11D Viral infections
INFECTIONS & INFESTATIONS
;
Also: Interferon alfa-2b
INTRON A SOLUTION MULTIDOSE PENS
Interferon alfa-2b, recombinant; 18million IU, 30million
IU, 60million IU; per pen; for SC inj; contains m-cresol.
Indications: Chronic hepatitis C. Chronic hepatitis B.
Adults: Use appropriate preparation and route: see
literature. Use SC route if platelets ;
50,000/mm3.
Hepatitis C: 3million IU IM or SC three times weekly for
16 wks; if tolerated with normalization of ALT, continue
to 18–24 months ( 72–96 wks). Hepatitis B: 5million
IU daily or 10million IU IM or SC three times weekly
for 16 wks; reduce dose by ½ or interrupt dose if
WBCs, granulocyte or platelet count decreases.
Children: ;1yr: not recommended. Use appropriate
preparation and route: see literature. ;1yr of age for
chronic hepatitis B: 3million IU/m2 SC three times
weekly for 1 week, then increase to 6million IU/m2
(max 10million IU) three times weekly for a total of
16–24 weeks; reduce dose by ½ or interrupt dose if
WBCs, granulocytes or platelet counts decrease.
Contraindications: Hepatitis: decompensated liver
disease. Autoimmune disorders.
Warnings/Precautions: May cause or exacerbate
fatal or life-threatening neuropsychiatric, autoimmune,
ischemic, or infectious disorders: monitor closely,
discontinue if they worsen. Severe psychiatric
disorders (esp. depression). Cardiovascular or
pulmonary disease. Severe myelosuppression.
Uncontrolled thyroid abnormalities. Diabetes.
Coagulation disorders. Maintain adequate hydration.
Monitor blood, thyroid, visual and liver function before
and during therapy; EKG in cardiovascular disease
and cancer patients. Psoriasis. Renal dysfunction.
Transplant recipients. Elderly. Debilitated. Pregnancy
(Cat.C). Nursing mothers: not recommended.
Interactions: Caution with myelosuppressives, and
drugs that can exacerbate depression. May potentiate
theophylline (may double its levels).
Adverse reactions: Flu-like symptoms (fever,
headache, myalgia, fatigue); hepatic, hematologic,
respiratory, skin, genitourinary system, CNS,
cardiovascular, endocrine (esp thyroid), GI, or visual
disorders; colitis, hypertriglyceridemia, pancreatitis,
infections, injection site reactions; others (see
literature).
How supplied: Pwd (w. diluent): 10million,
18million, 50million IU/vial– 1; Soln (vials): 10million
IU/vial– 6 (kit w. supplies); Soln (multidose vials):
18million, 25million IU/vial– 1; Soln (multidose pens,
6 doses/pen): 3million IU/0.2mL, 5million IU/0.2mL,
10million IU/0.2mL– 1
;LAMIVUDINE
EPIVIR GlaxoSmithKline
Nucleoside analogue (reverse transcriptase inhibitor).
Lamivudine 150mg (;), 300mg; tabs; (;) scored.
Also: Lamivudine
EPIVIR ORAL SOLUTION
Lamivudine 10mg/mL; strawberry-banana flavor;
contains sucrose 3g/15mL.
Indications: HIV infection.
;
Adults and Children: ;3months: not
recommended. 3months–16years: 4mg/kg (max
150mg) twice daily; renal impairment: reduce
dose or prolong dosing interval. ;16years, CrCl
;50mL/min: 300mg once daily or 150mg twice
daily; CrCl 30–49mL/min: 150mg once daily; CrCl
15–29mL/min: 150mg for 1st dose then 100mg once
daily; CrCl 5–14mL/min: 150mg for 1st dose then
50mg once daily; CrCl ;5mL/min: 50mg for 1st dose
then 25mg once daily.
Warnings/Precautions: Discontinue if pancreatitis
(increased risk in pediatric patients) or lactic acidosis
occurs. Suspend therapy if hepatotoxicity (eg,
hepatomegaly, steatosis) occurs. Women, obesity,
or prolonged nucleoside exposure: increased risk of
toxicity (ie, lactic acidosis, steatosis). Hepatitis B
(monitor for post-treatment exacerbation). Other liver
disease risk factors. Diabetes (oral soln). Children
with prior antiretroviral nucleoside exposure, history of
pancreatitis or risk factors for pancreatitis. Pregnancy
(Cat.C). Nursing mothers: not recommended.
Interactions: Concomitant zalcitabine: not
recommended. Avoid concomitant drugs that contain
lamivudine or emtricitabine. Caution with drugs
eliminated by active organic cationic secretion (eg,
trimethoprim). Increased lamivudine absorption
with TMP/SMX (clinical significance unknown).
Triple therapy (once daily regimen) with abacavir ;
tenofovir or with didanosine ; tenofovir: high rate of
early viral non-response (see literature). Monitor for
treatment-associated toxicities with interferon-alpha
with or without ribavirin.
Adverse reactions: Adults: headache, malaise,
fever, GI upset, neuropathy, dizziness, sleep or
depressive disorders, rash, respiratory effects,
musculoskeletal pain, lactic acidosis, severe
hepatomegaly with steatosis, fat redistribution,
neutropenia, abnormal liver function tests. Children:
pancreatitis, paresthesias, peripheral neuropathy,
fever, rash, respiratory effects, neutropenia, anemia,
abnormal liver function tests.
Note: Register pregnant patients exposed to
lamivudine by calling (800) 258-4263.
How supplied: Tabs 150mg– 60; 300mg– 30;
Soln–240mL
;LAMIVUDINE
EPIVIR-HBV GlaxoSmithKline
Nucleoside analogue (reverse transcriptase inhibitor).
Lamivudine 100mg; tabs.
Also: Lamivudine
EPIVIR-HBV ORAL SOLUTION
Lamivudine 5mg/mL; strawberry-banana flavor.
Indications: Chronic hepatitis B associated with
viral replication and active liver inflammation.
Adults: 100mg once daily. Renal impairment: CrCl
30–49mL/min: 100mg for 1st dose then 50mg once
daily; CrCl 15–29mL/min: 100mg for 1st dose then
25mg once daily; CrCl 5–14mL/min: 35mg for 1st
dose then 15mg once daily; CrCl ;5mL/min: 35mg
for 1st dose then 10mg once daily.
;
