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When taking Epclusa (sofosbuvir/velpatasvir) for hepatitis C treatment, it is important to be aware of certain risks and precautions to ensure safe usage. Below are key safety points to consider:

• Hepatitis B Reactivation: Patients with a history of hepatitis B should be cautious, as treatment with Epclusa can sometimes cause hepatitis B to worsen or reactivate. It is crucial to inform your healthcare provider if you have ever had hepatitis B. Monitoring for symptoms such as persistent nausea, loss of appetite, abdominal pain, dark urine, or yellowing of the skin and eyes is advised. Testing for hepatitis B before starting Epclusa is recommended.

• Heart Rate Concerns: There is a risk of slow heart rate and serious heart issues if Epclusa is used in conjunction with amiodarone, especially in individuals with existing heart or liver conditions or those on beta blockers. Notify your healthcare provider if you are taking amiodarone or have a history of heart disease. Seek immediate medical attention if you experience faintness, dizziness, weakness, or breathing difficulties when these medications are used together.

• Ribavirin Side Effects: Some patients may need to take ribavirin along with Epclusa, especially if they have certain liver conditions. Ribavirin has its own set of side effects, so discussing its use with your healthcare provider and pharmacist is essential before starting treatment.

• Medication Interactions: Epclusa can interact with various medications and herbal supplements, potentially reducing its effectiveness. Inform your healthcare provider and pharmacist about all medications and supplements you are currently taking, including those available over-the-counter, to avoid any adverse interactions.

Taking these precautions will help manage potential risks associated with Epclusa and enhance the safety and efficacy of your hepatitis C treatment. Always consult your healthcare provider for personalized advice and guidance.

Common side effects:

• tiredness
• headache
• nausea
• diarrhea
• difficulty sleeping

Less common but important to monitor:

• skin rash
• weakness

Serious side effects:

• severe allergic reactions

Interactions with high risk of serious adverse effects and should be avoided:

• Amiodarone
• Other products that contain sofosbuvir

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Apalutamide
• Efavirenz
• Rifamycins (such as rifampin, rifabutin)
• St. John's wort
• Tipranavir/ritonavir
• Seizure medications (such as phenobarbital, carbamazepine, phenytoin, primidone)

Interactions with low risk that usually do not require a change in therapy:

• Topotecan