Mosby's 2014 Nursing Drug Reference (67 page)

• Adults: PO
Before starting therapy peginterferon alfa and ribavirin must be given 4 wk, then add boceprevir 800 mg (four 200 mg caps) PO TID (7-9 hours). Treatment length is determined by HCV RNA conc at treatment wk 4, 8, 12, and 24. If patient has undetectable HCV RNA conc at wk 8 and 24, discontinue all 3 medications at wk 28 (previously untreated); 36 wk (partial responders/relapsers). If HCV RNA is detectable at wk 8 but undetectable at wk 24, the 3-drug regimen through wk 36, then give only peginterferon alfa and ribavirin through treatment wk 48. If the patient has a poor response to peginterferon alfa and ribavirin during the initial 4 wk, continue treatment with all 3 medications for a total of 48 wk. Discontinue the 3-drug regimen if the HCV RNA conc >100 international units/ml at treatment wk 12 or a detectable HCA RNA conc at treatment wk 24.

• Adults: PO
Before starting therapy with boceprevir; peginterferon alfa and ribavirin must be given 4 wk; then add boceprevir 800 mg (four 200 mg caps) PO TID (7-9 hr) to peginterferon alfa and ribavirin for an additional 44 wk (48 wk total)

• 
Only use in combination with peginterferon alfa and ribavirin; never give as monotherapy.

• 
Discontinue in hepatitis C virus (HCV)if RNA concentrations ≥100 international units/ml at wk 12 or a confirmed detectable HCV RNA concentrations at wk 24

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Any contraindication to peginterferon alfa or ribavirin also applies to boceprevir.

• 
Give with food

Increase:
adverse reactions of each product—phosphodiesterase type 5 (PDE5) inhibitors (for erectile dysfunction), acetaminophen, alfentanil, aliskiren, almotriptan, alosetron, ALPRAZolam, aminophylline, amiodarone, amitriptyline, amLODIPine, ARIPiprazole, astemizole, atorvastatin, atorvastin, bepridil, boceprevir, bosentan, budesonide, bupivacaine, buprenorphine, busPIRone, carvedilol, cevimeline, chloroquine, cilostazol, cinacalcet, citalopram, clarithromycin, clomiPRAMINE, clonazePAM, clopidogrel, cloZAPine, colchicine, cyclobenzaprine, cycloSPORINE, dapsone, DAUNOrubicin, desipramine, desloratadine, dexamethasone, dexlansoprazole, dextromethorphan, diazepam, diclofenac, digoxin, diltiazem, disopyramide, disulfiram, DOCEtaxel, dolasetron, donepezil, DOXOrubicin, droperidol, dutasteride, ebastine, eletriptan, eplerenone, erlotinib, erythromycin, estazolam, eszopiclone, ethosuximide, etoposide, exemestane, felodipine, fentaNYL, fexofenadine, finasteride, flecainide, flunitrazepam, flurazepam, galantamine, gefitinib, glyburide, granisetron, halofantrine, haloperidol, HYDROcodone, ifosfamide, imipramine, indiplon, irinotecan, isradipine, itraconazole, ivermectin, ixabepilone, ketoconazole, lansoprazole, lidocaine, loperamide, loratadine, losartan, maraviroc, mefloquine, meloxicam, mirtazapine, mitoMYcin, montelukast, morphine, nateglinide, niCARdipine, NIFEdipine, nisoldipine, nortriptyline, omeprazole, ondansetron, oxybutynin, oxyCODONE, PACLitaxel, palonosetron, paricalcitol, plicamycin, posaconazole, prasugrel, praziquantel, propafenone, quazepam, QUEtiapine, quinacrine, quiNIDine, ramelteon, repaglinide, rifabutin, risperiDONE, ropivacaine, salmeterol, selegiline, sertraline, sibutramine, silodosin, sirolimus, sitaxsentan, solifenacin, SUFentanil, SUNItinib, systemic corticosteroids, tacrolimus, telithromycin, teniposide, terfenadine, testosterone, theophylline, tiaGABine, tinidazole, tolterodine, tolvaptan, traMADol, traZODone, vardenafil, venlafaxine, verapamil, vinBLAStine, vinCRIStine, voriconazole, warfarin, and others; use cautiously, may need to reduce dose

Increase:
hyperkalemia—drospirenone

Decrease:
estrogen levels—ethinyl estradiol

Decrease:
boceprevir effect—CYP3A4 inhibitors (phenytoin, carBAMazepine, PHENobarbital, rifampin)

Decrease:
effect of—methadone

Possible treatment failure:
efavirenz, ritonavir, atazanavir, lopinavir with ritonavir

• 
Do not use with St. John’s wort

Decrease:
Hgb

 
Pregnancy:
obtain a pregnancy test before, monthly during, and for 6 mo after treatment is completed; those who are not willing to practice strict contraception should not receive treatment; report any cases of prenatal ribavirin exposure to the Ribavirin Pregnancy Registry at (800) 593-2214

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Anemia:
monitor Hgb before, at treatment wk 4, 8, 12, and as needed. If Hgb is <10 g/dL, decrease ribavirin dosage; if Hgb is <8.5 g/dL, discontinuation of therapy is recommended; dosage should not be altered based on adverse reactions; anemia may be managed through ribavirin dose modifications; never alter the dose of boceprevir. If anemia persists despite a reduction in ribavirin dose, consider discontinuing boceprevir. If management of anemia requires permanent discontinuation of ribavirin, treat
ment with boceprevir MUST also be permanently discontinued. Once boceprevir has been discontinued, it must not be restarted; monitor CBC with differential at treatment wk 4, 8, 12, and at other treatment points as needed

• 
To take with food to increase absorption

• 
To use precautions to prevent transmission of hepatitis C

• 
To inform prescriber of all medications, herbs, supplements used

•
 
To use 2 forms of effective contraception (intrauterine devices and barrier methods) during treatment and for 6 mo after treatment (pregnancy X), to avoid breastfeeding