Adult Dosing
Adjuvant treatment of melanoma [Sylatron]
- Initial dose: 6 mcg/kg/wk SC x 8 doses
- Followed by 3 mcg/kg/week SC for up to 5 yrs
Notes:- Premedicate with acetaminophen 500-1000 mg PO, 30 minutes prior to the first dose of sylatron and as needed for subsequent doses
- Refer package insert for toxicity related dose adjustments
Chronic hepatitis C [PegIntron]
Combination therapy
- Genotype 1: 1.5 mcg/kg/wk SC x 48 wks
- Genotype 2 & 3: 1.5 mcg/kg/wk SC x 24 wks
Monotherapy
Notes:- Administer on the same day of the wk
- Discontinue therapy if patient do not achieve at least a 2 log 10 drop or loss of HCV-RNA at 12 wks of therapy, or whose HCV-RNA levels remain detectable after 24 wks of therapy
- Refer package insert for toxicity related dose adjustments
Pediatric Dosing
Chronic hepatitis C [PegIntron]
Combination therapy (3-17 yrs)
- Genotype 1: 60 mcg/m2/wk SC x 48 wks
- Genotype 2 & 3: 60 mcg/m2/wk SC x 24 wks
Monotherapy (3-17 yrs)
Notes:- Administer on the same day of the wk
- Discontinue therapy if patient do not achieve at least a 2 log 10 drop or loss of HCV-RNA at 12 wks of therapy, or whose HCV-RNA levels remain detectable after 24 wks of therapy
- Refer package insert for toxicity related dose adjustments
Sylatron
- Safety and effectiveness in pediatric patients <18 yrs have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Renal Impairment
- 30 to 50 mL/min: Reduce dose by 25%
- 10-29 mL/min: Reduce dose by 50%
- Use with ribavirin in CrCl less than 50 mL/min should not be used
- Discontinue treatment if renal function decreases during treatment
Hepatic Dose Adjustment
- Hepatic impairment
- Autoimmune hepatitis: Contraindicated
- Hepatic decompensation (Child-Pugh class B and C) in cirrhotic patients: Contraindicated
- Hepatic decompensation (Child-Pugh class B and C) with HIV: Contraindicated
Dose modifications due to adverse reactions or lab abnormalities
- Refer package insert for complete information on dose modifications due to severe adverse reactions or abnormal laboratory findings
- Life-threatening or fatal neuropsychiatric reactions including suicide, suicidal and homicidal ideation, depression has been reported with peginterferon alfa-2b therapy [US Black Box Warning]
- Ribavirin can cause hemolytic anemia resulting in worsening of cardiac disease
- Cardiac adverse reactions, including myocardial infarction, bundle-branch block, ventricular tachycardia, and supraventricular arrhythmia can occur with peginterferon alfa-2b therapy. Permanently discontinue the therapy on the onset of ventricular arrhythmia or cardiovascular decompensation
- Development or exacerbation of autoimmune disorder such as thyroiditis, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura, rheumatoid arthritis, interstitial nephritis, systemic lupus erythematosus, and psoriasis has been reported, use cautiously in patients with autoimmune disorders. Discontinue use if symptom persist or worsen
- Peginterferon alfa-2b can induce or aggravate retinal and ocular changes including macular edema, retinal artery or vein thrombosis, retinal hemorrhages and cotton wool spots, optic neuritis, papilledema, and serous retinal detachment. Perform eye examination (visual acuity and indirect ophthalmoscopy or fundus photography) at baseline and anytime during the therapy and permanently discontinue the therapy, if patients develops new or worsening retinopathy
- Increases the risk of hepatic decompensation and death has been reported in patients with cirrhosis. Monitor hepatic function at base line and then at 2 & 8 wks and at 2 & 3 months following initiation of therapy and then every 6 months. Permanently discontinue the therapy for evidence of severe hepatic injury or hepatic decompensation
- New onset or worsening of hypothyroidism, hyperthyroidism, and diabetes mellitus can occur, obtain TSH levels within 4 wks prior to initiation of therapy, at 3 and 6 months following initiation, then every 6 months thereafter. If patient develops hypothyroidism, hyperthyroidism or diabetes mellitus permanently discontinue the therapy
- In combination with ribavirin can cause birth defects and death of the unborn child [US Black Box Warning]
- Interferon alfa therapies, can cause ischemic and hemorrhagic cerebrovascular events
- Interferon alfa 2b therapy can cause bone marrow suppression, resulting in severe cytopenias, discontinue the therapy if patient develops severe decrease in neutrophil or platelet counts
- Alpha interferon therapy can cause fatal and nonfatal pancreatitis, discontinue the therapy if pancreatitis develops
- Fatal and nonfatal ulcerative or hemorrhagic/ischemic colitis manifested as abdominal pain, bloody diarrhea, and fever has been reported within 12 wks of interferon therapy, discontinuation of alpha interferon resolves the sign and symptoms within 1-3 wks
- Dyspnea, pulmonary infiltrates, pneumonia, pneumonitis, pulmonary hypertension, and sarcoidosis, some resulting in respiratory failure and/or patient deaths have been reported. Suspend the combination treatment in patients who develop pulmonary infiltrates or pulmonary function impairment
- Interferon alpha can increase serum creatinine levels in patients with renal insufficiency, closely monitor these patients for the signs and symptoms of interferon toxicity
- Serious, acute hypersensitivity reactions and cutaneous eruptions can occur during alpha interferon therapy, discontinue the treatment and provide appropriate therapy
- Prolong treatment can cause damaging effect on teeth and mucous membranes of the mouth, advise patients to brush their teeth thoroughly twice daily and have regular dental examinations
- Elevated triglyceride levels resulting in pancreatitis has been reported, manage hypertriglyceridemia as clinically appropriate
- Weight and height gain in children treated with peginterferon alfa-2b plus ribavirin lags behind that compared with normative population
- Peripheral neuropathy has been reported when alpha interferons are used in combination with telbivudine
Cautions: Use cautiously in
- CrCl <50 mL/min
- Cardiac diseases
- Endocrine disorders
- Ophthalmologic disorders
- Cerebrovascular disorder
- Myelosuppression
- Autoimmune disorders
- Psychiatric disorder
- Pulmonary disorders
Pregnancy Category:C
Breastfeeding: Poorly excreted into breastmilk. Unlikely to adversely affect the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 29 April 2011). Excreted in the milk of mice; Because of the potential for possible serious adverse reactions in nursing infants a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Peg-Intron 120 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $640.99
3 0.5ml = $1882.92 - Peg-Intron 50 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $579.98
3 0.5ml = $1708.88 - Peg-Intron Redipen 120 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $685
3 0.5ml = $1918 - Peg-Intron 80 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $630.01
3 0.5ml = $1859.99 - Peg-Intron Redipen 150 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $708
3 0.5ml = $2085.87 - Peg-Intron 150 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $671.02
3 0.5ml = $1972.96 - Peg-Intron Redipen 80 MCG/0.5ML KIT [Box] (SCHERING)
1 0.5ml = $635.99
3 0.5ml = $1851.97 - Peg-Intron Redipen Pak 4 50 MCG/0.5ML KIT [Box] (SCHERING)
4 0.5ml = $2281.32
12 0.5ml = $6547.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
18 yrs old
