What's the dose of medication for Hepatitis C treatment?

Hepatitis C Treatment Dosing Guidelines

The appropriate dose for Hepatitis C treatment depends on the specific medication regimen selected, with several FDA-approved options available in fixed-dose combinations that are taken once daily. 1

Available Medications and Dosing

Direct-Acting Antivirals (DAAs) - First-Line Options

Medication	Dose	Administration
Sofosbuvir	400 mg	One tablet once daily (morning) [1]
Sofosbuvir/ledipasvir	400 mg/90 mg	One tablet once daily (morning) [1]
Paritaprevir/ombitasvir/ritonavir	75 mg/12.5 mg/50 mg	Two tablets once daily (morning) [1]
Dasabuvir	250 mg	One tablet twice daily (morning and evening) [1]
Simeprevir	150 mg	One capsule once daily (morning) [1]
Daclatasvir	30 or 60 mg	One tablet once daily (morning) [1]
Glecaprevir/pibrentasvir	Fixed-dose	Preferred for severe renal impairment [1]
Grazoprevir/elbasvir	Fixed-dose	For genotype 1b with severe renal impairment [1]

Older Regimens (Less Commonly Used)

• PegIFN-α2a: 180 μg subcutaneous injection once weekly 1
• PegIFN-α2b: 1.5 μg/kg subcutaneous injection once weekly 1
• Ribavirin: Weight-based dosing
  • <75 kg: 1000 mg daily (2 capsules morning, 3 evening)
  • ≥75 kg: 1200 mg daily (3 capsules morning, 3 evening) 1

Treatment Selection Algorithm

1. Determine HCV genotype and subtype - This is essential for selecting the appropriate regimen
2. Assess liver fibrosis/cirrhosis status - Patients with decompensated cirrhosis need specific regimens
3. Evaluate renal function - eGFR impacts medication choice
4. Check for drug interactions - Especially important with HIV medications, immunosuppressants
5. Consider prior treatment history - Treatment-experienced patients may need longer duration

Special Population Considerations

Renal Impairment

• Mild to moderate impairment (eGFR >30 ml/min/1.73 m²): No dose adjustment needed for most DAAs 1
• Severe impairment (eGFR <30 ml/min/1.73 m²):
  • Preferred: Glecaprevir/pibrentasvir or grazoprevir/elbasvir (for genotype 1b) 1
  • Sofosbuvir should be used with caution due to increased exposure of metabolite GS-331007 1

Decompensated Cirrhosis

• With mild-moderate renal impairment: Sofosbuvir/velpatasvir with ribavirin for 12 weeks 1
• With severe renal impairment: Sofosbuvir/velpatasvir without ribavirin for 24 weeks 1

HIV Coinfection

• Same regimens as HCV monoinfection but must consider drug interactions 1
• Ledipasvir/sofosbuvir may increase tenofovir levels, requiring careful monitoring 1

Common Pitfalls and Caveats

1. Drug interactions: Many HCV medications interact with common drugs. For example:

   • P-gp inducers (rifampin, carbamazepine, St. John's wort) significantly decrease sofosbuvir plasma concentrations 2
   • Ritonavir in HCV regimens can boost HIV protease inhibitors 1

2. Renal function monitoring: Required for sofosbuvir-based regimens in patients with impaired renal function

3. Ribavirin contraindications:

   • Pregnancy (Category X) - strict birth control required during and 6 months after treatment
   • Hemoglobin <10 g/dL
   • Severe renal impairment without close monitoring

4. Treatment prioritization: While all patients with HCV should be considered for treatment, priority should be given to those with:

   • Significant fibrosis or cirrhosis (METAVIR F3-F4)
   • Decompensated cirrhosis
   • HIV or HBV coinfection
   • Pre/post-liver transplant
   • Significant extrahepatic manifestations 1

By following these evidence-based dosing guidelines and considering patient-specific factors, treatment of hepatitis C can achieve sustained virologic response rates exceeding 90% with modern DAA regimens.