Drug Summary
Adverse Effects
Class and Mechanism
Indications
Dosing
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Leukopenia: The dose of peginterferon alfa-2a should be reduced to 135 mcg in patients who have an absolute neutrophil count (ANC) that declines to less than 750 cells/mm3; if the ANC declines to less than 500 cells/mm3, discontinue peginterferon alfa-2a until the ANC rises to greater than 1000 cells/mm3 and then restart at 90 mcg with close monitoring of the ANC.
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Thrombocytopenia: The dose of peginterferon alfa-2a should be reduced to 90 mcg in patients who have a decline in platelet count to a less than 50,000 cells/mm3; discontinue therapy if the platelet count declines to less than 25,000 cells/mm3.
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Renal Insufficiency: If the creatinine clearance is less than 30 mL/min or the patient is on hemodialysis, the dose of peginterferon alfa-2a should be reduced to 135 mcg and the patient should have close monitoring for any signs of medication toxicity. If toxicity (laboratory or clinical) develops, the dose of peginterferon alfa-2a can be reduced further to 90 mcg.
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Increased Alanine Transaminase (ALT): In patients who have persistent elevations in ALT levels above baseline, the recommendation is to have increased frequency of monitoring and reduce the dose of peginterferon alfa-2a to 135 mcg.
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Depression: the dose of peginterferon alfa-2a 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, the dose of peginterferon alfa-2a should be reduced to 135 mcg (or 90 mcg in some instances), with close follow-up and consideration for psychiatric consultation. With severe depression, therapy should be discontinued and the patient should immediate psychiatric consultation should be obtained.