Hepatitis Drug Therapy

Our Specialty Pharmacy offers pharmacy services to people with hepatitis who need long-term interferon drug therapy. Our pharmacy staff can also provide medication after you return home from the clinic. Experienced pharmacy professionals work closely with your Mayo Clinic care team to develop a personalized medication management program at no additional cost. We coordinate all billing and claims on your behalf, relieving you of up-front costs and the headaches of completing insurance forms and filing claims.

About Hepatitis
The Role of Medications in Treating Hepatitis
Always Ask Your Pharmacist

About Hepatitis

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, the infection becomes chronic, leading to liver failure, liver cancer or cirrhosis, a condition that causes permanent scarring of the liver. The hepatitis B virus is transmitted in the blood and body fluids of someone who is infected, the same way the human immunodeficiency virus (HIV), the virus that causes AIDS, spreads. Yet hepatitis B is nearly 100 times as infectious as HIV. Intravenous (IV) drug users who share needles or other paraphernalia, persons who have unprotected sexual contact with an infected partner, and persons who were born in or traveled to parts of the world where hepatitis B is widespread are especially at risk. Women with HBV can pass the infection to their babies during childbirth.

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Eighty percent of those infected with the hepatitis C virus (HCV) have no symptoms. In fact, most people don't know they have the disease until decades later when liver damage shows up during routine medical tests. Over time, HCV infection can lead to liver cancer, liver failure or cirrhosis. It ranks second only to alcoholism as a cause of liver disease and is the leading reason for liver transplants in the United States. Unlike HIV, the virus that causes AIDS, HCV usually isn't transmitted through sexual contact. Its primary mode of transmission is contaminated blood, through needles shared by drug users or through blood transfusions.

The Role of Medications in Treating Hepatitis

Hepatitis B
Doctors generally use three medications to treat chronic HBV infection:

Interferon. Your body naturally produces interferon to help protect against invading organisms such as viruses. Genetically engineered interferon, given through an injection beneath your skin or into you muscle, can stimulate your body's immune system to attack HBV. In some cases, interferon therapy will eliminate the virus, although the infection can return later. Another form of the drug, pegylated (PEG) interferon, is given just once a week and could be more effective than standard interferon treatments. Pegylated interferon both enhances the immune system and prevents the growth of the virus.

Lamivudine (Epivir). This antiviral medication helps prevent HBV from replicating in your cells. It is usually taken by mouth, once a day for 12 months. Common side effects include cough, diarrhea, nausea or vomiting, and hair loss. If you experience worsening jaundice or any unusual bruising, bleeding or fatigue, call your doctor right away.

Adefovir dipivoxil (Hepsera). This drug, approved in 2002, is taken by mouth and also helps prevent HBV from replicating in your cells. An added benefit is that it is effective in people who are resistant to lamivudine. Adefovir isn't without side effects. In clinical trials, about one-fourth of people using adefovir experienced a severe worsening of their symptoms when they stopped taking the drug. Adefovir may also cause kidney toxicity in people with underlying kidney disease.

Hepatitis C
Until recently, the best weapon against hepatitis C was interferon treatment. But interferon worked in only about 20 percent of cases. Now, injections of interferon are usually combined with oral doses of ribavirin (Rebetol, Copegus), a broad-spectrum antiviral medication. Treatment usually takes from six months to one year and is successful in about 40 percent of people with HCV.

Some studies have shown that pegylated (PEG) interferon may be twice as effective as regular interferon. In January 2001, the Food and Drug Administration approved the use of peginterferon alfa-2a (PEGASYAS) and peginterferon alfa-2b (PEG-Intron) for treatment of hepatitis C.

Side Effects
Side effects from drug therapy include severe flulike symptoms from the interferon and a temporary drop in hemoglobin (anemia), white cell or platelet counts in your blood. Chronic side effects, which affect about half of those receiving treatment with interferon-ribavirin, include extreme fatigue, anxiety, irritability and depression. A small percentage of people may experience psychosis or suicidal behavior.

Interferon is not recommended for people who have a history of major depression. Those who have untreated thyroid disease, low blood cell counts or autoimmune disease, or who drink alcohol or use drugs are also not good candidates for this treatment.

Unfortunately, if treatment isn't effective or you cannot tolerate the side effects, you may have few other options. But researchers are investigating the use of protease inhibitors in people with HCV. These medications have helped some people who have the AIDS virus.

Always Ask Your Pharmacist

If you experience problems with hepatitis treatment, your pharmacist is a reliable source of information about hepatitis medication management and can help you monitor your condition, maximize the benefits of your medications, limit side effects and identify drug-drug or drug-disease interactions. Your pharmacist will work closely with your doctor to create a safe and appropriate care plan.

Optimal treatment of hepatitis requires coordinated care by your health care team. Doctors, nurses and other caregivers must work closely with pharmacists and others to ensure therapy is safe and effective. Incomplete treatment of hepatitis or another medical condition may lead to complications or limit the success of treatment.