Viral Hepatitis in Emergency Medicine Medication

  • Author: Adrienne M Buggs, MD, FACEP, FAAEM; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Aug 23, 2011
 

Medication Summary

Certain patients may benefit from pharmacologic therapy. For chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections in particular, the goals of therapy are to reduce liver inflammation and fibrosis and to prevent progression to cirrhosis and its complications.

Because the treatment regimens for hepatitis are being actively researched, medication recommendations, indications, and dosages are all subject to change. Make any decision to administer medications in consultation with a gastroenterologist or a hepatologist.

In addition to the medications listed below, the nucleoside analogues lamivudine and adefovir have shown promising results in the treatment of patients with chronic HBV. Other antiviral agents that are being studied for treatment of chronic HBV include entecavir and tenofovir. In addition to being active against HBV, lamivudine, adefovir and tenofovir are also active against human immunodeficiency virus (HIV), making them useful in the treatment of patients who are co-infected with HBV and HIV.

For patients with chronic HCV infection, one current treatment option is combination therapy with pegylated interferon (PEG-IFN) and the antiviral ribavirin. This regimen may be recommended for a certain subset of patients with moderate or severe inflammation and/or fibrosis. The combination of the 2 drugs provides a more sustained clearance of HCV RNA from the serum of infected individuals when compared to monotherapy. Other therapeutic options are being explored for treatment of chronic HCV with the goals of increasing efficacy and decreasing toxicity. These include protease inhibitors, ribozymes, and viral vaccines.

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Interferons

Class Summary

These are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons may be given topically, systemically, and intralesionally.

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Interferon alpha-2b (Intron A)

 

Protein product manufactured by recombinant DNA technology that uses genetically engineered Escherichia coli bacterium.

Mechanisms by which it exerts antiviral activity are not clearly understood; however, modulation of host-immune response may play an important role.

Induces remission in 25-50% of patients with chronic HBV and 40% of patients with chronic HCV and decreases abnormal aminotransferase concentrations in chronic HBV/HCV. Also may play a role in delaying or preventing development of hepatocellular cancer, independent of its antiviral effect, in patients with cirrhosis.

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Antivirals

Class Summary

These agents inhibit viral replication.

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Amantadine (Symmetrel)

 

Antiviral agent that prevents penetration of virus into host by inhibiting uncoating of virus; may be useful in patients with HCV who do not respond to interferon.

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Famciclovir (Famvir)

 

Prodrug that, when biotransformed into active metabolite penciclovir, may inhibit viral DNA synthesis/replication.

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Entecavir (Baraclude)

 

Guanosine nucleoside analogue with activity against HBV polymerase. Competes with natural substrate deoxyguanosine triphosphate to inhibit HBV polymerase activity (ie, reverse transcriptase). Less effective for lamivudine-refractory HBV infection. Indicated for treatment of chronic hepatitis B infection. Available as tab and oral solution (0.05 mg/mL; 0.5 mg = 10 mL).

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Corticosteroids

Class Summary

These agents may be used in cholestatic HAV. A brief course may shorten the illness; however, it may be most effective in a milder disease.

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Prednisone (Deltasone, Sterapred, Orasone)

 

Inactive and must be metabolized to active metabolite prednisolone; conversion may be impaired in patients with liver disease.

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Contributor Information and Disclosures
Author

Adrienne M Buggs, MD, FACEP, FAAEM  Medical Director, Drug Enforcement Administration Training Academy Health Unit

Adrienne M Buggs, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

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

Joseph K Lim, MD  Associate Professor of Medicine, Director, Yale Viral Hepatitis Program, Section of Digestive Diseases, Yale University School of Medicine

Joseph K Lim, 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.

Specialty Editor Board

Robert M McNamara, MD, FAAEM  Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

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

Eugene Hardin, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Wasley A, Grytdal S, Gallagher K. Surveillance for acute viral hepatitis--United States, 2006. MMWR Surveill Summ. Mar 21 2008;57(2):1-24. [Medline]. [Full Text].

  2. Previsani N, Lavanchy D. World Health Organization. Hepatitis B (WHO/CDS/CSR/LYO/2002.2). 2002;[Full Text].

  3. Previsani N, Lavanchy D. World Health Organization. Hepatitis A (WHO/CDS/CSR/EDC/2000.7). 2000;[Full Text].

  4. Previsani N, Lavanchy D. World Health Organization. Hepatitis C (WHO/CDS/CSR/LYO/2003.). 2002;[Full Text].

  5. Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. Aug 13 2011;378(9791):571-83. [Medline].

  6. Krawitt EL. Autoimmune hepatitis: classification, heterogeneity, and treatment. Am J Med. Jan 17 1994;96(1A):23S-26S. [Medline].

  7. Adhami T, Levinthal G. Hepatitis D. The Cleveland Clinic Disease Management Project. May 29, 2002.

  8. Previsani N, Lavanchy D. World Health Organization. Hepatitis D. (WHO/CDS/CSR/NCS/2001.1). 2001;[Full Text].

  9. Previsani N, Lavanchy D. World Health Organization. Hepatitis E. (WHO/CDS/CSR/EDC/2001.12.). 2001;[Full Text].

  10. Adhami T, Levinthal G. Hepatitis E and Hepatitis G/GBV-C. The Cleveland Clinic Disease Management Project. May 29, 2002.

  11. FDA News Release. FDA Approves Rapid Test for Antibodies to Hepatitis C Virus. June 25, 2010. [Full Text].

  12. [Guideline] Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. Oct 19 2007;56(41):1080-4. [Medline]. [Full Text].

  13. [Guideline] Centers for Disease Control and Prevention. Viral hepatitis. Hepatitis B vaccination. June 2007;[Full Text].

  14. Alter MJ, Gallagher M, Morris TT, et al. Acute non-A-E hepatitis in the United States and the role of hepatitis G virus infection. Sentinel Counties Viral Hepatitis Study Team. N Engl J Med. Mar 13 1997;336(11):741-6. [Medline].

  15. Alter MJ, Mast EE. The epidemiology of viral hepatitis in the United States. Gastroenterol Clin North Am. Sep 1994;23(3):437-55. [Medline].

  16. Baffis V, Shrier I, Sherker AH, Szilagyi A. Use of interferon for prevention of hepatocellular carcinoma in cirrhotic patients with hepatitis B or hepatitis C virus infection. Ann Intern Med. Nov 2 1999;131(9):696-701. [Medline].

  17. Balfour HH Jr. Antiviral drugs. N Engl J Med. Apr 22 1999;340(16):1255-68. [Medline].

  18. Barash C, Conn MI, DiMarino AJ Jr, Marzano J, Allen ML. Serologic hepatitis B immunity in vaccinated health care workers. Arch Intern Med. Jul 12 1999;159(13):1481-3. [Medline].

  19. Bondesson JD, Saperston AR. Hepatitis. Emerg Med Clin North Am. Nov 1996;14(4):695-718. [Medline].

  20. Boni C, Bertoletti A, Penna A, et al. Lamivudine treatment can restore T cell responsiveness in chronic hepatitis B. J Clin Invest. Sep 1 1998;102(5):968-75. [Medline].

  21. Buti M, Esteban R. Entecavir, FTC, L-FMAU, LdT and others. J Hepatol. 2003;39 Suppl 1:S139-42. [Medline].

  22. Clay KD, Hanson JS, Pope SD, Rissmiller RW, Purdum PP 3rd, Banks PM. Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review. Ann Intern Med. Mar 21 2006;144(6):415-20. [Medline].

  23. de Groen PC. Hepatitis E in the United States: a case of "hog fever"?. Mayo Clin Proc. Dec 1997;72(12):1197-8. [Medline].

  24. Dinsmoor MJ. Hepatitis in the obstetric patient. Infect Dis Clin North Am. Mar 1997;11(1):77-91. [Medline].

  25. Dusheiko G, Barnes E, Webster G, Whalley S. The science, economics, and effectiveness of combination therapy for hepatitis C. Gut. Aug 2000;47(2):159-61. [Medline].

  26. Dykhuizen RS, Brunt PW, Atkinson P, Simpson JG, Smith CC. Ecstasy induced hepatitis mimicking viral hepatitis. Gut. Jun 1995;36(6):939-41. [Medline].

  27. Fishman LN, Jonas MM, Lavine JE. Update on viral hepatitis in children. Pediatr Clin North Am. Feb 1996;43(1):57-74. [Medline].

  28. Furbee RB, Barlotta KS, Allen MK, Holstege CP. Hepatotoxicity associated with herbal products. Clin Lab Med. Mar 2006;26(1):227-41, x. [Medline].

  29. Galan MV, Potts JA, Silverman AL, Gordon SC. The burden of acute nonfulminant drug-induced hepatitis in a United States tertiary referral center [corrected]. J Clin Gastroenterol. Jan 2005;39(1):64-7. [Medline].

  30. Gross JB Jr. Clinician's guide to hepatitis C. Mayo Clin Proc. Apr 1998;73(4):355-60; quiz 361. [Medline].

  31. Guntupalli SR, Steingrub J. Hepatic disease and pregnancy: an overview of diagnosis and management. Crit Care Med. Oct 2005;33(10 Suppl):S332-9. [Medline].

  32. Hirschman SZ. Current therapeutic approaches to viral hepatitis. Clin Infect Dis. Apr 1995;20(4):741-3; quiz 746. [Medline].

  33. Hoofnagle JH, di Bisceglie AM. The treatment of chronic viral hepatitis. N Engl J Med. Jan 30 1997;336(5):347-56. [Medline].

  34. Hugle T, Cerny A. Current therapy and new molecular approaches to antiviral treatment and prevention of hepatitis C. Rev Med Virol. Nov-Dec 2003;13(6):361-71. [Medline].

  35. Kane MA. Hepatitis viruses and the neonate. Clin Perinatol. Mar 1997;24(1):181-91. [Medline].

  36. Kanel GC, Cassidy W, Shuster L, Reynolds TB. Cocaine-induced liver cell injury: comparison of morphological features in man and in experimental models. Hepatology. Apr 1990;11(4):646-51. [Medline].

  37. Koff RS. Hepatitis A. Lancet. May 30 1998;351(9116):1643-9. [Medline].

  38. Krawitt EL. Autoimmune hepatitis. N Engl J Med. Apr 4 1996;334(14):897-903. [Medline].

  39. Kwo PY, Schlauder GG, Carpenter HA, et al. Acute hepatitis E by a new isolate acquired in the United States. Mayo Clin Proc. Dec 1997;72(12):1133-6. [Medline].

  40. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet. Dec 20 2003;362(9401):2089-94. [Medline].

  41. Lee WM. Hepatitis B virus infection. N Engl J Med. Dec 11 1997;337(24):1733-45. [Medline].

  42. Lemon SM, Thomas DL. Vaccines to prevent viral hepatitis. N Engl J Med. Jan 16 1997;336(3):196-204. [Medline].

  43. Levy MJ, Herrera JL, DiPalma JA. Immune globulin and vaccine therapy to prevent hepatitis A infection. Am J Med. Nov 1998;105(5):416-23. [Medline].

  44. Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med. Feb 15 2000;132(4):296-305. [Medline].

  45. Lutwick LI. Postexposure prophylaxis. Infect Dis Clin North Am. Dec 1996;10(4):899-915. [Medline].

  46. Mieli-Vergani G, Vergani D. Autoimmune hepatitis. Arch Dis Child. Jan 1996;74(1):2-5. [Medline].

  47. Poordad FF, Tran T, Martin P. Developments in hepatitis C therapy during 2000-2002. Expert Opin Emerg Drugs. May 2003;8(1):9-25. [Medline].

  48. Poynard T, Yuen MF, Ratziu V, Lai CL. Viral hepatitis C. Lancet. Dec 20 2003;362(9401):2095-100. [Medline].

  49. Public Health. Hepatitis A. CMAJ. Feb 15 1997;156(4):545-6. [Medline].

  50. Purcell RH. The discovery of the hepatitis viruses. Gastroenterology. Apr 1993;104(4):955-63. [Medline].

  51. Sagliocca L, Amoroso P, Stroffolini T, et al. Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: a randomised trial. Lancet. Apr 3 1999;353(9159):1136-9. [Medline].

  52. Sjogren MH. Serologic diagnosis of viral hepatitis. Gastroenterol Clin North Am. Sep 1994;23(3):457-77. [Medline].

  53. Tepper MI, Gully PR. Viral hepatitis: know your D, E, F and Gs. CMAJ. Jun 15 1997;156(12):1735-8. [Medline].

  54. [Guideline] The Centers for Disease Control and Prevention. From the Centers for Disease Control and Prevention. Update: recommendations to prevent hepatitis B virus transmission--United States. JAMA. Mar 3 1999;281(9):790. [Medline].

  55. Thomas DL, Astemborski J, Rai RM, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA. Jul 26 2000;284(4):450-6. [Medline].

  56. Zimmerman HJ, Lewis JH. Chemical- and toxin-induced hepatotoxicity. Gastroenterol Clin North Am. Dec 1995;24(4):1027-45. [Medline].

 
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