Hepcinat
Hepcinat (Sofosbuvir 400 mg) — Natco generic of Sovaldi. Pan-genotypic NS5B chain-terminator backbone for HCV; partnered with NS5A inhibitor for 12-week treatment.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
Quick Answer
Hepcinat — sofosbuvir 400 mg (Natco Pharma). NS5B nucleotide polymerase inhibitor — backbone DAA for chronic hepatitis C, used in combination with NS5A inhibitors (daclatasvir, ledipasvir, velpatasvir) to achieve cure rates of 95-99%. Generic of Gilead Sovaldi.
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All DAA Hep C therapies carry an FDA black-box warning for hepatitis B virus reactivation in patients co-infected with HCV + HBV (which can be fulminant and fatal). Test for HBsAg and HBV DNA before starting any DAA regimen. If HBV-positive, hepatology must manage co-treatment or prophylactic anti-HBV therapy.
How sofosbuvir works
Sofosbuvir is a uridine-nucleotide prodrug. Inside hepatocytes it is phosphorylated to its active triphosphate form, which is incorporated by the HCV NS5B RNA-dependent RNA polymerase into the growing viral RNA chain. Once incorporated it acts as a chain terminator — viral replication halts. Sofosbuvir is pan-genotypic and has a high barrier to resistance.
Sofosbuvir is rarely used alone — it is the backbone of every modern HCV combination regimen. Common partners: daclatasvir (Natdac/Mydekla/Daclahep/Hepcdac), ledipasvir (in fixed combinations Hepcvir L / Ledifos / MyHep LVIR), velpatasvir (in fixed combinations Velasof / Velpanat / Hepcvel / MyHep All).
Treatment-duration table
| Population | Regimen |
|---|---|
| Genotype 1 / 4 / 5 / 6, treatment-naive, no cirrhosis | 12 weeks (typically combined with NS5A inhibitor) |
| Genotype 2, no cirrhosis | 12 weeks (sofosbuvir + ribavirin or sofosbuvir + daclatasvir) |
| Genotype 3, no cirrhosis | 12 weeks sofosbuvir + daclatasvir (sofosbuvir + velpatasvir is pan-genotypic alternative) |
| Compensated cirrhosis (any genotype) | 12 weeks combination DAA + ribavirin in selected cases; 24 weeks if treatment-experienced |
Sustained virologic response at 12 weeks post-treatment (SVR12) is the marker of cure — achieved in ~95-99% of patients across modern DAA regimens.
Important drug interactions
| Drug | Effect & action |
|---|---|
| Amiodarone + sofosbuvir | FDA warning — symptomatic bradycardia, deaths reported. Avoid combination. If unavoidable, in-hospital cardiac monitoring required. |
| PPIs (omeprazole, pantoprazole) | Reduce ledipasvir absorption (pH-dependent). Take ledipasvir-containing regimens with food and PPIs ≥4 hours apart, or use H2 blockers/antacids instead. Velpatasvir also pH-sensitive — same advice. |
| Rifampicin, rifabutin | Strong CYP3A4 + P-gp inducers — significantly reduce DAA levels. Avoid combination. |
| St John’s wort | CYP3A4 induction — reduces DAA levels and risks treatment failure. Avoid throughout therapy. |
| Phenytoin, carbamazepine, oxcarbazepine | Anticonvulsant inducers — significantly reduce DAA levels. Switch to non-inducing antiepileptic (lamotrigine, levetiracetam) before starting Hep C therapy. |
| Statins (rosuvastatin, atorvastatin) | Variable rises in statin levels. Use lowest dose; rosuvastatin generally avoided with sof+vel; atorvastatin acceptable at low dose. |
| Warfarin | INR can fluctuate as the liver recovers during DAA therapy. Monitor INR weekly until stable. |
| HIV antiretrovirals | Tenofovir + ledipasvir — increased tenofovir exposure; monitor renal function. Efavirenz reduces velpatasvir levels — avoid combination. HCV-HIV co-infection always needs ID/hepatology specialist input. |
Frequently Asked Questions
What is the cure rate?
Modern DAA regimens achieve sustained virologic response (SVR12) — undetectable HCV RNA at 12 weeks post-treatment, considered cure — in 95-99% of patients across genotypes. Cirrhosis, prior treatment failure, and HCV/HIV co-infection slightly reduce response rates.
What is SVR12?
Sustained Virologic Response at 12 weeks post-treatment. After completing a 12-week DAA course, HCV RNA is checked at 12 weeks after the last dose. Undetectable = cure. Late relapse beyond SVR12 is <1%.
Will I need a follow-up test?
Yes. HCV RNA at the end of treatment + at 12 weeks post-treatment confirms SVR12. Liver biochemistry and FibroScan/imaging at 6-12 months in cirrhotic patients to assess regression. Even after cure, screen for hepatocellular carcinoma every 6 months if cirrhosis is established.
What about hepatitis B?
All DAAs carry an FDA black-box warning for HBV reactivation in HCV+HBV co-infected patients. Test HBsAg and HBV DNA before starting. If HBV-positive, hepatology must coordinate.
Can I drink alcohol?
Avoid alcohol throughout treatment and ideally for 6-12 months after. Active alcohol use does not preclude DAA therapy but worsens long-term liver outcomes regardless of HCV status.
Pregnancy?
Sofosbuvir is FDA pregnancy category B (no human teratogenicity data; animal data reassuring). Most DAAs lack pregnancy data. Contraception during therapy is standard. Ribavirin (where used as adjunct) is strongly teratogenic — both partners must use contraception during ribavirin therapy and 6 months after.
Side effects?
Modern DAAs are generally well tolerated. Common: fatigue, headache, nausea, insomnia. Less common: rash, diarrhoea. Treatment-limiting side effects are rare.
Generic vs branded — does it matter?
Indian generic DAAs are manufactured under voluntary licences from Gilead (Sovaldi, Harvoni, Epclusa), AbbVie, and BMS. They are bioequivalent and have the same molecule. Multiple real-world studies (CT2, Plus-Asia) show equivalent SVR12 rates to branded products.
Drug interactions to watch?
Most important: amiodarone + sofosbuvir (bradycardia black-box), rifampicin (kills DAA levels), PPIs (reduce ledipasvir/velpatasvir), HIV ARV adjustments needed in co-infection. Always disclose all medications including herbal/OTC.
After cure — can I get HCV again?
Yes. SVR clears the current infection but does not provide future immunity. Re-infection through new exposures (IV drug use, unsafe medical procedures, MSM with HIV co-infection) is possible. Counsel on prevention and offer HCV RNA testing at any new risk exposure.
Sofosbuvir is rarely used as monotherapy in modern Hep C protocols — for chronic HCV genotype 1, 4, 5, or 6 the standard regimen pairs sofosbuvir with ledipasvir as a single fixed-dose combination, available as Hepcinat LP (sofosbuvir 400 mg + ledipasvir 90 mg).
See also: Hepcinat LP (sofosbuvir + ledipasvir) — Natco’s generic Harvoni — sofosbuvir 400 mg + ledipasvir 90 mg in a single 12-week course for hepatitis C genotypes 1, 4, 5, 6.
Other Hepatitis C Medications
- Natdac — daclatasvir 30/60 mg — pan-genotypic NS5A partner for sofosbuvir
- Velpanat — sofosbuvir + velpatasvir fixed combination — pan-genotypic single-tablet
- Ledifos — sofosbuvir + ledipasvir fixed combination — for genotypes 1, 4, 5, 6
- Hepcvel — sofosbuvir + velpatasvir — Cipla brand
- MyHep All — sofosbuvir + velpatasvir — Mylan brand
More options in Hepatitis Medication
Ranked by recent MedsBase order volume — what other customers in this category are picking.
| Strength | 400 mg |
|---|---|
| Quantity | 28 Tablet/s, 56 Tablet/s, 84 Tablet/s |
| Pharma Form | Tablet/s |
| Manufacturer | Natco Pharma |
| Treatment | Chronic hepatitis C virus (HCV) infection |
| Generic Brand | Sofosbuvir |
Hepcinat
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