Can You Drink Alcohol on Epclusa?

We commonly hear that alcohol can be harmful to our liver, which is why those of us with hepatitis C are advised to avoid alcohol. But what about during the treatment of hepatitis C?

Epclusa, a medication frequently prescribed for hepatitis C surprisingly doesn’t state any direct interactions with alcohol. Does this mean it’s ok to drink while taking Epclusa? Not quite. Let’s examine how Epclusa’s mechanism works and how it can indirectly interact with alcohol.

What Is Epclusa?

Epclusa is the brand name medication for the combination of the drugs sofosbuvir and velpatasvir. The combination of drugs that make up Epclusa is FDA-approved to treat all six hepatitis genotypes. 

Sofosbuvir, one of the components of Epclusa, blocks the enzyme NS5B, which interferes with the reproduction of the virus within our genetic material. Velpatasvir, the other component in Epclusa, blocks the protein NS5A that prevents the virus from replicating. Together, they’re categorized as a direct-acting antiviral that stops hepatitis C from multiplying and infecting new cells. 

The medication is commonly prescribed for chronic hepatitis C and can be used for patients with or without cirrhosis (liver damage). Epclusa is a daily medication that is prescribed for a 12-week period to help treat hepatitis C.

Epclusa Side Effects

Epclusa, like most medications, is associated with a range of side effects. Common side effects of Epclusa include the following:

• Fatigue
• Headache
• Nausea
• Insomnia
• Muscle weakness
• Irritability

Less common and more severe side effects include the following:

• Hepatitis B reactivation
• Allergic reaction
• Depression
• Jaundice
• Stomach pain

To determine if drinking on Epclusa is a good idea, let’s first get a better understanding of the condition the medication is used to treat — hepatitis C.

Understanding Hepatitis C 

Hepatitis C is a viral infection that causes liver inflammation and infection. Untreated, hepatitis C can lead to liver damage (cirrhosis) and liver cancer. According to the Centers for Disease Control and Prevention (CDC), chronic hepatitis C is the leading cause of liver transplants.

The hepatitis C virus is spread through the blood and can cause both acute and chronic illness. Common symptoms of hepatitis C include the following:

• Fever
• Fatigue
• Loss of appetite
• Nausea and vomiting
• Abdominal pain
• Dark urine
• Jaundice

Unlike hepatitis A and B which can be prevented through vaccines, hepatitis C doesn’t have a vaccine and is treated through antivirals. Treatment is crucial, as the CDC reported 15,713 hepatitis C-related deaths in 2018, which is believed to be an underestimate. Epclusa reports a 98% cure rate, but can drinking while taking the medication affect it?

The Interaction Between Alcohol and Epclusa

No direct interactions between alcohol and Epclusa have been reported. This means that alcohol won’t directly change Epclusa’s mechanisms in how it prevents the hepatitis C virus from multiplying. 

Studies have found, however, that alcohol worsens hepatitis C. Furthermore, a study on hepatitis C and alcohol concluded that alcohol consumption can increase the risk of developing fibrosis and cirrhosis in hepatitis C patients. A different study reported similar findings and also found that heavy alcohol use impeded patients’ responses to treatment for hepatitis C.

Since Epclusa treats hepatitis C, could it block the damage that alcohol causes to the virus? 

Can You Drink Alcohol While on Epclusa?

While alcohol and Epclusa don’t have strict contraindications or direct interactions, it still isn’t a good idea to drink while taking the medication. 

Although alcohol may not directly impact the effectiveness of Epclusa, alcohol’s effects on the systems in our body can indirectly impact the medication and treatment of hepatitis C. That being said, is one drink ok while taking Epclusa?

How Much Alcohol Is Too Much?

Since alcohol affects each of us differently depending on individual factors, it’s impossible to determine a safe amount that won’t interfere with hepatitis C treatment. 

Most studies review the effects of heavy drinking on hepatitis C, but this analysis of findings from multiple studies shows that moderate drinking can also cause the progression of the disease. Let’s further examine the potential risks of mixing alcohol and Epclusa. 

Negative Effects of Drinking on Epclusa

Alcohol’s toxic effects on our organs and systems can indirectly affect Epclusa. Some negative effects of drinking while taking Epclusa include the following:

• Increased side effects. Side effects from drinking and Epclusa can overlap — causing exacerbated symptoms. This may include pounding headaches, nausea, diarrhea, and fatigue.

• Increase the risk of liver damage. Hepatitis C and alcohol use are associated with liver inflammation. Excessive drinking and ineffective treatment for hepatitis C can increase liver damage and scarring, which can lead to liver failure.
• Interfere with treatment regimen. Alcohol can also affect our inhibitions and judgment — interfering with our ability to adhere to the medication regimen of Epclusa. Taking the medication daily is crucial in ensuring the virus isn’t able to multiply and affect new cells.

Drinking while taking Epclusa isn’t recommended, but what about after discontinuing the medication? 

Can You Drink After Taking Epclusa?

Although drinking after stopping Epclusa does not impact hepatitis C treatment and may have fewer side effects, it is still not advisable.

Since alcohol is linked to lowered inhibitions and decreased judgment, it increases the chance of participating in risky behaviors like sharing needles and participating in unsafe sex. Given that the hepatitis C virus is transmitted through contaminated blood, individuals engaging in these activities may likely be at a greater risk of contracting and transmitting hepatitis C.

Alcohol not only increases the risk of contracting hepatitis C, it can also continue to worsen our liver function. Although Epclusa may treat hepatitis C and prevent further damage to our liver from the virus, alcohol also directly harms the liver — increasing the risk of liver disease and liver cancer. Drinking while taking Epclusa and after stopping Epclusa can both have adverse effects. That being said, should we panic if we’ve already had a drink?

What To Do if You Drink on Epclusa

If we’ve already unknowingly had a drink, there’s no reason to panic. In fact, panicking will increase our stress levels, which can aggravate many diseases and pathological conditions. There are five simple steps we can take if we’ve had a drink while taking Epclusa:

1. Stop drinking. One drink may not have immediate harm, but if we continue to drink, it opens the door to increased complications and potential consequences. To prevent any further harm, it's best to stop drinking now that we better understand the consequences. 
2. Monitor symptoms. Intoxication and Epclusa can cause side effects. Although we may not always experience side effects, it can be a good idea to look out for them and keep track. This way we can watch out for any dangerous symptoms and consult with a physician if needed. 
3. Consult with a physician. Since many individual factors can impact the way alcohol and Epclusa affect us, consulting with a physician can give us more personalized medical advice. Some of us may be at higher risk or be taking other medications that can directly interact with alcohol. Consulting with a physician is our safest bet.
4. Continue medication. It’s important to continue taking Epclusa as it’s prescribed. This helps to maximize the effectiveness of the medication and stop the hepatitis C virus from multiplying and spreading. 

5. Seek emergency treatment. Dangerous symptoms aren’t commonly reported but can still happen. If you experience any severe symptoms from drinking, taking Epclusa, or both, it's best to seek emergency medical treatment. In the US, call 911 for medical/safety emergencies.

It’s important to remember that not all harmful effects will be visible to us. Although we may not always experience immediate effects, alcohol is a toxic substance that can affect our body in ways we can’t see. To prevent the risk of complications, let’s review some ways we can navigate Epculsa and alcohol more intentionally.

Approaching Epclusa and Alcohol Consumption Safely

Although Epclusa and alcohol don’t have any direct interactions, mixing the two can open the door to increased complications and potential risks. Some ways we can prioritize our health and safety include the following mindful drinking practices:

• Find alternatives. Alcohol-free alternatives can be a great option for those of us who may want to continue participating in the social aspect of drinking. Try a new mocktail recipe or explore non-alcoholic options at the bar to stay on track with Epclusa treatment. 
• Be mindful of other interactions. Epclusa has direct interactions with other medications and so does alcohol. If we take any other prescription or over-the-counter medications, it’s important to check for interactions.
• Prioritize liver health. Hepatitis C and alcohol can be extremely damaging to our liver. Taking care of our liver health through quitting or cutting back on alcohol and other toxic substances can help prevent further liver damage. 
• Consult with a physician. We may have individual risk factors and reach Epclusa or alcohol differently. Consulting with a doctor regarding our personal needs can help us get personalized treatment to ensure our safety and well-being.

Hepatitis C is unpleasant but can be effectively treated with Epclusa. To give us the best chance to fight back against the virus, quitting or cutting back on alcohol is the best course of action.

To Sum it Up

Epclusa is an effective treatment for chronic hepatitis C that can be affected by alcohol, although indirectly. Drinking may not change the way Epclusa inhibits the spreading of the hepatitis C virus, but it can add to the progression of the condition and negatively affect treatment. To set us up for success, it’s best to quit or cut back on alcohol while taking Epclusa. Give hepatitis C the boot by avoiding mixing alcohol and Epclusa.