Management and Treatment of Hepatitis C Viral Infection: Table 8

Hepatitis C

for Health Care Providers

Table 8. General Guidelines for Peginterferon Dose Reduction or Discontinuation
LABORATORY VALUES	MANUFACTURER PACKAGE INSERT RECOMMENDATIONS
ANC = absolute neutrophil count; WBC = white blood cell counts *If dose is maintained outside of manufacturer recommendations, monitor ANC more frequently and counsel patient on neutropenic precautions. In cirrhotic, post-liver transplantation or HIV/HCV coinfected patients who remain neutropenic despite dose reduction, consider starting GCSF until resolution. †If dose is maintained outside of manufacturer recommendations, monitor platelet counts more frequently and for signs and symptoms of unusual bleeding or bruising.
WBC
<1.5 x 10⁹/L	Reduce peginterferon alfa-2b dose by 50% and reevaluate
<1.0 x 10⁹/L	Discontinue peginterferon alfa-2b until resolution
ANC*
<0.75 x 10⁹/L	Peginterferon alfa-2a: reduce dose to 135 mcg/wk and reevaluate Peginterferon alfa-2b: reduce dose by 50% and reevaluate
<0.50 x 10⁹/L	Discontinue peginterferon alfa until resolution
Platelets†
<80 k/mm³	Peginterferon alfa-2b: reduce dose by 50% and reevaluate
<50 k/mm³	Peginterferon alfa-2a: reduce dose to 90 mcg/wk and reevaluate Peginterferon alfa-2b: discontinue until resolution
<25 k/mm³	Peginterferon alfa-2a: discontinue until resolution