[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Hepatitis B antivirals](https://durgical.com/en/pharmacology/classes/hepatitis-b-antivirals/) › Bulevirtide

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Hepatitis B antivirals](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

⇄**Sodium taurocholate co-transporting polypeptide (NTCP)**Bulevirtide

ⓘ The figure shows bulevirtide bound to human NTCP; the highlighted ligand is its myristoyl (fatty acid) anchor.

**Target in 3D:** Sodium taurocholate co-transporting polypeptide (NTCP). PDB structure 8RQF (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8RQF) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/viral-hepatitis/)

## Adverse effects

### Common

- Redness, itching, bruising, pain or swelling at the injection site
- Headache
- Itching
- Abdominal pain and tiredness

### Serious (rare, important)

- Severe flare of hepatitis D or B after stopping
- Serious allergic reactions

## 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

## Memory aid

BULE-virtide: a «bully» at the door of the liver cell (NTCP) that keeps B and D out.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/bulevirtide/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Entecavir](https://durgical.com/en/pharmacology/entecavir/)
- [Tenofovir disoproxil](https://durgical.com/en/pharmacology/tenofovir-disoproxil/)
- [Interferon alfa](https://durgical.com/en/pharmacology/interferon-alfa/)

## Related conditions 1

- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)

[← Back to the class: Hepatitis B antivirals](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a626071.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Cryo-EM structure of human NTCP-Bulevirtide complex](https://www.rcsb.org/structure/8RQF) (RCSB Protein Data Bank, 2024); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AX28) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/bulevirtide/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/bulevirtide/