Drug Summary
Adverse Effects
Class and Mechanism
Indications
- Peginterferon alfa-2b is indicated in combination with ribavirin and an approved HCV NS3/4A protease inhibitor for adult patients with genotype 1 infection.
- Peginterferon alfa-2b is indicated in combination with ribavirin for the treatment of HCV genotypes other than 1.
- Peginterferon alfa-2b is indicated in combination with ribavirin for the treatment of HCV genotype 1 where use of an HCV NS3/4A protease inhibitor is not warranted because of contraindications, inability to tolerate, or other clinical factors.
Dosing
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Leukopenia: The dose of peginterferon alfa-2b should be reduced in patients who have a white blood cell (WBC) count in the range of 1000 to less than 1550 cells/mm3 or an absolute neutrophil count (ANC) in the range of 500 to less than 750 cells/mm3; therapy should be discontinued ;if the WBC declines to less than 1000 cells/mm3 or the ANC declines to less than 500 cells/mm3.
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Thrombocytopenia: The dose of peginterferon alfa-2b should be reduced in patients who have a platelet count in the range of 25,000 to less than 50,000 cells/mm3; therapy should be discontinued if the platelet count declines to less than 25,000 cells/mm3.
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Renal Insufficiency: If the patient has moderate renal insufficiency (creatinine clearance 30 to 50 mL/min), the dose of peginterferon alfa-2b should be reduced by 25% (from the standard dose of 1.5 mcg/kg once weekly to 1.125 mcg/kg once weekly). For patients with severe renal insufficiency (creatinine clearance 10 to 29 mL/min), including those on hemodialysis, the recommended dose of peginterferon alfa-2b should be reduced by 50% (from 1.5 mcg/kg once weekly to 0.75 mcg/kg once weekly). In addition, peginterferon alfa-2b should be discontinued if renal dysfunction develops during therapy.
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Depression: the dose of peginterferon alfa-2b may need adjusting in patients who develop depression. In general, mild depression does not require a dose adjustment, but does warrant close monitoring. For moderate depression, reduce the dose of peginterferon alfa-2b, with close follow-up, and consider psychiatric consultation. With severe depression, therapy should be discontinued, and the person should immediate psychiatric consultation should be obtained.