Harvoni

Harvoni is generally well tolerated, and very few people need to discontinue treatment due to side effects. The most commonly reported side effects are fatigue, headache, nausea, diarrhea, and insomnia, and are all considered to be mild in severity. Additional side effects observed in patients with decompensated cirrhosis or after liver transplant were thought to be due to their medical condition rather than the medication. Harvoni has not been studied in pregnant or nursing women, so its impact on fetal development or nursing babies is unknown. Pregnant women or women who are trying to become pregnant should avoid use if the addition of ribavirin is required (see ribavirin page). 

Before starting Harvoni, be sure to tell your medical provider or pharmacist about all of the medications, supplements, and herbal products you take, whether they are prescribed, over-the-counter, or illicit. It is also important to inform them of any changes to your medications as they happen during treatment. Harvoni should not be taken within 4 hours of antacids. If taking H2-receptor antagonists, take Harvoni at the same time or separate by 12 hours at a dose that does not exceed doses comparable to famotidine 40 mg twice per day. Use of proton pump inhibitors (PPI) is not recommended, but if medically necessary, Harvoni should be taken at the same time as a PPI comparable to omeprazole 20 mg or lower under fasted conditions (on an empty stomach). Harvoni should not be taken with the HIV medication tipranavir/ritonavir. Avoid use if taking tenofovir disoproxil fumarate (TDF) with an HIV protease inhibitor, ritonavir, or cobicistat due to possible increase in TDF concentrations resulting in adverse reactions, such as decreased renal function. It should not be taken with the rifamycin antimicrobials, such as rifabutin, rifampin, or rifapentine, nor should it be taken with the anticonvulsants carbamazepine, phenytoin, phenobarbital, or oxcarbazepine, as they reduce the concentrations of both components of Harvoni and may reduce its effectiveness. Do not take Harvoni with St. John’s wort; in general, herbal products should be avoided due to lack of information regarding potential for interaction. There are no interactions with methadone or other common medications used for opioid, alcohol, or nicotine dependency. Use with certain statins (cholesterol medicine) may cause increased risk of muscle pain (myopathy) or muscle breakdown (rhabdomyolysis). Your doctor should decide if your statin should be continued or changed during treatment with Harvoni. No sofosbuvir-based HCV regimens are to be used with amiodarone due to possible symptomatic bradycardia (slow heart rate). Signs of bradycardia include fainting, dizziness, lightheadedness, weakness, excessive fatigue, shortness of breath, chest pains, and confusion or memory problems. Consult a medical provider should any of these symptoms occur.

Harvoni was an exciting development for treating HCV in 2014 as it was the first one-pill, once-daily regimen with minimal side effects and high cure rates with treatment durations ranging from 8 to 24 weeks. Although there are now many treatment options available, Harvoni is still used.

Harvoni can be used in several special populations. It can safely be used in people with kidney disease, including those on dialysis, with no need for dosage adjustment. It is FDA approved for use in children ages 3 and older. It is also recommended to be used in people after they receive a liver or kidney transplant.

Go to hcvguidelines.org for additional information on clinical studies and treatment recommendations.

Black Box Warning

Before starting treatment with any direct-acting antiviral (DAA), including Epclusa, patients should take a blood test to check for hepatitis B (HBV) infection. HBV infection could worsen or reactivate during or after DAA treatment, potentially leading to serious liver problems, including liver failure or death. Patients with current or past HBV infection should be monitored during HCV DAA treatment, and some may need to take HBV treatment. See HBV Reactivation on page 27 for more information and consult your medical provider. (link to Black Box Warning)

Harvoni dosing