Viral Hepatitis Medication

Updated: Jun 12, 2017
  • Author: Naga Swetha Samji, MD; Chief Editor: BS Anand, MD  more...
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Medication

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.

In addition to the medications listed below (eg, interferons [IFNs], antivirals, and corticosteroids), the nucleoside analogues lamivudine and adefovir have shown promising results in the treatment of patients with chronic hepatitis B. Other antiviral agents that are being studied for treatment of chronic hepatitis B are entecavir and tenofovir. Besides being active against HBV, lamivudine, adefovir, and tenofovir are also active against human immunodeficiency virus (HIV) and thus are potentially useful in the treatment of patients with HBV-HIV coinfection.

For patients with chronic HCV infection, one current treatment option is combination therapy with pegylated IFN (PEG-IFN) and the antiviral ribavirin. This regimen may be recommended for a certain subset of patients with moderate or severe inflammation or fibrosis. The combination of the two drugs provides a more sustained clearance of HCV RNA from the serum of infected individuals than monotherapy does.

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

IFNs are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. IFN alfa, beta, and gamma may be given topically, systemically, and intralesionally.

Interferon alfa 2b (Intron A)

IFN alfa-2b is a protein product manufactured by recombinant DNA technology. The adult dosage is 3 million units subcutaneously (SC) 3 times weekly. Modulation of host immune response by IFN may play an important role in the treatment of viral diseases.

Interferon alfacon 1 (Infergen)

This product was discontinued in September 2013. IFN alfacon is a protein product manufactured by recombinant DNA technology. Modulation of host immune response by IFN may play an important role in the treatment of viral diseases. This product is synthesized by combining the most common amino acid sequences from all 12 naturally occurring IFNs. The adult dosage is 9 mcg SC 3 times weekly.

Peginterferon alfa-2b (PEG-Intron)

PEG-IFN consists of IFN alfa-2b attached to a single 12-kd PEG chain. It is excreted by the kidneys. PEG-IFN has sustained absorption, a slower rate of clearance, and a longer half-life than unmodified IFN, which permits more convenient once-weekly dosing and significantly improves quality of life for patients. The adult dose is 1.5 mcg/kg SC.

Pegylated interferon alfa-2a (Pegasys)

PEG-IFN alfa-2a consists of IFN alfa-2a attached to a 40-kd branched PEG molecule. It is predominantly metabolized by the liver. The adult dosage is 180 mcg/kg SC once weekly.

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Antivirals

Class Summary

Antiviral agents inhibit viral replication.

Famciclovir (Famvir)

Famciclovir is a prodrug that, when biotransformed into active metabolite penciclovir, may inhibit viral DNA synthesis or replication.

Entecavir (Baraclude)

Entecavir is a guanosine nucleoside analogue with activity against HBV polymerase. It competes with the natural substrate, deoxyguanosine triphosphate, to inhibit HBV polymerase activity (ie, reverse transcriptase). It is less effective for lamivudine-refractory HBV infection. Entecavir is indicated for treatment of chronic HBV infection. It is available as a tablet and as an oral solution (0.05 mg/mL; 0.5 mg = 10 mL).

Ribavirin (Rebetol, Virazole, Copegus)

Ribavirin is an antiviral nucleoside analogue. Its chemical name is D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. Given alone, ribavirin has little effect on the course of hepatitis C. Given with IFN, it significantly augments the rate of sustained virologic response. The adult dosage is 10.6 mg/kg orally once daily or in 2 divided doses.

Boceprevir (Victrelis)

NS3/4A protease inhibitors interfere with the ability of HCV to replicate by inhibiting a key viral enzyme, NS3/4A serine protease. Boceprevir inhibits replication of the hepatitis C virus by binding reversibly to nonstructural protein 3 (NS 3) serine protease. Boceprevir must be administered in combination with PGN-INF alfa and ribavirin. The dosage is 800 mg orally 3 times daily.

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Corticosteroids

Class Summary

Corticosteroids may be used in cholestatic HAV. A brief course may shorten the illness; however, this may be most effective in patients with milder disease.

Prednisone

Prednisone decreases autoimmune reactions, possibly by suppressing key components of immune system. Prednisone is inactive and must be metabolized to the active metabolite prednisolone; this conversion may be impaired in patients with liver disease.

Prednisolone (Orapred ODT, Prelone, Millipred)

Prednisolone decreases autoimmune reactions, possibly by suppressing key components of immune system. This agent does not need to undergo hepatic metabolism.

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Vaccines, Viral, Prevention

Class Summary

The hepatitis B vaccine is used for active immunization against disease caused by HBV.

Hepatitis B vaccine, Recombinant (Engerix-B, Recombivax HB)

This agent is used for immunization against infection caused by all known subtypes of hepatitis B virus.

Hepatitis A vaccine, inactivated, and hepatitis B vaccine (Twinrix)

This combined hepatitis A–hepatitis B vaccine is used for active immunization of persons older than 18 years against disease caused by HAV and infection by all known subtypes of hepatitis B virus (HBV).

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Immune Globulins

Class Summary

Immune globulins may be used for passive immunization against viral diseases.

Hepatitis B Immune Globulin (HepaGam D, HyperHEP B, Nabi-HB)

This immune globulin is prepared from plasma preselected for high-titer anti-HBs. It provides passive immunization for individuals who describe recent exposure to a patient infected with HBV. HBIG is also administered after liver transplantation to persons infected with HBV in order to prevent HBV-induced damage to the liver allograft.

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