A hepatitis C antiviral
Sofosbuvir
A cornerstone hepatitis C antiviral that, as part of a combination tablet, cures most people in a short course.
What is Sofosbuvir?
Sofosbuvir is a direct-acting antiviral that, as part of a combination tablet, cures hepatitis C in most people. It is almost always paired with another antiviral — for example with velpatasvir as Epclusa, or with ledipasvir as Harvoni — and taken as a short course lasting weeks. It is well tolerated by most people. Importantly, it must not be combined with amiodarone (a heart-rhythm medicine), as together they can cause a dangerously slow heartbeat, and it interacts with some other medicines, so always tell your specialist team everything you take. It is prescribed and supervised by a specialist liver or infection team.
Education and reference only. This is a plain-language guide to Sofosbuvir — 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
Sofosbuvir is one of the direct-acting antivirals (DAAs) that transformed hepatitis C from a long, hard-to-treat illness into one that can usually be cured with a short course of tablets. It is almost never used on its own; it is combined with at least one other antiviral, such as velpatasvir (the Epclusa tablet) or ledipasvir (the Harvoni tablet), so a single pill often does the work of two medicines. Hepatitis C is a virus that infects the liver and, left untreated, can lead to scarring (cirrhosis) and liver cancer over many years. A typical course lasts a number of weeks, and most people clear the virus completely. It is started and overseen by a specialist liver or infectious-diseases team.
How it works
Hepatitis C reproduces inside liver cells by copying its genetic material using its own machinery. Sofosbuvir blocks one of the key enzymes the virus needs to copy itself (called NS5B), so the virus can no longer multiply. Combining it with a second antiviral that works on a different part of the virus attacks hepatitis C from more than one angle at once, which makes treatment more effective and helps prevent the virus becoming resistant. Over the weeks of treatment the amount of virus in the blood falls to undetectable levels; a blood test some weeks after finishing confirms whether the virus has been cleared for good (a cure).
Company & origin
Originated / developed by: Gilead Sciences.
A direct-acting antiviral developed for hepatitis C and now a cornerstone of the short, curative tablet courses used across the UK.
Practical use
How to take Sofosbuvir
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as your specialist team directs, usually once a day, and finish the entire course even when you feel completely well.
- It is taken as a combination tablet (such as Epclusa or Harvoni), so follow the instructions for the specific product you are given.
- Tell your team about every medicine, supplement and herbal remedy you take, especially amiodarone for the heart, which must not be combined with it.
- If you take a dose late, follow the advice given with your medicine; do not double up to catch up.
- Attend your follow-up blood test after the course finishes, as this is what confirms whether the virus has been cleared.
Weighing it up
Advantages & disadvantages of Sofosbuvir
Advantages
- A cornerstone of modern hepatitis C treatment that cures the great majority of people.
- Taken as a short course of weeks, usually as a single combination tablet that is simple to take.
- Generally very well tolerated, with far fewer side effects than older hepatitis C treatments.
Disadvantages
- Must not be combined with amiodarone, as together they can cause a dangerously slow heartbeat.
- Interacts with several medicines that can stop it working, so the full medicine list must be checked.
- Only available through specialist services and requires a follow-up test to confirm cure.
Practical use
Good to know
Hepatitis C is now a curable illness for the great majority of people, and sofosbuvir-based courses are central to that. It is usually very well tolerated, with tiredness and headache being the most common complaints. The single most important safety point is that it must not be taken with amiodarone, a medicine for abnormal heart rhythms, because the combination can cause a seriously slow heartbeat that has occasionally been life-threatening. It also interacts with several other drugs — including some used for epilepsy, tuberculosis and the herbal remedy St John's wort — which can stop it working, so your specialist team will check your full medicine list carefully. Completing the whole course exactly as prescribed gives the best chance of a cure, and a follow-up blood test confirms the virus has gone.
Who should not take it / use with caution
- People taking amiodarone for heart rhythm problems should normally avoid sofosbuvir, because together they can cause a dangerously slow heartbeat; it is only ever combined when there is no alternative, and then with close heart monitoring in hospital.
- It is avoided alongside certain medicines (such as some epilepsy drugs, rifampicin and St John's wort) that stop it working.
- It is used with care, and the combination chosen carefully, in advanced liver or kidney disease.
Monitoring
- A blood test some weeks after finishing the course to confirm the virus has been cleared.
- Checks on liver function and overall response during treatment.
- Review of all current medicines before and during the course to avoid harmful interactions.
Side effects
- Tiredness and headache are the most common effects and are usually mild.
- Nausea, trouble sleeping or muscle aches in some people.
- Rarely, a very slow heartbeat if taken with amiodarone, which needs urgent attention.
Key interactions
- Must not be combined with amiodarone, because of the risk of a dangerously slow heartbeat.
- Some epilepsy medicines, rifampicin (for tuberculosis) and St John's wort can lower its levels and stop it working.
- It can affect certain other medicines, so your specialist team will review everything you take before you start.
Available as: Tablets taken by mouth, usually as a fixed combination with another antiviral.
Answers
Sofosbuvir: frequently asked questions
Will sofosbuvir cure my hepatitis C?
As part of a combination tablet it cures the great majority of people; a blood test some weeks after the course confirms the virus has gone.
Why is it combined with another antiviral?
Combining it with a medicine that attacks a different part of the virus makes treatment more effective and helps stop the virus becoming resistant; Epclusa and Harvoni are common examples.
Why must I avoid amiodarone?
Taken with amiodarone, a heart-rhythm medicine, it can cause a dangerously slow heartbeat, so this combination is not used.
How long is the course?
Most courses last a number of weeks; your specialist team will tell you the exact length and it is important to finish it all.
Do I need follow-up after treatment?
Yes. A blood test some weeks after the last tablet checks whether the virus has been cleared for good, which is how a cure is confirmed.
The wider class
About Hepatitis C antiviral (NS5B inhibitor)
Sofosbuvir belongs to the hepatitis c antiviral (ns5b 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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