Mavyret is a combination antiviral pill that cures hepatitis C by blocking two proteins the virus needs to copy itself. It works against all six major genotypes of hepatitis C, with cure rates of 98% to 99% in clinical trials. Most people take it for just eight weeks.
How Mavyret Attacks Hepatitis C
Hepatitis C is a virus that hijacks liver cells to reproduce. It relies on specific proteins to assemble new copies of itself, and Mavyret shuts down two of them simultaneously.
The first ingredient, glecaprevir, blocks a protein the virus uses to cut apart its own raw materials into usable building blocks. Without this step, the virus can’t process the components it needs to assemble new viral particles. The second ingredient, pibrentasvir, targets a different protein that organizes viral replication and helps new virus particles leave the cell. Blocking both proteins at once means the virus can’t reproduce through either pathway, which makes it extremely difficult for the virus to develop resistance.
This dual attack is what makes Mavyret a “pangenotypic” treatment. Hepatitis C comes in six major genetic varieties (genotypes), and older treatments only worked well against some of them. Both of Mavyret’s ingredients were designed to be effective across all six genotypes, so the treatment works regardless of which strain you carry.
Cure Rates Across All Genotypes
Doctors consider hepatitis C “cured” when the virus is undetectable in your blood 12 weeks after finishing treatment. In an analysis of over 2,000 patients without cirrhosis across nine clinical trials, 98% of those treated for eight weeks and 99% of those treated for 12 weeks reached this milestone. The difference between the two durations wasn’t statistically significant, confirming that eight weeks is enough for most people.
These high cure rates held up across patient groups that historically responded less well to treatment, including different genotypes, viral loads, and demographic factors. Serious drug-related side effects were extremely rare, occurring in fewer than 0.1% of patients.
How Long Treatment Lasts
If you haven’t been treated for hepatitis C before and you don’t have cirrhosis (significant liver scarring), the standard course is eight weeks. People who have cirrhosis or who have tried previous hepatitis C treatments typically need 12 to 16 weeks. Your doctor will determine the right duration based on your liver health and treatment history.
You take three tablets together once a day, always with food. The food requirement isn’t optional: it helps your body absorb the medication properly. Each daily dose delivers 300 mg of glecaprevir and 120 mg of pibrentasvir. The same dosing applies to adolescents 12 and older who weigh at least 45 kg (about 99 pounds).
Common Side Effects
Mavyret is generally well tolerated. Across nine clinical trials covering all six genotypes, the most common side effects were headache (13% of patients), fatigue (11%), and nausea (8%). These were mostly mild and didn’t require stopping treatment.
In one controlled trial comparing Mavyret to a placebo over 12 weeks, some of these symptoms also showed up in the placebo group, though at lower rates. Headache occurred in 9% of Mavyret patients versus 6% on placebo. Nausea hit 6% on Mavyret versus 2% on placebo. Diarrhea was reported by 5% versus 2%. So while side effects are real, a portion of what people experience during treatment may come from the stress of the process itself or unrelated causes.
A Key Safety Warning: Hepatitis B Reactivation
Mavyret carries an FDA boxed warning (the most serious type) about hepatitis B reactivation. If you’ve ever been infected with hepatitis B, even in the past, successfully treating hepatitis C can sometimes cause dormant hepatitis B to flare up. In rare cases this has led to severe liver failure and death. For this reason, everyone is tested for current or past hepatitis B infection before starting Mavyret. People who carry both viruses need close monitoring during and after treatment.
Why It Works for Kidney Disease Patients
One of Mavyret’s practical advantages is that it’s safe for people with severe kidney disease, including those on dialysis. Many older hepatitis C treatments were cleared through the kidneys, which made them risky or unusable for this population. Both of Mavyret’s ingredients are primarily processed by the liver instead.
Pharmacokinetic studies showed that while drug levels rise somewhat as kidney function declines (up to 56% higher for glecaprevir and 46% higher for pibrentasvir in the most severe cases), this didn’t translate into safety problems. Hemodialysis itself removes very little of the medication, so dosing doesn’t need to change around dialysis sessions. In the EXPEDITION-4 trial, which specifically enrolled patients with severe kidney impairment, 98% achieved a cure with no virologic failures.
Medications That Don’t Mix With Mavyret
Mavyret has two strict contraindications with other drugs. Atazanavir, an HIV medication, and rifampin, an antibiotic commonly used for tuberculosis, must not be taken alongside Mavyret. Both interfere with how Mavyret is processed in the body in ways that can either reduce its effectiveness or increase toxicity.
Mavyret is also contraindicated in people with severe liver impairment (classified as Child-Pugh C), which is the most advanced stage of chronic liver disease. For people with mild to moderate liver disease, including compensated cirrhosis, Mavyret remains an option with adjusted treatment duration. If you take any other medications regularly, your prescriber will review them for interactions before you start.