One of the BIG issues in the current Hep C treatment world is the relapse.
Statistically about 1 in 40 people treating with Sofosbuvir 400 mg + Velpatasvir 90 mg (Epclusa) will relapse.
Why this happens is not entirely clear however factors such as fibrosis level, previous treatment history and length of treatment are certainly factors.
Another factor, one that we can directly control, is what food and supplements we consume during treatment with Epclusa.
In this post I will talk a little about relapse and give you some tips that might help make a small difference, but which might make the difference between clearing the Hepatitis C or relapsing after treatment.
Firstly I will mention treatment times.
If you have failed a previous Hepatitis C treatment then you should seriously consider do the maximum Epclusa treatment period, which is generally considered to be 24 weeks.
One of the reasons for this is because it is likely that the Hepatitis C virus in your body has developed some degree of resistance to treatment. If you can not afford to do 24 weeks you should seriously consider at least 16 weeks treatment. The length of treatment time is something you should discuss with your doctor.
If you have high liver fibrosis levels, F3 or F4, your should also consider doing a longer treatment period.
Epclusa is a very effective treatment for all Hepatitis C genotypes and it is particularly good for treating Hepatitis C genotype 3. However because genotype 3 has proven to be a difficult genotype of Hep C to cure it is worth considering doing more than 12 weeks treatment with Epclusa if you are treating genotype 3. The rule of thumb is “The longer the treatment time the higher the cure rates.
8 Weeks 90%>
12 Weeks 95%> (+5%)
16 Weeks 97%> (+2%)
20 Weeks 98%> (+1%)
24 Weeks 98.5% > (+0.5%)
The first thing to understand when taking Epclusa is that Epclusa is two drugs, Sofosbuvir and Velpatasvir. Velpatasvir is not a water soluble chemical. That is to say it does not dissolve easily.
Sofosbuvir is very soluble, Velpatasvir is not very soluble.
Velpatasvir relies heavily on the stomach acids to dissolve it and make it easy for the body to absorb.
This is why you must never take antacids when you are taking Epclusa or any other substance that might neutralise your stomach acid.
On the instructions that come with the bottle of pills it says that Epclusa can be taken with or without food.
However there is now a general agreement that it is better to take your pill with a small amount of food.
Because having a small amount of food in the stomach will stimulate the stomach acids and assist in the absorption process.
The Epclusa is absorbed in the stomach, through the stomach walls.
Not a large amount of food, not a huge meal, because some of the Velpatasvir is going to get caught up in the mass of food.
Also I would not suggest drinking a large amount of water right after taking your pill.
For the same reason.
We want that Velpatasvir to hang around in some nice strong stomach acid for a while, not get washed away in a flood of H20.
Certain herbal supplements will speed up the rate that the active ingredients in Epclusa are removed from the blood stream, which can lead to ” under dosing” .
Sofosbuvir and Velpatasvir are removed from the body by enzymes created by your liver. These enzymes are from a family of enzymes called CYP Enzymes, which are created to breakdown and remove toxins from the blood. Certain herbs, such as St John’s Wort cause the body to create a lot of CYP enzymes, which in turn will cause the Sofosbuvir and Velpatasvir to be broken down much faster than normal. Because we do not know how many herbal supplements will effect CYP enzyme levels it is wise not to take any form of herbal supplement during your Hepatitis C treatment.
Coffee, or rather caffeine causes the body to produce CYP enzymes because the liver considers caffeine to be a toxin and wants to remove it. If you drink large amounts of coffee while doing treatment with Epclusa it is possible that this may effect treatment outcomes. Please remember that it is the caffeine, not the coffee, that is the problem this means that any drink containing high levels of caffeine should be consumed in moderation during treatment with Epclusa.
One or two cups of coffee a day is not a problem but if you are drinking ten or more cups of coffee a day you should consider reducing this whilst taking Epclusa. The same applies to energy drinks containing high levels of caffeine.
It is also a good idea to get a seven day pill box. This is a small plastic box with a compartment for each day of the week. If you lay out your pills for the week in the pill box you will not miss a day or accidentally double dose.
So in summary:
Take your pill at about the same time each day.
Take it with a small amount of food.
Don’t drink too much water immediately after taking your pill.
No antacids and its probably a good idea not to take magnesium supplement during treatment.
No herbal supplements during treatment
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