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Sofosbuvir, Velpatasvir
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What is Epclusa?

Epclusa is prescribed to treat chronic hepatitis C virus infections in adults and children 3 years+. It works against different virus types regardless of severe liver damage. It contains sofosbuvir and velpatasvir. 

For advanced liver damage, Epclusa may be combined with ribavirin. Before starting, discuss medical conditions like hepatitis B, liver issues, kidney problems, HIV, and pregnancy with your healthcare provider. 

Women using Epclusa with ribavirin should avoid pregnancy during and post-treatment. When breastfeeding, consult your healthcare provider on the safest feeding method during Epclusa treatment.

How Does Epclusa Work?

Epclusa works by combining two ingredients: sofosbuvir and velpatasvir, which directly attack the hepatitis C virus. 

Sofosbuvir acts by blocking an enzyme known as NS5B, which is crucial for the virus to replicate itself inside liver cells. This action prevents the virus from making copies of itself, essentially halting its ability to spread and cause further damage to the liver.

Velpatasvir targets another protein called NS5A, which is involved in the virus’s ability to assemble and spread within the body. By blocking NS5A, Epclusa further disrupts the virus’s lifecycle, preventing it from infecting new cells and continuing its harmful effects.

Dosage Information and Usage

Dosage Form and Strengths of Epclusa

Epclusa is available in two forms for oral use: tablets and oral pellets.


  • 400 mg sofosbuvir + 100 mg velpatasvir (pink, film-coated)
  • 200 mg sofosbuvir + 50 mg velpatasvir (pink, film-coated)

Oral Pellets:

  • 200 mg sofosbuvir + 50 mg velpatasvir (white to off-white, in unit-dose packets)
  • 150 mg sofosbuvir + 37.5 mg velpatasvir (white to off-white, in unit-dose packets)


Epclusa is prescribed for the treatment of chronic hepatitis C virus (HCV) infection in patients aged 3 years and older. 

The recommended dosage depends on the patient’s age, weight, and severity of liver disease. 

For adults, the usual dose is one 400 mg/100 mg tablet taken orally once daily with or without food. Pediatric patients, depending on their weight, may take either oral pellets or tablets once daily as prescribed by their healthcare provider. 

It’s important to follow your healthcare provider’s instructions carefully and not miss doses, as this can affect the effectiveness of the treatment. 

If your child has difficulty swallowing tablets, your healthcare provider may recommend oral pellets, which can be mixed with non-acidic soft foods for easier administration.

Storage Information

Store Epclusa tablets and oral pellets below 30°C (86°F). Keep the tablets in their original bottle with a child-resistant cap. Each bottle contains 28 tablets. 

For oral pellets, keep them in their original cartons. Do not use the oral pellets if the seal on the carton or packet is broken or damaged.

Side Effects of Epclusa

Common Side Effects

  • Headache
  • Tiredness
  • Nausea (especially when used with ribavirin)
  • Trouble sleeping (especially when used with ribavirin)
  • Diarrhea (especially when used with ribavirin)
  • Vomiting (more common in children under 6 years old)

Serious but Rare Side Effects:

  • Reactivation of hepatitis B virus
  • Slow heart rate (bradycardia), especially when taken with amiodarone, which can lead to:
    • Fainting or near-fainting
    • Dizziness or lightheadedness
    • Feeling unwell
    • Weakness
    • Extreme tiredness
    • Shortness of breath
    • Chest pains
    • Confusion
    • Memory problems

Warnings and Precautions

  • Risk of Hepatitis B Virus Reactivation: Epclusa can reactivate hepatitis B in patients with both hepatitis C and B, leading to severe liver problems like fulminant hepatitis (acute liver failure), liver failure, and even death. Patients should be tested for HBV before starting Epclusa and monitored during and after treatment.
  • Serious Symptomatic Bradycardia: Taking Epclusa with amiodarone, a heart medication, can cause a dangerously slow heart rate (bradycardia) with severe symptoms such as fainting, dizziness, extreme tiredness, shortness of breath, chest pain, and confusion. Patients may need close heart monitoring if they need both medications.
  • Risk of Reduced Effectiveness with Certain Drugs: Some drugs, like rifampin, St. John’s wort, and carbamazepine, can reduce the effectiveness of Epclusa by lowering its blood levels. Patients should avoid these drugs while on Epclusa.
  • Risks with Ribavirin Combination Treatment: When used with ribavirin, Epclusa carries the additional risks associated with ribavirin, such as anemia, birth defects, and heart problems. Patients should follow ribavirin-specific warnings and precautions.

Overdosage of Epclusa

If someone takes too much Epclusa, there is no specific antidote to counteract the overdose. The patient needs to be watched closely for any signs of toxicity. 

Treatment involves general supportive care, which means checking vital signs and observing the patient’s overall condition. 

Hemodialysis can help remove a significant amount of the main metabolite of sofosbuvir (a component of Epclusa), but it is not very effective for removing velpatasvir, another component of Epclusa, because it binds strongly to proteins in the blood.

Drug Interactions With Other Medications

  • Drugs that Lower Epclusa’s Effectiveness: Some drugs, such as rifampin (used for tuberculosis) and St. John’s wort (a herbal supplement for depression), can decrease the levels of Epclusa in your blood, making it less effective. It’s important to avoid using these drugs while taking Epclusa.
  • Epclusa Increasing Other Drugs’ Levels: Epclusa can increase the levels of certain drugs in your body by affecting transport proteins like P-gp and BCRP. This means other medications you are taking might need their doses adjusted to avoid potential side effects.
  • Liver Function Changes: Epclusa can change how your liver functions, which might impact how other medications work. This is particularly important for people with diabetes, as it can affect blood sugar control, or those taking warfarin, as it can affect blood clotting. Regular monitoring of blood sugar and blood clotting parameters is recommended.
  • Acid Reducing Agents: Medications that reduce stomach acid, such as antacids, H2-receptor antagonists (like famotidine), and proton-pump inhibitors (like omeprazole), can lower the levels of velpatasvir in Epclusa. To prevent this, antacids should be taken at least 4 hours apart from Epclusa. For H2-receptor antagonists, they can be taken at the same time or 12 hours apart. Proton-pump inhibitors should generally be avoided, but if necessary, Epclusa should be taken with food and at least 4 hours before the proton-pump inhibitor.
  • Antiarrhythmics: Amiodarone, a medication used to treat irregular heartbeats, can cause a dangerously slow heart rate when taken with Epclusa. If you need to take both, you should be monitored closely in a hospital setting, especially during the first 48 hours of starting this combination, and continue monitoring your heart rate at home for at least the first two weeks.
  • Anticancer Drugs: The anticancer drug topotecan can increase in your body if taken with Epclusa, which might lead to more side effects. Therefore, this combination is not recommended.
  • Anticonvulsants: Medications used to control seizures, such as carbamazepine, phenytoin, and phenobarbital, can lower the levels of Epclusa, making it less effective. These drugs should be avoided while taking Epclusa.
  • Antimycobacterials: Medications like rifabutin, rifampin, and rifapentine, used to treat infections like tuberculosis, can reduce the levels of Epclusa, decreasing its effectiveness. Avoid using these medications with Epclusa.
  • HIV Antiretrovirals: Some HIV medications, like efavirenz and those containing tenofovir DF, can interact with Epclusa. This can either decrease Epclusa’s effectiveness or increase the levels of tenofovir, leading to side effects. Close monitoring and possibly adjusting the dose of these HIV medications is necessary.
  • Herbal Supplements: St. John’s wort, a herbal supplement for depression, can lower the levels of Epclusa, making it less effective. It’s important not to use St. John’s wort while taking Epclusa.
  • HMG-CoA Reductase Inhibitors: Medications like rosuvastatin and atorvastatin, used to lower cholesterol, can increase in concentration when taken with Epclusa, raising the risk of muscle problems such as myopathy or rhabdomyolysis. If you need to take these drugs with Epclusa, your doctor may lower the dose of the cholesterol medication and monitor you closely for muscle-related side effects.

Cost & Discounts

Epclusa Canada

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The most important thing to know about Epclusa is that it can cause serious side effects, including hepatitis B virus reactivation. Before starting treatment, your healthcare provider will test you for hepatitis B. If you’ve had hepatitis B before, the virus could become active again during or after treatment with Epclusa, leading to severe liver problems or even death.

Epclusa is a prescription drug for treating chronic hepatitis C virus (HCV) infections in adults and children aged 3+. It combats various HCV genotypes (1-6), with or without cirrhosis. In advanced cirrhosis, it’s used with ribavirin. Epclusa contains sofosbuvir and velpatasvir. Note: Safety and effectiveness in children under 3 years old are not established.

Before taking Epclusa, tell your healthcare provider about the following:

  • If you’ve had hepatitis B virus infection in the past.
  • Any liver problems other than hepatitis C infection.
  • History of liver transplant.
  • Kidney problems or if you are on dialysis.
  • HIV-1 infection status.
  • If you are pregnant, breastfeeding, or planning to become pregnant or breastfeed.
  • All medications you take, including prescriptions, over-the-counter medicines, vitamins, and herbal supplements.

Yes, you can use Epclusa to treat your Hepatitis C while in recovery. It’s a key step in improving your overall health. Epclusa can be taken with certain medication-assisted treatments.

For most patients, Epclusa doesn’t require additional medicines to treat Hepatitis C. It’s a single daily medication that can be taken with or without food, containing all the necessary medications. In cases of advanced cirrhosis, Epclusa may be taken with ribavirin. If your healthcare provider suggests this combination, it’s crucial to follow their instructions closely.

Yes, Epclusa may still work for you even if previous Hepatitis C treatments didn’t succeed. It has been effective in treating chronic Hepatitis C in patients who didn’t respond to prior therapies that included medications like peginterferon alfa, ribavirin, and protease inhibitors such as Incivek (telaprevir) or Victrelis (boceprevir).

Yes, you can take Epclusa for chronic hepatitis C, even with cirrhosis. If your cirrhosis is advanced, your doctor may suggest using Epclusa with ribavirin. Consult your doctor to see if Epclusa is right for you. Even with cirrhosis, Epclusa can effectively treat your hepatitis C.

Yes, you should consult your healthcare provider to see if it’s safe to take Epclusa while on birth control.

Epclusa can interact with other medicines you’re taking. Tell your healthcare provider about all your current medications – prescriptions, over-the-counter drugs, vitamins, and herbal supplements. This ensures your safety and the treatment’s effectiveness.

You take Epclusa for a total of 12 weeks, regardless of your hepatitis C genotype.

Epclusa stays in your system for about 3 days after the last dose. This duration is determined based on the half-life of velpatasvir, which is 15 hours, and sofosbuvir, which is 0.5 hours. The half-life represents the time it takes for half of the medication to be eliminated from your body.

Epclusa received FDA and European Medicines Agency approval in 2016. It treats adult patients with chronic hepatitis C virus (HCV), with or without advanced liver disease (cirrhosis). For those with severe cirrhosis, it’s used with ribavirin. Epclusa combines sofosbuvir (2013) and velpatasvir, the first treatment for all major HCV forms.

There are no known interactions between Epclusa and alcohol. However, it’s advisable to consult with your doctor regarding alcohol consumption during Epclusa treatment. Alcohol can potentially worsen hepatitis C, which Epclusa is intended to treat effectively.

The recommended dose of Epclusa for adults is one tablet taken orally once a day. Each tablet contains 400 mg of sofosbuvir and 100 mg of velpatasvir. You can take it with or without food.

Yes, you can take Epclusa at night. It’s flexible and can be taken in the morning or evening, whichever suits your routine best. The key is to take it around the same time every day to help you remember. Many people find it easier to take in the morning right after waking up.

Epclusa is a prescription medication used to treat chronic hepatitis C virus (HCV) infection in adults and children.

Yes, Epclusa has the potential to cause liver problems, although this is rare. Your healthcare provider will monitor your liver function during and after treatment to ensure your safety. If you experience any symptoms of liver problems such as jaundice (yellowing of the skin or eyes), dark urine, or abdominal pain, contact your healthcare provider immediately.

Taking Epclusa during pregnancy is generally not recommended due to insufficient data on its safety for pregnant women.

No, Epclusa does not have a generic version. However, the same medications are available under the generic name sofosbuvir/velpatasvir.

Epclusa has been associated with the reactivation of hepatitis B virus (HBV), which can cause symptoms such as fever and joint pain.

Epclusa may cause anemia, particularly in people with cirrhosis, as a common side effect. Anemia can result in symptoms like pale skin, tiredness, feeling light-headed, shortness of breath, and cold hands and feet.

Epclusa is taken orally once a day, either with or without food. Swallow the tablet whole with a full glass of water; do not crush, chew, or break it. It’s advisable to take Epclusa at approximately the same time each day to maintain consistency. Continue taking Epclusa for the entire duration prescribed by your healthcare provider, which is typically 12 weeks.