Pronunciation:

EL-bas-vir, graz-OH-pre-vir

Brand Names:

• Zepatier

Dosage Forms:

• Tablet

Warnings:

Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with elbasvir/grazoprevir. HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death. Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated .

Classifications:

Therapeutic—

Antiviral

Pharmacologic—

Hepatitis C Virus NS5A Inhibitor

Uses of This Medicine:

Elbasvir and grazoprevir combination is used with or without ribavirin to treat chronic hepatitis C infection.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of elbasvir and grazoprevir combination in children younger than 12 years of age weighing less than 30 kilograms (kg). Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of elbasvir and grazoprevir combination in the elderly. However, elderly patients are more likely to have liver problems, which may require caution in patients receiving this medicine.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Atazanavir
• Carbamazepine
• Cyclosporine
• Darunavir
• Efavirenz
• Eltrombopag
• Enzalutamide
• Fosphenytoin
• Lopinavir
• Mitotane
• Phenytoin
• Rifampin
• Ritonavir
• Saquinavir
• St John's Wort
• Tipranavir

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abametapir
• Alpelisib
• Asciminib
• Atorvastatin
• Bosentan
• Clarithromycin
• Cobicistat
• Conivaptan
• Darolutamide
• Drospirenone
• Elexacaftor
• Encorafenib
• Ethinyl Estradiol
• Etravirine
• Fedratinib
• Fexinidazole
• Fosnetupitant
• Fostemsavir
• Itraconazole
• Ketoconazole
• Leflunomide
• Leniolisib
• Mavacamten
• Midostaurin
• Modafinil
• Nafcillin
• Netupitant
• Nirmatrelvir
• Norethindrone
• Norgestimate
• Omaveloxolone
• Phenobarbital
• Primidone
• Rosuvastatin
• Tacrolimus
• Teriflunomide
• Trofinetide
• Warfarin

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Hepatitis B, history of—Use with caution. May cause this condition to become active again.

• Liver disease, moderate to severe—Should not be used in patients with this condition.

Proper Use of This Medicine:

To help clear up your infection completely, take Zepatier® together with or without ribavirin for the full time of treatment, even if you begin to feel better after a few days. Also, it is important to keep the amount of medicine in your body at a steady level. To help keep the amount constant, Zepatier® must be used on a regular schedule.

This medicine should come with a patient information leaflet. Read and follow the information carefully. Ask your doctor if you have any questions.

You may take this medicine with or without food.

Make sure you understand how to use all of the medicines your doctor prescribed.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For chronic hepatitis C infection (used together with or without ribavirin):
    • Adults and children 12 years of age and older or weighing 30 kilograms (kg) or more—One tablet once a day. Each tablet contains 50 milligrams (mg) of elbasvir and 100 mg of grazoprevir.
    • Children younger than 12 years of age weighing less than 30 kg—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep the tablets in the original container until you are ready to use it.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine together with ribavirin while you are pregnant can harm your unborn baby. Birth defects may occur if the father is using this medicine when his sexual partner becomes pregnant. If a pregnancy occurs while you are using this medicine, tell your doctor right away.

Do not use the following medicines while you are using Zepatier®: cyclosporine (Gengraf®, Neoral®, Sandimmune®), rifampin (Rifadin®, Rimactane®), St. John's wort, medicine to treat HIV infection (including atazanavir, darunavir, efavirenz, lopinavir, saquinavir, tipranavir, Invirase®, Kaletra®, Reyataz®, Sustiva®), or medicine to treat seizures (including carbamazepine, phenytoin, Dilantin®, Tegretol®).

Check with your doctor right away if you are weak or tired, have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Discouragement

feeling sad or empty

irritability

loss of appetite

loss of interest or pleasure

trouble concentrating

trouble sleeping

unusual tiredness

Incidence not known

Dark urine

fever with or without chills

large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

light-colored stools

nausea and vomiting

upper stomach pain

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Headache

Less common

Diarrhea

stomach pain

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.