bulevirtide bulevirtide bulevirtide, sold under the brand name hepcludex, is an antiviral medication for the treatment of chronic hepatitis d (in the presence of hepatitis b). bulevirtideclinical datatrade nameshepcludexother namesmyrb, myrcludex-blicense data eu ema: by inn routes ofadministrationsubcutaneousatc codej05ax28 (who) legal statuslegal status uk: pom (prescription only) eu: rx-only identifierscas number2012558-47-1drugbankdb15248uniiwkm56h3tlbkeggd11877as salt: d11878chemblchembl4297711chemical and physical dataformulac248h355n65o72molar mass5398.951 g·mol−13d model (jsmol)interactive image smiles cccccccccccccc(=o)ncc(=o)n(c(=o)n(cc(n)=o)c(=o)n(cc(c)c)c(=o)n(co)c(=o)n(c(=o)n1ccc1c(=o)n(cc(n)=o)c(=o)n1ccc1c(=o)n(cc(c)c)c(=o)ncc(=o)n(cc1ccccc1)c(=o)n(cc1ccccc1)c(=o)n1ccc1c(=o)n(cc(=o)o)c(=o)n(cc1ccn1)c(=o)n(ccc(n)=o)c(=o)n(cc(c)c)c(=o)n(cc(=o)o)c(=o)n1ccc1c(=o)n(c)c(=o)n(cc1ccccc1)c(=o)ncc(=o)n(c)c(=o)n(cc(n)=o)c(=o)n(co)c(=o)n(cc(n)=o)c(=o)n(cc(n)=o)c(=o)n1ccc1c(=o)n(cc(=o)o)c(=o)n(cc1cc2ccccc12)c(=o)n(cc(=o)o)c(=o)n(cc1ccccc1)c(=o)n(cc(n)=o)c(=o)n1ccc1c(=o)n(cc(n)=o)c(=o)n(ccccn)c(=o)n(cc(=o)o)c(=o)n(cc1ccn1)c(=o)n(cc1cc2ccccc12)c(=o)n1ccc1c(=o)n(ccc(=o)o)c(=o)n(c)c(=o)n(cc(n)=o)c(=o)n(ccccn)c(=o)n(c(=o)ncc(n)=o)c(c)c)c(c)c)(c)o inchi 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the most common side effects include raised levels of bile salts in the blood and reactions at the site of injection. bulevirtide works by attaching to and blocking a receptor (target) through which the hepatitis delta and hepatitis b viruses enter liver cells. by blocking the entry of the virus into the cells, it limits the ability of hdv to replicate and its effects in the body, reducing symptoms of the disease. bulevirtide was approved for medical use in the european union in july 2020. structural formula bulevirtide is a 47-amino acid peptide with the following sequence: ch3(ch2)12co-gly-thr-asn-leu-ser-val-pro-asn-pro-leu-gly-phe-phe-pro-asp-his-gln-leu-asp-pro-ala-phe-gly-ala-asn-ser-asn-asn-pro-asp-trp-asp-phe-asn-pro-asn-lys-asp-his-trp-pro-glu-ala-asn-lys-val-gly-nh2 (c13h27co-gtnlsvpnplgffpdhqldpafgansnnpdwdfnpnkdhwpeankvg-nh2) medical uses bulevirtide is indicated for the treatment of chronic hepatitis delta virus (hdv) infection in plasma (or serum) hdv-rna positive adult patients with compensated liver disease. pharmacology mechanism of action bulevirtide binds and inactivates the sodium/bile acid cotransporter, blocking both viruses from entering hepatocytes. the hepatitis b virus uses its surface lipopeptide pre-s1 for docking to mature liver cells via their sodium/bile acid cotransporter (ntcp) and subsequently entering the cells. myrcludex b is a synthetic n-acylated pre-s1 that can also dock to ntcp, blocking the virus's entry mechanism. the drug is also effective against hepatitis d because the hepatitis d virus is only effective in the presence of a hepatitis b virus infection.