Viral Hepatitis

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Pharmaceutical Options for Managing Viral Hepatitis and Cirrhosis Complications

for Health Care Providers

Pharmaceutical Options for Managing Viral Hepatitis and Cirrhosis Complications in the VA Health Care System

Tables:

Hepatitis B
*Note: PegIFN-a2a is the only peginterferon currently approved for the treatment of chronic hepatitis B in the United States. Refer to Chronic hepatitis B. (AASLD Practice Guidelines)Link will take you outside the VA website. [Lok AS and McMahon BJ. Hepatology. 2007 Feb;45(2):507-39] and Chronic Hepatitis B: Update 2009 [Lok AS and McMahon BJ. Hepatology. 2009 Sep;50(3):1-36 ] for detailed information, place in therapy and dosing of peg-IFN a in hepatitis B, or consult with your local VA pharmacist.
Use may be restricted to Gastroenterology and Infectious Disease Services.
Adefovir (Hepsera)
Entecavir (Baraclude)
Interferon alfa (Intron A)
Lamivudine (Epivir-HBV, 3TC)
Peginterferon alfa (PegIFN-a)*
Telbivudine (Tyzeka)
Tenofovir (Viread)
Hepatitis C
See also: VA Hepatitis C Treatment Recommendations (2012)
Use may be restricted to Gastroenterology and Infectious Disease Services.
Boceprevir (Victrelis)
Peginterferon alfa-2a (PegIFN-a2a, Pegasys)
Peginterferon alfa-2b (PegIFN-a2b, PEG-Intron)
Ribavirin (Rebetol, Copegus)
Telaprevir (Incivek)
Approved agents for HCV but not yet evaluated for VA formulary:
Simeprevir (Olysio)
Sofosbuvir (Sovaldi)
Side Effects
Use may be restricted to Gastroenterology, Infectious Disease and Hematology/Oncology Services.
Hematological
Granulocyte Colony Stimulating Factor
(GCSF, Neupogen, Filgrastim)
Epoetin alfa (Epogen, Procrit)
Other Side Effects
For expanded information and options to consider for management of other side effects, see The Hepatitis C Treatment Side Effect Management Chart.
Cirrhosis Management
Note: Antibiotics may include sulfamethoxazole/trimethoprim or fluoroquinolones. Selection should depend on local antibiotic susceptibility patterns. Consult with your local VA pharmacy for the preferred antibiotic in your area.
Ascites

Furosemide (Lasix)

Spironolactone (Aldactone)

Encephalopathy
Lactulose (Enulose)
Rifaximin (Xifaxan)
Portal Hypertension and Varices

Propranolol (Inderal)

Nadolol (Corgard)

Spontaneous Bacterial Peritonitis (SBP) Prophylaxis and Treatment

Rimethoprim-sulfamethoxazole (Bactrim DS; Bactrim; Septra DS; Septra)

Fluoroquinolones (Ciprofloxacin; Norfloxacin; Levofloxacin; Ofloxacin; Gatifloxacin and others)

Prevention

Influenza vaccination

Pneumococcal vaccination

Hepatitis A vaccination

Hepatitis B vaccination

For detailed information on the administration of hepatitis A and B vaccination, please refer to the Vaccination Pocket Card.

For additional information on these agents, refer to the Pharmacy Benefits Management Website.