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velpatasvir

NS5A inhibitor · Antiviral, Hepatitis C agent

NS5A inhibitorAntiviral, Hepatitis C agent
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
—
not curated
Top interactionssee all 12 →
  • RifampinContraindicatedTextbookG&G 14e · p1239, p1242
  • AntacidsSevereTextbookG&G 14e · p1239, p1242
  • Domperidone + OmeprazoleSevereTextbookG&G 14e · p1239, p1242
  • H2 BlockerSevereTextbookG&G 14e · p1239, p1242

Mechanism

Velpatasvir is an inhibitor of the non-structural protein 5A (NS5A) of the hepatitis C virus, which plays a critical role in viral RNA replication and virion assembly.

Indications

All HCV genotypes (1–6) (as part of fixed-dose combination with sofosbuvir)Children aged 6 years or older and weighing 17 kg or more (as part of fixed-dose combination with sofosbuvir)Decompensated cirrhosis (as part of fixed-dose combination with sofosbuvir, often with ribavirin)

Dosing

Adult
100 mg (as part of fixed-dose combination with sofosbuvir) once daily
Pediatric
Adult dose for children weighing ≥30 kg (as part of SOF/VEL); 50 mg (as part of SOF/VEL 200 mg/50 mg) for children weighing 17 kg to <30 kg
Renal adjustment
AUC increases by 50% in severe renal impairment (eGFR <30 mL/min/1.73 m2), but no specific dose adjustment mentioned

Pharmacokinetics

Half-life
15 h
Protein binding
Greater than 99.5% bound to plasma proteins
Metabolism
Substrate for CYPs 3A4, 2C8, and 2B6
Excretion
Predominantly in feces as parent and metabolite (<1% in urine)

Contraindications

  • Concomitant use with efavirenz, rifampin, and other potent P-gp or CYP3A inducers

Side effects

Common
HeadacheFatigueNauseaAstheniaInsomniaDiarrhea

Drug interactions

Rifampin
Contraindicated
Textbook

Approximately 82% reduction in velpatasvir AUC, potentially leading to treatment failure.

Rifampin and other potent inducers should be avoided. Do not use with potent P-gp or CYP3A inducers.

Source: G&G 14e · p1239, p1242

Antacids
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

Antacids should be separated by 4 hours. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Domperidone + Omeprazole
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

H2 Blocker
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

H2 blocker doses should not exceed the equivalent of 40 mg famotidine twice daily. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Pantoprazole + Domperidone
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Pariet
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Rabeprazole + Domperidone
Severe
Textbook

Reduced velpatasvir concentrations, potentially leading to treatment failure.

PPI doses should not exceed the equivalent of 20 mg omeprazole daily. SOF/VEL should be taken with food 4 hours prior to a PPI dose. Velpatasvir requires acidic gastric pH.

Source: G&G 14e · p1239, p1242

Berotralstat
Severe
Database

Drug interaction classified as: metabolism

Source: DDInter

Bosentan
Severe
Database

Drug interaction classified as: metabolism

Source: DDInter

Cenobamate
Severe
Database

Drug interaction classified as: metabolism

Source: DDInter

Colchicine
Severe
Database

Drug interaction classified as: excretion

Source: DDInter

Dabrafenib
Severe
Database

Clinical effect not specified

Source: DDInter

Related guidelines

Hepatitis B — chronic infection
INASL · Gastroenterology · 2023
Cirrhosis
OTHER · Hepatology · 2021
Hepatitis B — chronic infection
WHO · Hepatology · 2025
Hepatitis B — chronic infection
EASL · Gastroenterology · 2025
Hepatitis C — chronic infection
EASL · Gastroenterology · 2020

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Sources: Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-10 · House clinical team