A first-generation hepatitis C protease inhibitor
Boceprevir
An early hepatitis C medicine, used with peginterferon and ribavirin, now obsolete and replaced by modern treatments.
What is Boceprevir?
Boceprevir is a first-generation medicine for hepatitis C, a virus that infects the liver. It is a protease inhibitor (it blocks an enzyme the virus needs) and was used together with two older treatments, peginterferon and ribavirin. It is taken as a capsule by mouth. Its main problems are anaemia (a fall in red blood cells) and changes in taste, along with many drug interactions. It is now obsolete and has been completely replaced by modern direct-acting antivirals that are far more effective and much better tolerated.
Education and reference only. This is a plain-language guide to Boceprevir — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Boceprevir is an early, first-generation direct-acting antiviral for hepatitis C, working as a protease inhibitor that blocks an enzyme (NS3/4A) the virus needs to multiply. It was never used alone but added to the older 'backbone' treatment of peginterferon (an injection) and ribavirin (a tablet), as a long and demanding course. It is taken by mouth as a capsule. It is now considered obsolete: modern direct-acting antiviral combinations have completely replaced it, so it is no longer used in the UK. It was prescribed and supervised by a specialist.
How it works
Hepatitis C uses an enzyme called a protease (NS3/4A) to process its own proteins so it can copy itself. Boceprevir blocks this enzyme, slowing the virus down. On its own it was not enough, so it was added to peginterferon and ribavirin, which work in different ways to help the immune system fight the virus and stop it multiplying. Together this three-medicine course improved cure rates compared with the older two-medicine treatment, but it was long, hard to tolerate and is now far surpassed by modern treatments.
Company & origin
Originated / developed by: Specialist manufacturer.
An early hepatitis C medicine used with peginterferon and ribavirin, now obsolete in the UK and replaced by modern treatments.
Practical use
How to take Boceprevir
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It was taken by mouth as a capsule, with food, on a frequent daily schedule as prescribed.
- It had to be taken together with peginterferon and ribavirin, never on its own.
- Blood counts were checked regularly because of the risk of anaemia.
- A full list of all other medicines was needed, as it interacts with many of them.
- Today, modern direct-acting antivirals are used instead, so a specialist would prescribe one of those.
Weighing it up
Advantages & disadvantages of Boceprevir
Advantages
- Improved hepatitis C cure rates compared with the older peginterferon-and-ribavirin treatment alone.
- Was an all-important step forward when first introduced.
- Taken by mouth as a capsule.
Disadvantages
- Commonly caused anaemia (a fall in red blood cells) and changes in taste.
- Had to be used with peginterferon and ribavirin in a long, difficult course, with many drug interactions.
- Now obsolete and completely replaced by modern, far better-tolerated treatments.
Practical use
Good to know
The most important points about boceprevir are its side effects and its now-obsolete status. A characteristic problem is anaemia (a drop in red blood cells), which adds to the anaemia already caused by ribavirin and can cause marked tiredness and breathlessness, so blood counts were watched closely. Changes in the sense of taste (a metallic or unpleasant taste) were also very common. It interacts with many other medicines and had to be taken on a strict, frequent schedule with food. Because it was used with peginterferon and ribavirin, the overall course was long and difficult to tolerate. It has been completely replaced by modern direct-acting antivirals, which are simpler, shorter and far better tolerated, so it is no longer used.
Who should not take it / use with caution
- People who have had a serious allergic reaction to boceprevir should not take it.
- It could not be used by people who could not take peginterferon or ribavirin, since it was always combined with them.
- It should not be used now, as modern direct-acting antivirals have replaced it.
Monitoring
- Regular blood counts to watch for anaemia from boceprevir and ribavirin.
- Blood tests to check the hepatitis C response over the course.
- Reviewing other medicines for interactions and watching for side effects.
Side effects
- Anaemia (a fall in red blood cells), causing tiredness and breathlessness.
- Changes in taste, often a metallic or unpleasant taste.
- Tiredness, nausea and headache.
- The flu-like and mood effects that came with the peginterferon and ribavirin it was used with.
Key interactions
- It interacts with a large number of other medicines, so a full medicines review was essential.
- It could raise or lower the levels of other drugs processed by the liver.
- Medicines that strongly affect its levels could stop it working or increase side effects.
Available as: Capsules taken by mouth, as part of a combination with peginterferon and ribavirin.
Answers
Boceprevir: frequently asked questions
What was boceprevir used for?
It was an early hepatitis C medicine used together with peginterferon and ribavirin to help clear the infection; it is now obsolete.
Why did it cause anaemia?
Boceprevir can lower red blood cells, and it was used with ribavirin, which also causes anaemia, so blood counts were checked closely.
Why did it affect my taste?
Changes in taste, often a metallic or unpleasant taste, were a very common side effect of boceprevir.
Is it still used?
No. It has been completely replaced by modern direct-acting antivirals that are simpler, shorter and far better tolerated.
Why was it not used on its own?
On its own it was not enough to clear the virus, so it was always combined with peginterferon and ribavirin, which work in different ways.
The wider class
About Direct-acting antiviral (hepatitis C, protease inhibitor)
Boceprevir belongs to the direct-acting antiviral (hepatitis c, protease inhibitor) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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