Boceprevir

Boceprevir is an antiviral oral medication used to treat chronic hepatitis C, a viral infection that damages the liver.

Overview

The hepatitis C virus spreads by entering the cells of the liver, and “taking over” the cells, using them to produce new viral particles. In order to do this, it requires certain amino acids, which are the building blocks of proteins. The hepatitis C virus uses enzymes called “proteases” to break the proteins in the body down into the amino acids that it needs to produce more viral particles.

Boceprevir belongs to a class of drugs called protease inhibitors. Boceprevir attaches to the proteases that the hepatitis C virus uses, blocking their action. Without access to the raw materials the virus needs to produce new viral particles, it cannot multiply, and will eventually die off.

In most cases, boceprevir is prescribed along with two other drugs, ribavirin, and peginterferon alfa. Patients who are being treated for hepatitis C for the first time usually receive all three drugs, as do patients who have not responded to treatment with ribavirin and peginterferon alfa alone. The course of treatment with all three drugs may last 12 to 44 weeks, although patients often take ribavirin and peginterferon alfa by themselves for a few weeks before and after boceprevir is added to the treatment.

Ribavirin, one of the drugs taken with boceprevir, should not be taken by pregnant women as it is very harmful to the unborn baby.

Many drugs interact with boceprevir in ways that produce potentially very serious side-effects. You should discuss with your doctor all medication and supplements that you are taking before you begin your treatment with this drug. Do not take any other drugs unless your doctor has confirmed that it is safe to do so.

Boceprevir is most commonly known under the brand name “Victrelis.”

Conditions Treated

  • Hepatitis C

Type of Medicine

  • Antiviral
  • Protease inhibitor

Side Effects

Many people who take Boceprevir experience side effects, and sometimes these side effects can be severe, especially if they are not properly managed. You will be prescribed this drug if your doctor believes that the benefits you will gain from it outweigh the negative impact of the potential side effects. It is important that you stay in contact with your doctor and report any unusual side effects that you experience.

Anemia

This medication may cause anemia, a condition in which the blood does not contain enough red blood cells. Consult your doctor immediately if you experience any side effects that might suggest you have anemia, which include the following:

  • Bleeding gums
  • Chills
  • Dark colored urine
  • Fatigue or weakness
  • Fever
  • Headaches
  • Low appetite
  • Nausea
  • Nosebleeds
  • Pain in the back, legs or stomach
  • Pain in the throat
  • Pale skin
  • Swelling anywhere on the body
  • Vomiting
  • Yellow skin or eyes
  • Increased Bleeding

While taking these medications you may have a lower level of platelets in the blood. Platelets are involved in clotting the blood, and while you are taking boceprevir you may experience more bleeding from cuts and bruises than you normally would. You should take steps to avoid bleeding, including:

Avoid situations where injuries, grazes, and bruises are likely to occur, such as contact sports.

Take extra care with any sharp objects, including nail clippers and razors.

Take extra care while brushing, flossing, or using toothpicks. Your doctor may advise you on alternative ways to keep your teeth clean.

Seek advice from your doctor if you get any dental work done.

Increased Risk of Infections

This medication may reduce your white blood cell count. White blood cells play an important role in your immune function, so you may be at higher risk of infections while you take boceprevir. Because of this, you should take extra precautions to avoid infections, such as:

Avoid touching your face, eyes or nose unless you have just washed your hands. This is a common way that infections enter the body.

Wash your hands frequently throughout the day.

Where possible, avoid contact with people who have infections.

Other Side Effects

Some other side effects are common in people who take boceprevir. If you notice any of the following side effects, contact your doctor immediately:

  • Black or tarry stools
  • Coughs
  • Difficult or painful urination
  • Excessive bleeding or bruising
  • Fatigue
  • Sores, ulcers, or white spots inside the mouth or nostrils
  • Tightness in the chest area

Some of the side effects that you may experience while taking boceprevir are less serious and may not need medical attention. Some side effects disappear by themselves after your body gets used to the drug. If you experience any of the side effects listed below for an extended period of time, of if you find them worrying, consult your doctor or pharmacist:

  • Changes in mood such as irritability
  • Changes in taste
  • Diarrhea
  • Difficulty sleeping
  • Dry mouth
  • Dry skin
  • Hair loss
  • Mild aches, pains or stiffness in the muscles or joints
  • Mild dizziness or disorientation

Drugs can affect people in unexpected ways and it is possible that you will experience a side effect not listed here while you are taking boceprevir. Be aware of how you feel while you are taking this medication. If you notice any side effects that are unusual or that you find bothersome, consult your doctor. Some side effects can be managed through the use of another drug or product, or in other cases, your doctor may want to send you for further tests.

Overdose

If you or anyone else takes an overdose of boceprevir, seek medical assistance immediately.

Allergic reaction

Serious allergic reactions to boceprevir are rare, but they can occur in some individuals. You should let your doctor know about any allergies you have, particularly if you are allergic to boceprevir or any of the inactive ingredients that are typically used as filler in tablets and capsules.

If you do experience the symptoms of an allergic reaction after taking this medication, seek medical attention immediately by calling 911. Such symptoms include the following:

  • Any breathing problems, such as wheezing, finding it hard to breathe in, or tightness and heaviness in the chest while you breathe
  • Extreme dizziness, drowsiness or disorientation
  • Redness in the skin, hives, or a rash
  • Swelling, especially when around the face or throat

Dosage

Every patient will be assessed individually and prescribed a dose of boceprevir that is most appropriate for them. This will depend on factors like age, body weight, and the severity of the symptoms that they are experiencing. You should only take this medication as advised to do so by your doctor. However, typical doses are as follows:

Adults: 2,400 mg daily, taken in three separate doses of 800 mg, spread evenly through the day

Children: Your doctor will determine an appropriate dose on a case-by-case basis

To give yourself the best chance of fighting off the hepatitis C virus, it is important to keep a constant presence of the drug in your body, so you should take boceprevir at the same times each day and do your best to stick to your schedule. You should also take the medication with or shortly after food.

If you are unable or forget to take a dose of your medication, and it is more than 2 hours before your next dose, you can take the missed dose. However, if you are due to take your next scheduled dose within the next 2 hours, simply skip the missed dose and continue with your schedule as normal. Do not take a double dose if you miss a previous one, as this may increase your risk of experiencing side effects.

Boceprevir is taken alongside two other drugs, peginterferon alfa, and ribavirin. In a typical treatment, patients receive peginterferon alfa and ribavirin for 4 weeks, then all three drugs together for 12 to 44 weeks, and then peginterferon alfa and ribavirin alone again for several more weeks.

Interactions

Many drugs interact with boceprevir in ways that can cause serious or even fatal side effects. Before you take this medication, discuss with your doctor any medications, herbal supplements, vitamins or other products that you are taking.

Some drugs are particularly dangerous when taken at the same time as boceprevir, so be sure to let your doctor know if you are taking or have ever taken any of the following:

  • Any antifungal medications (for example Sporanox, Nizoral, Noxafil)
  • Any medication for enlarged prostate
  • Any medications for heart problems
  • Any medications for high cholesterol
  • Any medication for HIV
  • Any medications for seizures
  • Alprazolam (Niravam, Xanax)
  • Bosentan (Tracleer)
  • Budesonide (Pulmicort, Rhinocort)
  • Buprenorphine (Buprenex, Butrans)
  • Cisapride
  • Clarithromycin (Biaxin)
  • Colchicine (Colcrys, Col-Probenecid)
  • Calcium channel blockers (such as felodipine or nicardipine)
  • Cyclosporin (Gengraf, Neoral, Sandimmune)
  • Desipramine (Norpramin)
  • Dexamethasone
  • Drospirenone
  • Ergot medicines
  • Midazolam
  • Pimozide
  • Rifabutin (Mycobutin)
  • Rifampin
  • Rimactane
  • Salmeterol (Advair, Serevent)
  • Sildenafil (Viagra)
  • Sirolimus (Rapamune)
  • St John’s Wort
  • Tacrolimus (Prograf)
  • Tadalafil (Cialis)
  • Trazodone
  • Triazolam
  • Vardenafil (such as Levitra or Staxyn)
  • Warfarin (Coumadin) or any other anticoagulant (blood thinning medication)

If you take these medications, it does not necessarily mean that you cannot take boceprevir. However, your doctor may want to adjust the dose of one or both of the medications, or they may want to see you often for check-ups, to ensure there are no problems.

Warnings

While you are taking this medication, it is likely that your doctor will arrange several check-up appointments and blood tests to keep a close eye on things like your liver function, blood counts, and platelet levels. Ensure that you keep all of these appointments as this will help your doctor identify and deal with any negative effects of the drug.

Note that while you are being treated for your hepatitis C infection, it is still possible for you to pass the virus on to other people. Ask your doctor for advice on how to avoid spreading the virus, and follow the instructions you are given strictly.

Existing Medical Conditions

Boceprevir may cause complications if taken by people with certain existing medical conditions. Before you take this medication, discuss with your doctor any medical conditions you presently have. Your doctor can then advise you on whether boceprevir is safe for you to take. Conditions that are of particular concern include:

  • Hepatitis B.
  • Immune system disorders.
  • Blood or bone marrow problems -- for example anemia, neutropenia, or pancytopenia. Boceprevir might make these issues worse.
  • Human immunodeficiency virus HIV or acquired immunodeficiency syndrome AIDS -- boceprevir can interfere with the medication you take for HIV.
  • Liver problems -- Boceprevir can make certain liver problems worse or interfere with the medication you take for them.
  • Liver or other organ transplants -- Boceprevir may not work as effectively or at all in people who have received an organ transplant.

In order to clear your infection, you need to keep taking boceprevir in addition to the other drugs you are given for the full period of treatment. Your symptoms may clear up and you might start feeling better before the end of the treatment, however, this does not mean that the infecting virus has been completely cleared. If you stop taking the drugs early, the symptoms may return.

Pregnancy

Ribavirin, one of the drugs taken alongside boceprevir, can cause very serious birth defects if taken by pregnant women. You should not take this medication if you are pregnant. Birth defects can also occur if you are a male and your partner becomes pregnant while you are taking these drugs. If a pregnancy occurs while you are taking this medication, you should consult your doctor immediately.

If you are a woman and able to become pregnant, you will be required to submit a negative pregnancy test before you are prescribed the medication. You may also be required to submit negative pregnancy test every month throughout your course of treatment with boceprevir in order to continue receiving the medications.

This combination of medications may stop hormonal birth control methods from working properly. This includes birth control pills, injections, patches, rings, and implants. You should not rely on these birth control methods while taking boceprevir, and instead use two other forms of birth control, such as condoms, diaphragms, contraceptive foam, or contraceptive jelly. Continue to use two effective forms of birth control for six months after you have completed your course of treatment.

Breastfeeding

Appropriate studies have not yet been conducted to determine whether boceprevir can enter the breast milk and pass to babies through breastfeeding. If you are presently breastfeeding, talk to your doctor about this, as they will be able to give you the latest information in this area. As a precautionary measure, you may be advised not to breastfeed while you are taking this drug.

Storage

If you do not store this medication properly, it may become weaker or it may become unsafe to take. Follow the guidelines below when storing this medication.

Keep refrigerated: This medication should ideally be stored in the refrigerator, at a temperature between (36 F and 46 F) (2 C and 8 C). If you do this, the medication will be safe to use until its expiration date. You can store the medication outside of the refrigerator, but if you do so it will only be stable for 3 months. If you do store the medication outside of the refrigerator, ensure that you keep it in a cool, dry place. Do not store the medication in your bathroom, the glove compartment of your vehicle, or near any source of heat including direct sunlight.

Do not freeze: Do not store this medication in the freezer, as this is too cold and may damage it.

Keep away from children: Keep this medication out of the sight and reach of children, and in a container that children are not able to open. A child-safe container is particularly important if you have a ground-level refrigerator that your children are able to access.

Shelf life -- Do not take any medication that has passed its expiration date.

Safe disposal: If your medication has become damaged, has passed its expiration date, or if you have finished your treatment and have some capsules remaining, do not throw them away in the trash. Ask your doctor or pharmacist how to dispose of the medication -- you will probably be directed to a “take-back” program operating in your local area.

Summary

Boceprevir is a type of antiviral drug known as a protease inhibitor. It is used to treat hepatitis C and is prescribed along with two other drugs called ribavirin and peginterferon alfa. The full course of treatment with these three drugs can take a long time, usually between 12 and 44 weeks.

Studies have shown that boceprevir is an effective treatment and produces better results than taking ribavirin and peginterferon alfa by themselves. However, the side-effect profile of this drug is not favorable -- many people experience side effects of some kind, and sometimes these side effects can be severe.

Because boceprevir is taken with ribavirin, it is very important not to use this drug while pregnant. Ribavirin can cause severe birth defects in the unborn child. Patients are required to submit a negative pregnancy test before they can be prescribed ribavirin, and will need to submit a further negative test every month of the treatment.

There is a long list of medications that boceprevir interacts with. This means that taking boceprevir at the same time as certain other medications might cause severe side effects. It is very important that you let your doctor know about any other medications or supplements you are taking before you take boceprevir.

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Last Reviewed:
December 25, 2017
Last Updated:
December 22, 2017
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