Like most drugs, hepatitis C medications may cause side effects. Before 2014, the drugs used to treat chronic hepatitis C virus (HCV) infection had many side effects, some of which were severe. The newest HCV drugs have fewer and milder side effects. Also, treatment lengths are shorter; less exposure to the medicines reduces the risk of side effects. The majority of people who used the new medicines in clinical trials experienced mild side effects. However, even though the risks are low, it is wise to know about potential side effects before starting a drug, along with tips that may help reduce the risk.

Although it is rare, side effects can develop into potentially life-threatening problems, especially if they are ignored or dismissed. The best way to handle side effects is to intervene early, reducing or stopping problems before they get out of control. Tell your health care provider about any side effects you may be having. You or your provider can report suspected adverse reactions to the U.S. Food and Drug Administration (FDA) at 800.332.1088 or to the drug manufacturer.

Here is a list of common side effects for approved HCV medications, along with tips for managing them if they occur. Because most HCV drugs are combined with other medications, review the side effects for all the medicines you are taking.

Approved hepatitis C drugs:

Daklinza (daclatasvir)
Approved to treat genotypes 1 and 3 HCV, Daklinza is prescribed with Sovaldi (sofosbuvir), with and without ribavirin.

  • Diarrhea
  • Fatigue
  • Headache
  • Nausea

Epclusa (sofosbuvir + velpatasvir)
Approved to treat genotypes 1 through 6 HCV, Epclusa may be prescribed with ribavirin in those with decompensated cirrhosis.

  • Fatigue
  • Headache

Harvoni (ledipasvir + sofosbuvir)
Approved to treat genotypes 1 and 4 HCV, may be prescribed with ribavirin.

  • Diarrhea
  • Fatigue
  • Headache
  • Insomnia
  • Nausea

Olysio (simeprevir)
Approved to treat genotype 1 HCV, Olysio is prescribed with one or more other HCV medications.

  • Nausea
  • Rash/itching (including a potentially serious photosensitivity reaction)

Pegasys (peginterferon)

Newer drugs known as direct-acting antivirals (DAAs) are replacing peginterferon (PEG). PEG may be used as an alternative treatment when other treatments fail to work. 

PEG is usually prescribed with two other HCV medications, ribavirin and a DAA. With over 40 potential side effects, PEG is the HCV medication with the highest risk.
These are the most common side effects:

  • Cough, runny nose, sore throat
  • Depression, irritability, moodiness, anxiety
  • Dizziness
  • Dry mouth, skin, eyes
  • Fatigue, weakness
  • Flu-like symptoms (chills, fever, joint and muscle aches)
  • Gastrointestinal disorders (abdominal pain, decreased appetite, diarrhea, nausea)
  • Hair loss
  • Headache
  • Injection site reaction
  • Insomnia
  • Neutropenia (low white cells)
  • Pain (back, joint, muscle)
  • Thrombocytopenia (low platelets)

Ribavirin (Brand names include Copegus, Moderiba, Ribasphere)
Ribavirin is prescribed with one or more other HCV medications. In many cases, newer drugs are replacing the need for ribavirin.

Warning: Ribavirin causes birth defects in animals, so it cannot be used by women who are pregnant or by the male partners of women who are pregnant. Extreme care must be taken to avoid pregnancy while taking the drug. As a result, men and women who are having intercourse must use two forms of birth control during HCV treatment and for the next six months afterward, since ribavirin can remain in the bloodstream after people stop taking it.

  • Anemia, hemolytic (low red cells)
  • Dizziness/lightheadedness*
  • Fatigue*
  • Impaired concentration*
  • Increased heart rate*
  • Insomnia
  • Loss of appetite
  • Mood issues (anxiety, depression, irritability, moodiness)
  • Nausea
  • Rash/itching/dry skin
  • Shortness of breath*
  • Taste perversion (dysgeusia)
  • Upset stomach (dyspepsia)
  • Weakness*

*Symptom of anemia

Sovaldi (sofosbuvir)
Sovaldi is prescribed with one or more other HCV medications.

  • Fatigue
  • Headache
  • Nausea

Technivie (ombitasvir + paritaprevir + ritonavir)
Approved for use with ribavirin to treat non-cirrhotic patients with genotype 4 HCV.

  • Fatigue
  • Insomnia
  • Nausea
  • Weakness

Viekira Pak (ombitasvir, paritaprevir, ritonavir + dasabuvir)
Approved to treat genotype 1 HCV. Viekira Pak may be prescribed with or without ribavirin.

  • Anemia (when used with ribavirin)
  • Fatigue (when used with ribavirin)
  • Increased liver-related lab tests (ALT, bilirubin)
  • Insomnia
  • Nausea
  • Skin reactions: itching, rashes, photosensitivity, etc.
  • Weakness (when used with ribavirin)

Viekira XR (ombitasvir, paritaprevir, ritonavir, + dasabuvir)
Approved to treat genotype 1 HCV. Viekira Pak may be prescribed with or without ribavirin.

  • Fatigue (when used with ribavirin)
  • Insomnia
  • Nausea
  • Skin reactions: itching, rashes, photosensitivity, etc.
  • Weakness (when used with ribavirin)

Zepatier (elbasvir + grazoprevir)
Approved to treat genotype 1 and 4 HCV. Zepatier may be prescribed with or without ribavirin.

  • Anemia (when used with ribavirin)
  • Diarrhea
  • Fatigue 
  • Headache (when used with ribavirin)
  • Insomnia
  • Nausea

Last Revised: March 13, 2017