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interferon [IFN]-alfa 2b (Intron A)

Interferon alpha-2B. Tradename: Intron-A. Indications: - chronic hepatitis B & hepatitis C - acute hepatitis C infection [4] - malignant melanoma - induction of remission for hairy cell leukemia - treatment of AIDS-related Kaposi's sarcoma - condyloma accuminata - carcinoid syndrome [5] - follicular lymphoma - mycosis fungoides-Sezary syndrome - cutaneous T-cell lymphoma - multiple myeloma - chronic myeloid leukemia - Philadelphia chromosome-positive CML - laryngeal papillomatosis - hemangioma - bladder cancer [5] Contraindications: Pregnancy category C Safety in lactation ? Dosage: 1) acute hepatitis C: [4] a) 5 million units daily for 4 weeks, then b) 3 times weekly for 20 weeks 1) chronic hepatitis C: a) optimal dose has not been established b) recommended dose in 3 million units IM/SC 3 times/week c) maximum reduction in ALT seen in 8-12 weeks d) therapy should continue for at least 6 months, preferably 12 months 2) melanoma (use only 50 million IU/mL vials) a) induction: 1] 20 million IU/m2 Monday-Friday as an IV infusion 2] continued for 4 weeks b) maintenance 1] 10 million IU/m2 SC 3 times/week for 48 weeks Powder for injection, lyophilized: - 3, 5, 10, 18, 25, 50 million units Syringe: 3 & 5 million units Pharmacokinetics: 1) filtered by renal tubules 2) proteolytic degradation during renal tubular reabsorption Monitor: 1) every 6 months a) complete blood count (CBC) b) electrolytes, BUN & serum creatinine c) liver function tests d) serum TSH 2) electrocardiogram in patients with cardiac disease or in advanced stage of cancer Adverse effects: 1) common (> 10%) - anemia - leukopenia - flu-like syndrome - skin rash - diarrhea - dizziness - fatigue - dry mouth - thrombocytopenia - metallic taste - anorexia - nausea/vomiting 2) less common (1-10%) - hepatotoxicity, dry skin, diaphoresis, leg cramps, blurred vision, neurotoxicity, peripheral neuropathy, stomatitis, alopecia 3) uncommon (< 1%) - cardiotoxicity, hypothyroidism, weight loss, arrhythmias, hypotension, nasal congestion, edema, ECG abnormalities, confusion, sensory neuropathy, fever/chills/rigors, headache, anemia, thrombocytopenia, increased serum transaminases, myalgias, arthralgias, proteinuria, hyperuricemia, renal insufficiency, cough, chest pain, neutralizing antibodies 4) other - gingivitis - burning at the site of injection - depression (SSRI may be of benefit) [3] Drug interactions: 1) antineoplastic agents: additive or synergistic myelosuppressive effects 2) may inhibit metabolism of agents metabolized by cyt P450 system 3) acyclovir: possible synergistic effect 4) zidovudine (AZT): possible additive myelosuppression 5) theophylline clearance may be decreased 6) vidarabine may increase neurotoxicity 7) paroxetine in combination may increase risk of retinal hemorrhage [3] Mechanism of action: 1) consists of at least 23 proteins & glycoproteins 2) complex antiviral, antineoplastic & immunomodulating activity

Specific

peginterferon alfa 2b (Pegintron)

General

biological response modifier; immune factor; immunomodulator; biomodulator interferon-alfa

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Journal Watch 21(8):67, 2001 Musselman et al, N Engl J Med 344:961, 2001
  4. Prescriber's Letter 8(11):64 2001
  5. Deprecated Reference

Component-of

IFN-alpha 2b/ribavirin (Rebetron)