Inhibitor and Combination Drug Treatments

Aside from ribavirin, there are newer types of nucleoside analogues available on the market. These include the polymerase inhibitor sovaldi (Sofosbuvir). Sovaldi works by inhibiting the RNA polymerase that the hepatitis C virus uses to replicate its RNA. This means it prevents the building blocks of the hepatitis C virus from coming together.

Sovaldi is available in a 400-mg oral tablet, taken once per day. Sovaldi is sometimes used in conjunction with ribavirin for up to 24 weeks. It also may be used to treat people with both hepatitis C virus infection and HIV infection.
The combination drug of ledipasvir and sofosbuvir (Harvoni) is used to treat chronic infection with HCV genotype 1 in adults. Ledipasvir is a NS5A inhibitor. It blocks the formation of a protein that helps the virus copy itself. Sofosbuvir is a polymerase inhibitor. It prevents the building blocks of the virus from coming together.
Harvoni is available as a film coated tablet in one strength: 90 mg of ledipasvir and 400 mg of sofosbuvir. The usual dose is one tablet, taken once per day, for 12-24 weeks, depending on whether or not cirrhosis is present.
Viekira Pak includes 28 tablets of the combination drug of ombitasvir (12.5 mg), paritaprevir (75 mg), and ritonavir (50 mg) and 28 tablets of dasabuvir (250 mg) in a single packet (56 tablets total). Ombitasvir is a NS5A inhibitor. It blocks the formation of a protein that helps the virus copy itself. Paritaprevir is a protease inhibitor, which helps stop the building of small pieces that make up the virus. Dasabuvir is a polymerase inhibitor. It prevents the building blocks of the virus from coming together. Ritonavir does not attack hepatitis. It helps increase the effectiveness of paritaprevir by making it last longer in your body.
The usual dose is two tablets of ombitasvir/paritaprevir/ritonavir every morning for 12 to 24 weeks, and one 250 mg tablet of dasabuvir twice a day for 12 to 24 weeks. Your doctor will decide the length of treatment.
These drugs should be taken with a meal and shouldn’t be crushed. 
The side effects of this drug combination include:

• nausea
• itching
• insomnia
• weakness

Alternative Medicine

Some people with HCV infection wish to explore the possibility of alternative medicine for treatment. This is in part due to a desire to not have side effects. According to the National Center for Complementary and Alternative Medicine (NCCAM), there are currently no supplements that have proven to effectively treat HCV infection. At the same time, some studies have been conducted on select herbs. You should not take an herbal treatment in place of your medication or without speaking to your doctor first. Herbs can be just as powerful as conventional drugs in causing interactions.

Licorice Root

Licorice root is indigenous to parts of Asia and the Middle East. Historically, the herb is used for infections, ulcers, and bronchitis. Licorice root is available in numerous forms, including:

• capsules
• dried powder
• liquid extracts
• tablets

According to the NCCAM, research has indicated that licorice root injections have shown promise as treatment for HCV infection. The problem is that these injectable forms are not available to people in the United States. Other forms of licorice root have not been as successful. Furthermore, the herb can cause side effects, such as high blood pressure and water retention.

Milk Thistle

Milk thistle comes from a Mediterranean plant. It’s sometimes used as a folk remedy for:

• cancer
• diabetes
• hepatitis
• high cholesterol
• liver disease

The herb primarily comes in the form of capsules and extracts. While it’s sometimes used for HCV infection in alternative medicine, the NCCAM says that milk thistle is not as effective as conventional drugs. Still, it may cause fewer side effects. Talk to your doctor before considering any treatment measure.