Maviret (Glecaprevir, Pibrentasvir)

Maviret is a direct‑acting antiviral indicated for chronic hepatitis C infection across multiple genotypes.

• Chronic hepatitis C (genotype 1): achieves sustained virologic response, effectively clearing the virus.
• Chronic hepatitis C (genotypes 2‑4): achieves sustained virologic response, reducing disease progression.
• Chronic hepatitis C (genotypes 5‑6): achieves sustained virologic response, improving liver health.

• Glecaprevir inhibits the HCV NS3/4A protease, preventing viral polyprotein processing, while pibrentasvir blocks the NS5A protein, disrupting replication and assembly of hepatitis C virus particles. The combined action halts viral replication, allowing the immune system to clear infected cells.

Common Side Effects

• Headache: mild to moderate intensity.
• Fatigue: transient tiredness reported by some patients.
• Nausea: occasional upset stomach.
• Diarrhea: loose stools in a minority of users.
• Abdominal pain: mild discomfort in the upper abdomen.
• Pruritus: occasional itching.

Serious or Rare Side Effects

• Elevated liver enzymes: may indicate liver injury.
• Severe rash or hypersensitivity: requires immediate medical attention.
• Hepatic decompensation: rare but serious liver failure.
• Anemia: significant drop in red blood cell count.
• Jaundice: yellowing of skin or eyes indicating liver dysfunction.
• Allergic reactions: including swelling of face or throat.

Before prescribing Maviret, clinicians should consider several safety measures.

• Baseline liver function assessment: obtain hepatic enzyme levels prior to initiation.
• Contraindication in moderate/severe hepatic impairment: avoid use in patients with Child‑Pugh B or C.
• Monitor for drug‑drug interactions: review concomitant medications that affect CYP3A4.
• Pregnancy safety unknown: use only if potential benefit justifies risk.
• Breastfeeding caution: insufficient data on excretion in milk.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Maviret has notable interactions that require attention.

Major Interactions (Avoid)

• Strong CYP3A inducers (e.g., rifampin, carbamazepine): may markedly reduce drug exposure.
• HIV protease inhibitors boosted with ritonavir: can increase exposure and risk of toxicity.
• St. John’s wort: potent CYP3A inducer that lowers efficacy.

Moderate Interactions (Monitor Closely)

• Statins (e.g., simvastatin, lovastatin): may increase statin plasma levels, raising risk of myopathy.
• Antacids containing aluminum or magnesium: can decrease absorption of the tablets.
• Certain anticonvulsants (e.g., phenytoin): may alter plasma concentrations of the antivirals.