For people with mild to moderate renal impairment (eGFR, 30–80 mL/min/1.73 m2), no dose adjustment is required for sofosbuvir, velpatasvir, ledipasvir, voxilaprevir, glecaprevir, pibrentasvir, paritaprevir–ritonavir, ombitasvir, dasabuvir, daclatasvir, elbasvir or grazoprevir. Ribavirin is renally excreted and cannot be removed by dialysis. Ribavirin accumulates in the setting of renal impairment with creatinine clearance < 50 mL/min and can cause severe anaemia.
The product information recommends that ribavirin should not be used in individuals with an eGFR < 50 mL/min/1.73 m2. In specialist centres, ribavirin-containing regimens may be considered for those with an eGFR < 50 mL/min/1.73 m2. In this setting, ribavirin therapy should be started at a low dose, with close monitoring of haemoglobin levels.
Recommended ribavirin dose according to eGFR is: > 50 mL/min/1.73 m2, no dose adjustment; 30–50 mL/min/1.73 m2, alternating doses of 200 mg and 400 mg every other day; < 30 mL/min/1.73 m2, 200 mg daily; haemodialysis, 200 mg pre-dialysis.