Bulevirtide
Hepatitis B antivirals
Hepatitis B antivirals
An injected peptide that blocks the liver receptor used by hepatitis B and D viruses to enter cells; it treats chronic hepatitis D.
Quick facts
- Group
- Hepatitis B antivirals
- Target
- Sodium taurocholate co-transporting polypeptide (NTCP)
- Used for
- Chronic hepatitis delta
- Key effects
- Redness · Headache · Itching
- Monitor
- HDV RNA and HBV DNA · Liver enzymes
- ATC
- J05AX28
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows bulevirtide bound to human NTCP; the highlighted ligand is its myristoyl (fatty acid) anchor.
Bulevirtide is a myristoylated peptide copied from the receptor-binding part of the hepatitis B surface protein. It binds NTCP, the bile acid transporter that hepatitis B virus (and hepatitis D virus, which uses the HBV envelope) needs to enter liver cells. Blocking entry stops new liver cells being infected. It does not remove virus already inside cells, so treatment is long.
- HBV and HDV use NTCP to enter liver cells
- Bulevirtide binds NTCP
- Virus cannot enter new liver cells
- Infection of new cells stops
Indications
- Chronic hepatitis delta (HDV) infection in selected adults Viral hepatitis →
Adverse effects
Common
- Redness, itching, bruising, pain or swelling at the injection site
- Headache
- Itching
- Abdominal pain and tiredness
Contraindications
- Hypersensitivity to bulevirtide
Key interactions
- Other medicines and supplements
- All are reviewed with the team before starting
What is monitored
- HDV RNA and HBV DNA
- Liver enzymes
- Liver tests for months after stopping
Administration and safety
- Powder mixed only with the supplied water; the solution must be clear and colourless
- Injected under the skin of the thigh or abdomen once a day
- The patient or caregiver is trained before the first injection
Pregnancy and breastfeeding
Human data are lacking; benefit and risk are weighed with the hepatology team.
Nursing care
- Teach injection technique and site rotation
- Teach not to stop suddenly: hepatitis can flare
- Check for allergy symptoms after early doses
- Arrange regular liver and viral load tests
Pharmacokinetics
- Absorption
- Subcutaneous injection; peptides are not absorbed by mouth
Test yourself
Think of the answer, then tap the question to see it.
What receptor does bulevirtide block?
NTCP, the liver bile acid transporter used by hepatitis B and D viruses to enter cells.
Why does hepatitis D depend on NTCP?
Hepatitis D virus uses the hepatitis B envelope, which binds NTCP.
What may happen after bulevirtide is stopped?
Hepatitis D or B can flare, so liver tests continue for months.
Connections
← Back to the class: Hepatitis B antivirals
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Bulevirtide-gmod Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Cryo-EM structure of human NTCP-Bulevirtide complex (RCSB Protein Data Bank, 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.