Vosevi is a once-daily tablet used to treat chronic hepatitis C virus (HCV) infection. It combines three direct-acting antiviral medicines:

• Sofosbuvir: a NS5B polymerase inhibitor that stops the virus from copying its genetic material
• Velpatasvir: a NS5A inhibitor that blocks a protein essential for viral replication
• Voxilaprevir: a NS3/4A protease inhibitor that blocks viral protein processing

The three-drug combination blocks three different stages of the hepatitis C virus replication cycle simultaneously, making Vosevi effective across all hepatitis C genotypes (pan-genotypic). It is particularly used for:

• Adults who have previously received an NS5A inhibitor-containing regimen and whose hepatitis C was not cured
• Patients with genotype 1a or 3 hepatitis C who have been previously treated with certain antivirals
• Pan-genotypic treatment in specific circumstances

Take one tablet once daily with food. Food significantly improves absorption, particularly of voxilaprevir.

Take at the same time each day. Treatment duration is typically 12 weeks. Complete the full course even if you feel well.

If you remember within 18 hours of your usual dose time, take it with food immediately. If more than 18 hours have passed, skip that dose and take the next one as usual. Never take two doses at once.

Contact your doctor or a poison control centre.

• Store below 30°C
• Keep in the original packaging
• Keep out of reach of children

Vosevi is generally well tolerated for a 12-week course.

Common side effects:

• Headache
• Fatigue
• Nausea
• Diarrhoea

Important monitoring:

• If you also have hepatitis B, stopping treatment can trigger a serious hepatitis B flare. Screening for hepatitis B is required before starting
• If combined with amiodarone (a heart medicine), serious slowing of the heart rate can occur

Liver function and viral load tests are done during and after treatment.

Vosevi has several important interactions:

• Rifampicin, carbamazepine, phenytoin, St John's Wort: significantly reduce drug levels. Avoid
• Atazanavir: increases voxilaprevir exposure. Avoid
• Cyclosporine: significant interaction. Avoid
• Rosuvastatin, atorvastatin, fluvastatin: Vosevi increases statin levels. Dose reductions or avoidance of certain statins may be needed
• Amiodarone: risk of serious heart slowing. Avoid or use with very close monitoring

Have a full interaction check done by your pharmacist before starting Vosevi.

Why is Vosevi used when other hepatitis C treatments have failed?

Vosevi contains three drugs from three different mechanistic classes. When a patient has already taken an NS5A inhibitor-containing regimen (such as Harvoni or Epclusa) without achieving a cure, there is often residual resistance to the NS5A class. Vosevi adds a protease inhibitor (voxilaprevir) to the NS5A inhibitor (velpatasvir) and NS5B inhibitor (sofosbuvir), covering multiple resistance pathways simultaneously and restoring the ability to cure the infection in most patients.

How do I know if my hepatitis C is cured after Vosevi?

Your doctor will check your hepatitis C viral load 12 weeks after completing the treatment course. If no virus is detectable at that point, you have achieved a sustained virological response (SVR), which is considered a cure. For the vast majority of patients who achieve SVR12, the virus does not return. However, you can still be re-infected with hepatitis C in the future if exposed again.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.