What is Victrelis (Boceprevir)?
Victrelis (also known as Boceprevir) is a new type of treatment for people with chronic hepatitis C. It is a protease inhibitor (PI) that targets the life cycle of the hepatitis C virus. Protease inhibitors belong to a group of medicines called Direct Acting Antivirals (DAAs). These protease inhibitors must also be taken with interferon and ribavirin.
Who is it for?
Victrelis has a licence to be used for adult patients with genotype 1 chronic hepatitis C virus:
- who are treatment naive (have not been treated before for hepatitis C);
- or who have previously been treated with interferon alone or in combination with ribavirin, including relapsers, partial responders and null responders.
Your doctor or nurse will discuss potential treatments with you for your hepatitis C depending on the genotype of the virus you have.
Who is unable to take it?
- Those patients who are taking any of the above listed medication
- Under 18’ – though in theory this may be allowed
- Those with auto immune hepatitis
- If you are pregnant or your sexual partner is pregnant or plans to become pregnant, do not take these medicines.
I have genotype 2 or 3 chronic hepatitis C, can I have Victrelis?
No, Victrelis is only licensed for patients with genotype 1 chronic hepatitis C.
How do you take Victrelis?
Victrelis comes in 200 mg capsules. The recommended dose of Victrelis is 800 mg administered orally three times daily (TID) with food (a meal or light snack). Maximum daily dose of Victrelis is 2,400 mg.
This will mean taking 4 pills orally three times a day.
If you are prescribed Victrelis, your doctor or nurse will explain about the tablets and when you should take them.
Do you still have to take peginterferon alfa and ribavirin with Victrelis or can it be taken on its own?
Victrelis must be taken in combination with peginterferon alfa and ribavirin and only when it has been prescribed by a doctor or nurse.
How long should you take Victrelis for?
Victrelis will be taken for a minimum 24 weeks and may need to be taken for up to 44 weeks depending on how you respond to treatment. However, if the virus does not respond well to Victrelis by week 12 of treatment, your doctor or nurse may stop the treatment.
You doctor or nurses will advise you on how long you should take Victrelis and your other medicines for. You should not stop Victrelis unless your doctor or nurse tells you to.
Does it work?
Victrelis can boost the success rate of clearing the virus from 50% to 80% and in some cases will shorten the time that a patient needs to be on treatment.
What side effects are there?
Victrelis can affect your bone marrow and cause low red blood cell, and low white blood cell, counts. In some people, these blood counts may fall to dangerously low levels. If your blood cell counts become very low, you can get anaemia or infections. (Anaemia was observed in 49% of cases compared to 29% when only taking interferon and ribavirin).
The most common side effects of Victrelis in combination with peginterferon alfa and ribavirin include:
- change in taste
Tell your healthcare provider about any side effect that bothers you or that does not go away.
These are not all the possible side effects of Victrelis. Further information about the side effects of Victrelis can be found on page 10 of the Victrelis Pharmaceutical Information document that is available at the bottom of this page.
Side effects will be managed by your doctor or nurse. Never reduce the dose or stop taking any of your treatments without speaking to your doctor or nurse first.
It is important to remember that Victrelis is taken in combination with interferon and ribavirin, therefore the side effects associated with traditional treatment may still occur.(click here for interferon and ribavirin side effects)
What steps may be taken in the event of increased anaemia?
A reduction in the dose of Ribavirin has been recommended although some clinicians may prescribe EPO or offer a blood transfusion.
Why do I need to take Victrelis with food?
Victrelis must always be taken together with food. The food is important to help absorption and get the right levels of medicine into your body.
Will Victrelis affect the other medicines I am taking?
Are there are any reactions with other drugs that people should be cautious about?
Yes, do not take Victrelis if you take any of the following:
- alfuzosin hydrochloride (UROXATRAL®)
- carbamazepine (CARBATROL®, EPITOL®, EQUETRO®, TEGRETOL®, TEGRETOL® XR, TERIL™)
- phenytoin (DILANTIN®)
- cisapride (PROPULSID®)
- drosperinone-containing medicines, including:
- YAZ®, YASMIN®, ZARAH®, OCELLA®, GIANVI®, BEYAZ®, SAFYRAL™
Ergot-containing medicines, including:
- dihydroergotamine mesylate (D.H.E. 45®, MIGRANAL®)
- ergonovine and methylergonovine (ERGOTRATE®, METHERGINE®), ergotamine
- ergotamine tartrate (CAFERGOT®, MIGERGOT®, ERGOMAR®, ERGOSTAT, MEDIHALER ERGOTAMINE, WIGRAINE, WIGRETTES)
- lovastatin (ADVICOR®, ALTOPREV®, MEVACOR®)
- midazolam (VERSED), when taken by mouth
- pimozide (ORAP®)
- rifampin (RIFADIN®, RIFAMATE®, RIFATER®, RIMACTANE)
- sildenafil (REVATIO®), when used for treating lung problems
- simvastatin (SIMCOR®, VYTORIN®, ZOCOR®)
- St. John’s Wort (Hypericum perforatum) or products containing St. John’s Wort
- tadalafil (ADCIRCA®), when used for treating lung problems
- triazolam (HALCION®)
Any drugs prescribed by a doctor or bought over the counter must be cleared with the treating team before being taken
A more precise list of how Victrelis may interact with other medicines can be found on page 6 the Victrelis Pharmaceutical Information document that is available at the bottom of this page.
Victrelis should also be used with caution with other medications not listed and therefore you should tell your doctor or nurse about ALL medicines you are taking BEFORE being prescribed Victrelis.
Can I chew, dissolve or break the Victrelis tablets?
No, tablets must be swallowed whole. Do not chew, break or dissolve the tablets before you swallow them. Tell your doctor or nurse if you have any problems swallowing whole tablets.
What if I miss a Victrelis dose?
If a patient misses a dose and it is less than 2 hours before the next dose is due, the missed dose should be skipped. If a patient misses a dose and it is 2 or more hours before the next dose is due, the patient should take the missed dose with food and resume the normal dosing schedule.
What happens if you are sick after taking a dose – should you take another to replace?
Yes – if it is within thirty minutes of taking - otherwise leave until the next dose is due.
What if I have taken more Victrelis than I should?
Contact the doctor or nurse treating you, so they can advise you of what to do.
How do I store Victrelis?
Store in a refrigerator (2°C – 8°C) until expiry.
Store outside of the refrigerator at or below 30°C for a period of not more than 3 months
Until expiry. After this period, the medicinal product should be disposed.
Store in the original blister in order to protect from moisture.
Can doctors insist standard treatment is tried first or will it be available to naïve patients?
Victrelis should be available to all
If it were available tomorrow would it be available at all hospitals?
Yes, in theory
What is the cost?
- £16,000 - £24,000 (or a £100 per day)
- And the additional cost of Interferon and Ribavirin (currently £2500 - £5000)
Are there gender/ethnic or age differences in success rates?
(American) black patients were 10% - 20% less likely to achieve SVR with Victrelis than other groups. Level of liver damage can also affect results
Will it be monitored by a nurse in the same way as standard treatment or will there be more frequent appointments?
It is hoped there will be more consultant involvement
If it doesn’t work first time can it be offered again – what would the success rate be then?
- It could be offered again pending results of a resistance test – however it is unlikely to have much chance of success if it doesn’t work first time round.
- If you become resistant to Victrelis - you are likely to be resistant to Incivo
- Don’t yet know if this will apply to second generation PI’s.
What extra support may be needed for those on methadone?
Closer monitoring as it is thought that methadone can reduce levels of Victrelis
What happens if you don’t eat fatty food with it?
Fatty foods help with absorption and increase effectiveness – doesn’t have to be fatty food – but a snack is essential