Hepatitis E Medication

Updated: Mar 13, 2019
  • Author: Prospere Remy, MD; Chief Editor: BS Anand, MD  more...
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Medication

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 Medical Management). Pegylated interferon alfa, if not contraindicated, is an alternate treatment option for patients with chronic hepatitis E infection who have 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 the 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 the severity of hypophosphatemia and the 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 experience ribavirin treatment failure. However, this medication should be used with caution in transplant patients.

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