Neutropenia ribavirin

Common side effects of peginterferon are given in Table 25-10. Common side effects of ribavirin are fatigue, flu-like symptoms, neutropenia, thrombocytopenia, and anemia. 

Bone marrow toxicity Peginterferon alfa-2a suppresses bone marrow function and may result in severe cytopenias. Ribavirin may potentiate the neutropenia and lymphopenia induced by alpha interferons including peginterferon alfa-2a. Alpha interferons may be associated with aplastic anemia very rarely. 

Peg Interferon Alfa 2b (PEG-Intron) [Antiviral/ Immunomodulator] WARNING Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disord s. Monitor pts closely Uses Rx Hep C Action Immune modulation Dose 1 mcg/kg/wk SQ 1.5 mcg/kg/wk combined w/ ribavirin Caution [C, X if used w/ ribavirin /-] w/ Hx psychiatric Contra Autoimmune H, decompensated Uvct Dz, hemoglobinopathy Disp Vials 50, 80, 120, 150 mcg/0.5 mL Redipen 50, 80,120,150 mcg/5 mL reconstitute w/ 0.7 mL w/ sterile water SE D ession, insomnia, suicidal behavior, GI upset, neutropenia, thrombocytopenia, alopecia, pruritus Interactions t Myelosuppression W/ antineoplastics t effects OF doxorubicin, theophylline t neurotox W7 vinblastine EMS See Peg Interf on Alfa-2a may cause flu-like Sxs... 

Zidovudine NRTI1 200 mg tid or 300 mg bid3 Macrocytic anemia, neutropenia, nausea, headache, insomnia, asthenia Avoid concurrent stavudine and myelosuppressive drugs (eg, ganciclovir, ribavirin)... 

In one study in 119 patients treated with interferon alfa and ribavirin for chronic hepatitis C, in whom neutropenia was not considered as a cause for exclusion or dosage modification, the neutrophil count fell by an average of 34% (31-74%) (226). During the course of treatment, 32 patients had at least one neutrophil count below 1 X 10 /1, 11 had a neutrophil count below 0.75 x 10 /1, and 2 had a neutrophil count below 0.5 x 10 /1 however, none of these patients required dosage modification because of neutropenia. None of the 22 patients who developed documented or suspected bacterial infections... 

Soza A, Everhart JE, Ghany MG, Doo E, Heller T, Promrat K, Park Y, Liang TJ, Hoofnagle JH. Neutropenia during combination therapy of interferon alfa and ribavirin for chronic hepatitis C. Hepatology 2002 36(5) 1273-9. 

Hematologic Factors that could help predict hematological abnormalities in patients with chronic hepatitis C taking pegylated interferon and ribavirin have been studied in 136 patients over 4 years, of whom 52 developed neutropenia (n = 28), anemia (30), or thrombocytopenia (11). Genotype 1, a history of hypertension, a low baseline platelet count, a low baseline hemoglobin, and a raised serum creatinine concentration were significant factors [31 ]. 

A meta-analysis examining the efficacy and safety of pegylated IFNa-2a- and IFNa-2b-ribavirin in children and adolescents with chronic hepatitis C revealed incidences of anaemia 11%, neutropenia 32%, leucopenia 52%, thrombocytopenia 5%, alopecia 13%, injection site erythema 27% and pruritus 10%. Discontinuation due to adverse events and viral breakthrough were each 4%. Small inhibitions of growth were seen during treatment [30 ]. 

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