PEGINTERFERON ALFA-2B

PEGINTERFERON ALFA-2B
(peg-in-ter-fer'on)
PEG-Intron
Classifications: immunomodulator; interferon;
Therapeutic: immunomodulator
; interferon
Prototype: Interferon alfa-2a
Pregnancy Category: C

Availability

100 mcg/mL, 160 mcg/mL, 240 mcg/mL, 300 mcg/mL powder for injection

Action

Binds to specific membrane receptors on the cell surface, thereby initiating enzyme induction, suppression of cell proliferation, enhanced phagocytic activity of macrophages, augmentation of specific cytotoxic lymphocytes for target cells, and inhibition of viral replication in virus-infected cells.

Therapeutic Effect

Induces antiviral effects by activation of macrophages, natural killer cells, and T-cells, thus boosting cellular immunity and suppressing hepatic inflammation and replication of hepatitis C virus.

Uses

Chronic hepatitis C.

Unlabeled Uses

Renal carcinoma.

Contraindications

Hypersensitivity to peginterferon; autoimmune hepatitis; decompensated liver disease; persistently severe or worsening S&S of life-threatening neuropsychiatric, autoimmune, ischemic, or infectious disorders; pregnancy (category C).

Cautious Use

History of neuropsychiatric disorder; bone marrow suppression; ulcerative and hemorrhagic colitis; pulmonary disorders; HBV or HIV coinfection; thyroid dysfunction; diabetes mellitus; cardiovascular disease; autoimmune disorders; pulmonary disease, COPD; retinal disease; renal impairment with creatinine clearance <50 mL/min; older adults; lactation. Safety and efficacy in children <18 y are not established.

Route & Dosage

Chronic Hepatitis C
Adult: SC Based on weight and injected once weekly x 1 y: 37–45 kg, 40 mcg; 46–56 kg, 50 mcg; 57–72 kg, 64 mcg; 73–88 kg, 80 mcg; 89–106 kg, 96 mcg; 107–136 kg, 120 mcg; 137–160 kg, 150 mcg

Administration

Subcutaneous
  • Give dose on the same day of each week.
  • Be aware that two Safety LokTM syringes are provided in the drug package: one for reconstitution and one for injection. Reconstitute with only 0.7 mL of supplied diluent and discard remaining diluent. Enter the vial only once as it does not contain a preservative. Swirl gently to produce a clear, colorless solution. Use solution immediately.
  • Serious adverse reactions warrant reduction or discontinuation of dose.
  • Store dry vial at 15°–30° C (59°–86° F). If necessary, store reconstituted solution up to 24 h at 2°–8° C (36°–46° F).

Adverse Effects (≥1%)

Body as a Whole: Musculoskeletal pain, fatigue, inflammation at injection site, flu-like symptoms, rigors, fever, weight loss, viral infection, pain, malaise, hypertonia. CNS: Headache, depression, anxiety, emotional lability, irritability, insomnia, dizziness. GI: Nausea, anorexia, diarrhea, abdominal pain, vomiting, dyspepsia, hepatomegaly. Endocrine: Hypothyroidism. Hematologic: Thrombocytopenia, neutropenia. Respiratory: Pharyngitis, sinusitis, cough. Skin: Alopecia, pruritus, dry skin, sweating, rash, flushing.

Interactions

Drug: May increase theophylline levels; additive myelosuppression with antineoplastics; zidovudine may increase hematologic toxicity; increase doxorubicin toxicity, increase neurotoxicity with vinblastine; aldesleukin (IL-2) may potentiate the risk of kidney failure.

Pharmacokinetics

Peak: 15–44 h. Duration: 48–72 h. Elimination: 30% in urine. Half-Life: 40 h (22–60 h).

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of hypersensitivity (e.g., angioedema, bronchoconstriction) and, if noted, institute appropriate medical action immediately. Note that transient rashes are not an indication to discontinue treatment.
  • Monitor for and report immediately S&S of neuropsychiatric disorders (e.g., psychosis, hallucinations, suicidal ideation, depression).
  • Monitor respiratory and cardiovascular status; report dyspnea, chest pain, and hypotension immediately; baseline and periodic ECG and chest X-ray.
  • Lab tests: Baseline and periodic creatinine clearance, CBC with differential, platelet count, Hct & Hgb, TSH, ALT, AST, bilirubin, blood glucose; with diabetics or hypertensives. Serum HCV RNA levels are assessed after 24 wk of treatment.
  • Withhold drug and notify physician for any of the following: severe neuropsychiatric events, severe neutropenia or thrombocytopenia, abdominal pain accompanied by bloody diarrhea and fever, S&S of pancreatitis, or any other severe adverse event (see CAUTIOUS USE).
  • Baseline and periodic ophthalmology exams are recommended.

Patient & Family Education

  • Drink fluids liberally while taking this drug, especially during the initial stages of therapy.
  • Learn reasons for withholding drug (see ASSESSMENT & DRUG EFFECTS).
  • Use effective means of contraception while taking this drug. Women should not become pregnant.
  • Follow up with lab tests; compliance with lab testing is extremely important while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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