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Hepatitis E Medication

  • Author: Prospere Remy, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Jul 14, 2016
 

Medication Summary

Medical therapy consists of electrolyte repletion and stabilization.

Ribavirin may be considered in severe acute hepatitis E or chronic hepatitis E of transplant recipients who are not able to clear HEV after immunosuppression is reduced (see "Treatment of chronic HEV infection" in Medical Management). Pegylated interferon alfa, if not contraindicated, is an alternate treatment option for patients with chronic hepatitis E infection who develop ribavirin-treatment failure. Sofosbuvir is a potential treatment option for HEV infection; however, to date, no data exist regarding its in-vivo effect.

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Electrolytes

Class Summary

Electrolytes are necessary in patients with profound malnutrition or dehydration. They may be replaced orally or parenterally, depending on the clinical state of the patient.

Potassium chloride

 

Potassium is essential for transmission of nerve impulses, contraction of cardiac muscle, maintenance of intracellular tonicity, skeletal and smooth muscles, and maintenance of normal renal function. Gradual potassium depletion occurs via renal excretion or GI loss or because of low intake. Depletion may result from severe diarrhea.

Potassium depletion sufficient to cause 1 mEq/L drop in the serum potassium level requires a loss of approximately 100-200 mEq of potassium from the total body store.

Calcium gluconate

 

Calcium moderates nerve and muscle performance and facilitates normal cardiac function. It can be given intravenously initially, and calcium levels can be maintained with a high calcium diet. Some patients require oral calcium supplementation. The 10% IV solution provides 100 mg/mL of calcium gluconate that equals 9 mg/mL (0.46 mEq/mL) of elemental calcium. One 10 mL ampule contains 93 mg of elemental calcium

Potassium phosphate

 

For severe hypophosphatemia (< 1 mg/dL), parenteral preparations of phosphate should be used for repletion. IV preparations are available as sodium or potassium phosphate (K2PO4). Response to IV serum phosphorus supplementation is highly variable and is associated with hyperphosphatemia, and hypocalcemia. The rate of infusion and choice of initial dosage should be based on severity of hypophosphatemia and presence of symptoms. Serum phosphate and calcium should be monitored closely.

For less severe hypophosphatemia (1-2 mg/dL), PO phosphate salt preparations can be used. PO preparations are available as sodium or potassium phosphate in capsule or liquid form. Neutra-Phos packets contain 250 mg of phosphorus/packet. Tablets contain either 250, 125.6, or 114 mg each. Liquid preparations are available as 250 mg/75 mL.

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Antiviral Agent, Oral

Ribavirin

 

Ribavirin may improve liver enzymes and functions in severe acute hepatitis E. Ribavirin monotherapy for at least 3 months seems to be the first treatment option for patients with chronic hepatitis E who are not able to clear the hepatitis E virus (HEV) after immunosuppression is reduced.

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Hepatitis B/Hepatitis C Agents

Peginterferon alfa 2a (Pegasys, Pegasys ProClick)

 

Pegylated interferon alfa monotherapy is an alternate treatment option for patients with chronic hepatitis E who develop ribavirin treatment failure. However, this medication is contraindicated in transplant patients.

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Contributor Information and Disclosures
Author

Prospere Remy, MD Assistant Professor of Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Internal Medicine, Bronx-Lebanon Hospital Center

Prospere Remy, MD is a member of the following medical societies: American College of Physicians, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

David Widjaja, MD Attending Physician, Department of Medicine (Gastroenterology), Bronx Lebanon Hospital Center

David Widjaja, MD is a member of the following medical societies: American College of Physicians, Indonesian Medical Association

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

David Eric Bernstein, MD Director of Hepatology, North Shore University Hospital; Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Kenneth D Flora, MD Adjunct Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Oregon Health Sciences University School of Medicine; Consulting Staff, Department of Gastroenterology, The Oregon Clinic

Kenneth D Flora, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Kenneth Ingram, PAC Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University School of Medicine

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Jonathan M Schwartz, MD Associate Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Sciences University School of Medicine

Jonathan M Schwartz, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and American Hepato-Pancreato-Biliary Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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