Guidelines for Taking Epclusa

One of the Big issues for anyone doing Hep C treatment is the word “relapse”. Relapse is when the Hep C treatment is completed but the treatment is not successful. Across all genotypes and situations, the cure rate for a 12-week treatment with Epclusa is about 95%. However, some things may significantly reduce the chance of a successful treatment. For this reason I have written these simple guidelines for taking Epclusa.

Some Tips For Taking Epclusa

Whilst Epclusa (Sofosbuvir + Velpatasvir) is the most effective Hep C treatment across all genotypes and conditions, about 1 in 40 people treated with Sofosbuvir 400 mg + Velpatasvir 90 mg (Epclusa) will relapse.

There are a number of reasons why a person doing a 12-week treatment with Epclusa may fail their treatment. In this post, I would like to share some insights into Hep C treatment using Epclusa and give some tips that might help make that small difference hat might prevent you from relapsing.

Cirrhosis

If you have liver cirrhosis or a high level of liver fibrosis then your chances of treatment failure are higher by around 3% (failure rates are higher if treated with Mavyret if a person had cirrhosis). Even though Epclusa is the most effective treatment for people with liver cirrhosis.

So if you have cirrhosis (F4) or F3 you should consider doing more than a 12 weeks treatment. This will improve your chance of a cure.

Previous treatment.

If you have failed a previous treatment, either with a DAA or with Interferon your chance of a cure is lower than someone who is treatment naïve. So if you have failed a previous treatment you should consider doing a longer treatment time.

What is EPCLUSA?

The first thing to understand when taking Epclusa is that Epclusa is two chemicals in one pill. Sofosbuvir 400 mg + Velpatasvir 100 mg.

 Velpatasvir is not a water-soluble chemical. That is to say, it does not dissolve easily in water.

Sofosbuvir is soluble, Velpatasvir is not.

Velpatasvir relies heavily on your stomach acids to dissolve it and make it easier for the body to absorb.

No Antacids

This is why you must never take antacids, or other things that will reduce stomach acidity, when you are taking Epclusa.

On the instructions that come with the bottle of pills, it says that Epclusa can be taken with or without food.

Take Epclusa with Food

However, it is better to take your pill with a small amount of food.

Why?

Because having a small amount of food in the stomach will stimulate the stomach acids and assist in the absorption process.

Not a large amount of food, not a huge meal, because some of the Epclusa is going to get caught up in the mass of food.

Also, I would not suggest drinking a large amount of water when taking your pill or in the hour or so after. We don’t want the pill washed out of the stomach or diluted.
Most drugs are absorbed in the stomach, so we want the Epclusa to be in the stomach as long as possible.

We want that Velpatasvir to hang around in some nice strong stomach acid for a while, not get washed away in a flood of H20.

So, in summary:

Take your pill at about the same time each day.

Take it with a small amount of food.

Don’t drink too much water immediately after taking your pill.

No antacids and it’s probably a good idea not to take magnesium supplements during treatment.

No Herbal Supplements

You should also suspend any herbal supplements that you are taking while you are doing your treatment with Epclusa.

The reason for this is that some herbal supplements will stimulate your liver to make high levels of certain enzymes that speed up the rate that the Epclusa is removed from your blood.

Herbs like St John’s Wort are well known to do this, but it is likely that many other herbs have a similar effect. So, to be on the safe side no herbal supplements during treatment.

High levels of caffeine and Taurine can also cause your liver to make enzymes that will speed up the removal of Epclusa from your blood.
Coffee should be kept to one or two cups a day. Energy drinks like Red Bull and such use quite a bit of Taurine and should not be taken during treatment.

Taking other medications with Epclusa

There may be some medications that you are taking for other medical conditions that may react with Epclusa. There are several websites that you can consult for information on this subject. Or you can consult with your doctor. You should check this before starting treatment.

Epclusa and Insomnia

Another thing to consider when doing treatment with Epclusa is that Sofosbuvir can cause insomnia in some people. For this reason, some people take their Epclusa in the morning, so by the evening, by bedtime, its effect is minimal.

Take your Epclusa regularly.

It’s important to take your Epclusa around the same time every day. It’s very important not to miss a day. To be effective the levels of Epclusa need to be reasonably constant in your blood. So, it is a good idea to get a seven-day pill box. This is a small plastic box with a compartment for each day of the week. If you lay out your pills for the week in the pill box you will not miss a day or accidentally double dose.

Good luck 😊