PATIENT SELECTION FOR ANTIVIRAL THERAPY
For successful outcomes, it is imperative that clinicians spend the time up front to counsel and teach the patients and their families or other supportive individuals. Explain that commitment requires the full duration of the treatment. Have patients sign a consent form agreeing to frequent blood testing, scheduled office visits, pregnancy prevention, and abstention from alcohol and drug use.
There is significant risk for medication reactions with PIs. A thorough medication review must be obtained before starting these drugs. Several medications are contraindicated, including simvastatin (Zocor), St. John’s wort, and sildenafil (Viagra). Other medications require cautious use, including amlodipine (Norvasc), clarithromycin (Biaxin), methadone and zolpidem (Ambien). Please see the Victrelis and Incivek pagackage inserts for a complete list of potential drug interactions.
The goal with any of the treatments described is to support the patient through the process, foster a partnership in this unique opportunity to cure, and provide congratulations on the successes along the way.
Lynn Rapsilber, MSN, ANP-BC, APRN, is a nurse practitioner with Litchfield County Gastroenterology in Torrington, CT
- Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335-1374.
- Strader DB, Wright T, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2004;39:1147-1171.
- Ghany MG, Nelson DR, Strader DB, et al. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54:1433-1444.
- CDC. Hepatitis C information for health professionals.
- Victrelis (boceprevir) Package Insert. Merck & Co., Inc.; 2011.
- Incivek (telaprevir) Package Insert. Vertex Pharmaceuticals; 2011.
All electronic documents accessed September 15, 2012.
This article originally appeared on Clinical Advisor