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Zepatier (elbasvir, grazoprevir)

How is Zepatier used for HCV treatment?

Zepatier (elbasvir and grazoprevir) is a fixed-dose combination medication indicated for adults with chronic HCV genotype 1 or 4.1 For some individuals, Zepatier is indicated for use with ribavirin. Zepatier’s main components are direct-acting antiviral medications that act as an HCV NS5A inhibitor (elbasvir) and an NS3/4A protease inhibitor (grazoprevir). There is a potential for hepatitis B reactivation in individuals taking Zepatier who have a history of HBV. Prior to taking Zepatier, your provider should test you for HBV and note any history you have with the condition. It is important to also consult the prescribing information for any medications you are also taking in combination with Zepatier, including ribavirin.2

What are the ingredients in Zepatier?

The active ingredients in Zepatier are elbasvir and grazoprevir.

How does Zepatier work?

Zepatier’s first active ingredient, elbasvir, is a direct-acting antiviral that inhibits HCV NS5A. NS5A is a nonstructural protein made by the HCV virus that is important to the virus’ growth and replication. The exact mechanism by which NS5A works is unknown. The inhibitor works to eliminate these crucial proteins made by the virus utilized for RNA replication and virion assembly. Zepatier’s second active ingredient, grazoprevir, is also a direct-acting antiviral that acts as an HCV NS3/4A protease inhibitor. This protease is an essential enzyme required for viral replication. In theory, by inhibiting this enzyme the virus will be prevented from further growth and reproduction. Many direct-acting antivirals work in this manner, targeting proteins, enzymes, and specific steps in the HCV life cycle.

What are the possible side effects of Zepatier?

Multiple clinical trials evaluated the safety and efficacy of Zepatier. The most common side effects of Zepatier are headache, tiredness, and nausea. For those taking Zepatier and ribavirin together the most common side effects are anemia (low red blood cell count) and headache.

This is not an exhaustive list of all potential side effects of Zepatier. Talk to your healthcare provider or pharmacist for further information.

Things to note about Zepatier

There is a possibility of HBV reactivation while taking Zepatier if you have a history of HBV. Your provider will administer a blood test before starting Zepatier to monitor your risk of HBV reactivation. Reactivation of HBV could cause serious liver problems including liver failure or death.

When taking Zepatier, there is also a chance of developing severe liver problems. Your provider will monitor your liver function before and during treatment, however, you should contact your provider right away if you notice the following liver-related symptoms:

  • Weakness
  • Loss of appetite
  • Nausea and vomiting
  • Yellowing of skin or eyes
  • Color changes in stools
  • Tiredness

Before staring Zepatier talk to your provider if you:

  • Have or have had hepatitis B infection
  • Have or have had liver problems other than those related to HCV
  • Have any other medical conditions
  • Are taking any other medications, supplements, or vitamins
  • Are pregnant or are planning to become pregnant. It is not known if Zepatier will affect an unborn baby.
  • Are breastfeeding or planning to breastfeed. It is not known if Zepatier can pass through breast milk.

Individuals are advised to notify their provider immediately if they become pregnant, and to avoid becoming pregnant until 6 months after stopping Zepatier, if taking along with ribavirin.

Dosing information

Zepatier is a once-daily oral medication to be taken with or without food. A typical dose of Zepatier is one tablet with 50mg of elbasvir and 100mg of grazoprevir. Certain populations are instructed to take Zepatier alongside ribavirin. Do not start taking any medications without alerting your provider while on Zepatier. Do not stop taking Zepatier or change the dose of Zepatier without talking to your provider. If you take too much Zepatier, seek help at your local emergency room immediately.

Written by: Casey Hribar | Last reviewed: June 2019
  1. Zepatier Prescribing Information. Merck & Co., Inc. Mar 2017. Available from:
  2. Copegus (ribavirin) Prescribing Information. Aug 2011. Available from: