ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Pegylated interferon (peginterferon) alfa-2b (Discontinued by manufacturer; not available): Drug information

Pegylated interferon (peginterferon) alfa-2b (Discontinued by manufacturer; not available): Drug information
(For additional information see "Pegylated interferon (peginterferon) alfa-2b (Discontinued by manufacturer; not available): Patient drug information" and see "Pegylated interferon (peginterferon) alfa-2b (Discontinued by manufacturer; not available): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Neuropsychiatric disorders (PegIntron):

Alpha interferons, including PegIntron, may cause or aggravate fatal or life-threatening neuropsychiatric disorders. Closely monitor patients with periodic clinical and laboratory evaluations. Withdraw patients with persistently severe or worsening signs or symptoms of these conditions from therapy. In many, but not all cases, these disorders resolve after stopping PegIntron therapy.

Autoimmune disorders (PegIntron):

Alpha interferons, including PegIntron, may cause or aggravate fatal or life-threatening autoimmune disorders. Closely monitor patients with periodic clinical and laboratory evaluations. Withdraw patients with persistently severe or worsening signs or symptoms of these conditions from therapy. In many, but not all cases, these disorders resolve after stopping PegIntron therapy.

Ischemic disorders (PegIntron):

Alpha interferons, including PegIntron, may cause or aggravate fatal or life-threatening ischemic disorders. Closely monitor patients with periodic clinical and laboratory evaluations. Withdraw patients with persistently severe or worsening signs or symptoms of these conditions from therapy. In many, but not all cases, these disorders resolve after stopping PegIntron therapy.

Infectious disorders (PegIntron):

Alpha interferons, including PegIntron, may cause or aggravate fatal or life-threatening infectious disorders. Closely monitor patients with periodic clinical and laboratory evaluations. Withdraw patients with persistently severe or worsening signs or symptoms of these conditions from therapy. In many, but not all cases, these disorders resolve after stopping PegIntron therapy.

Depression and other neuropsychiatric disorders (Sylatron):

The risk of serious depression with suicidal ideation, completed suicides, and other serious neuropsychiatric disorders are increased with alpha interferons, including Sylatron. Permanently discontinue Sylatron in patients with persistently severe or worsening signs or symptoms of depression, psychosis, or encephalopathy. These disorders may not resolve after stopping Sylatron.

Brand Names: US
  • PegIntron [DSC]
Pharmacologic Category
  • Antineoplastic Agent, Biological Response Modulator;
  • Biological Response Modulator;
  • Interferon
Dosing: Adult

Note : PegIntron 80 mcg, 120 mcg, and 150 mcg vials have been discontinued in the US for more than 1 year.

Melanoma

Melanoma (adjuvant therapy): SubQ: Initial: 6 mcg/kg/week for 8 doses; Maintenance: 3 mcg/kg/week for up to 5 years. Note: Premedicate with acetaminophen (500 to 1,000 mg orally) 30 minutes prior to the first dose and as needed for subsequent doses thereafter.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Melanoma:

CrCl >50 mL/minute/1.73 m2: No dosage adjustment is necessary.

CrCl 30 to 50 mL/minute/1.73 m2: Reduce initial dose to 4.5 mcg/kg/week; reduce maintenance dose to 2.25 mcg/kg/week.

CrCl <30 mL/minute/1.73 m2 and ESRD on dialysis: Reduce initial dose to 3 mcg/kg/week; reduce maintenance dose to 1.5 mcg/kg/week.

Hemodialysis: Following a single 1 mcg/kg/ dose, no clinically meaningful amount of peginterferon alfa-2b was removed during hemodialysis.

Dosing: Hepatic Impairment: Adult

Decompensated liver disease or autoimmune hepatitis: Use is contraindicated.

Hepatic decompensation or severe (grade 3) hepatic injury during treatment (Child-Pugh score >6 [class B or C]): Discontinue immediately.

Dosing: Adjustment for Toxicity: Adult

Melanoma:

Discontinue for any of the following: Persistent or worsening severe neuropsychiatric disorders, grade 4 nonhematologic toxicity, new or worsening retinopathy, new-onset ventricular arrhythmia or cardiovascular decompensation, evidence of hepatic injury (severe; grade 3) or hepatic decompensation (Child-Pugh score >6 [class B or C]), development of hyper- or hypothyroidism or diabetes mellitus that cannot be effectively managed with medication, or inability to tolerate a dose of 1 mcg/kg/week.

Temporarily withhold for any of the following: ANC <500/mm3, platelets <50,000/mm3, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2, nonhematologic toxicity ≥ grade 3.

May reinitiate at a reduced dose once ANC ≥500/mm3, platelets ≥50,000/mm3, ECOG PS 0 to 1, and nonhematologic toxicity completely resolved or improved to grade 1.

Reduced dose schedule, weeks 1 to 8:

First dose reduction (if prior dose 6 mcg/kg/week): 3 mcg/kg/week.

Second dose reduction (if prior dose 3 mcg/kg/week): 2 mcg/kg/week.

Third dose reduction (if prior dose 2 mcg/kg/week): 1 mcg/kg/week.

Discontinue permanently if unable to tolerate 1 mcg/kg/week.

Reduced dose schedule, weeks 9 to 260:

First dose reduction (if prior dose 3 mcg/kg/week): 2 mcg/kg/week.

Second dose reduction (if prior dose 2 mcg/kg/week): 1 mcg/kg/week.

Discontinue permanently if unable to tolerate 1 mcg/kg/week.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Pegylated interferon (peginterferon) alfa-2b (Discontinued by manufacturer; not available): Pediatric drug information")

Note: Due to differences in dosage, patients should not change brands of interferon alfa therapy. PegIntron 80 mcg, 120 mcg, and 150 mcg vials have been discontinued in the US for >1 year.

Chronic hepatitis C

Chronic hepatitis C: Note: Although FDA approved for the treatment of chronic hepatitis C (CHC) in compensated liver disease, experts no longer recommend interferon-based treatment regimens for CHC infection (Ref).

Children ≥3 years and Adolescents ≤17 years: PegIntron: SubQ: 60 mcg/m2 once weekly (in combination with ribavirin). Treatment duration recommendations vary; some experts recommend 48 weeks regardless of genotype or HIV-status (Ref); the manufacturer labeling recommends the following: 48 weeks (genotype 1); 24 weeks (genotypes 2 and 3). Note: Adolescents who reach their 18th birthday during treatment should remain on the pediatric regimen.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing adjustment for toxicity:

Chronic hepatitis C: Dosage adjustment for depression (severity based upon DSM-IV criteria):

Mild depression: Children and Adolescents: No dosage adjustment required; evaluate once weekly by visit/phone call. If depression remains stable, continue weekly visits. If depression improves, resume normal visit schedule. For worsening depression, see "Moderate depression" below.

Moderate depression: Decrease dose as below. Evaluate once weekly with an office visit at least every other week. If depression remains stable, consider psychiatric evaluation and continue with reduced dosing. If symptoms improve and remain stable for 4 weeks, resume normal visit schedule; continue reduced dosing or return to normal dose. For worsening depression or development of severe depression, discontinue therapy permanently and obtain immediate psychiatric consultation. Utilize followup psychiatric therapy as needed.

Children and Adolescents: Decrease to 40 mcg/m2 once weekly, may further decrease to 20 mcg/m2 once weekly if needed.

Severe depression: Children and Adolescents: Discontinue peginterferon alfa-2b and ribavirin permanently. Obtain immediate psychiatric consultation.

Chronic hepatitis C: Dosage adjustment in hematologic toxicity:

Children and Adolescents:

Hemoglobin decrease >2 g/dL in any 4-week period in patients with stable cardiac disease: Reduce peginterferon alfa-2b dose by 50%; monitor and evaluate weekly. If after 4 weeks of dose reduction the hemoglobin remains <12 g/dL: Permanently discontinue both peginterferon alfa-2b and ribavirin.

Hemoglobin 8.5 to <10 g/dL in patients without history of cardiac disease: No dosage adjustment for peginterferon alfa-2b. Decrease ribavirin dose.

WBC 1,000 to <1,500/mm3, neutrophils 500 to <750/mm3, or platelets 50,000 to <70,000/mm3: Reduce peginterferon alfa-2b dose to 40 mcg/m2 once weekly; may further reduce to 20 mcg/m2 once weekly.

Hemoglobin <8.5 g/dL, WBC <1,000/mm3, neutrophils <500/mm3, or platelets <50,000/mm3: Permanently discontinue peginterferon alfa-2b and ribavirin.

Dosing: Kidney Impairment: Pediatric

Chronic hepatitis C:

Children ≥3 years and Adolescents: Combination therapy with ribavirin: Should not be used if CrCl <50 mL/minute.

Serum creatinine >2 mg/dL or CrCl <50 mL/minute: Discontinue treatment.

Dosing: Hepatic Impairment: Pediatric

All patients:

Decompensated liver disease or autoimmune hepatitis: Use is contraindicated.

Hepatic decompensation or severe hepatic injury during treatment (Child-Pugh class B or C): Discontinue immediately

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Antiviral:

>10%:

Central nervous system: Headache (56%), fatigue (including asthenia; ≤52%), depression (29%), anxiety (≤28%), emotional lability (≤28%), irritability (≤28%), insomnia (23%), rigors (23%), dizziness (12%)

Dermatologic: Alopecia (22%), pruritus (12%)

Endocrine & metabolic: Weight loss (11%)

Gastrointestinal: Nausea (26%), anorexia (20%), diarrhea (18%), abdominal pain (15%)

Infection: Viral infection (11%)

Local: Inflammation at injection site (47%), injection site reaction (47%)

Neuromuscular & skeletal: Myalgia (54%), weakness (52%), musculoskeletal pain (28%), arthralgia (23%)

Miscellaneous: Fever (22%)

1% to 10%:

Cardiovascular: Chest pain (6%), flushing (6%)

Central nervous system: Lack of concentration (10%), right upper quadrant pain (8%), malaise (7%), nervousness (4%), agitation (2%), suicidal ideation (≤2%)

Dermatologic: Diaphoresis (6%), skin rash (6%)

Endocrine & metabolic: Hypothyroidism (5%), menstrual disease (4%), hyperthyroidism (3%)

Gastrointestinal: Vomiting (7%), dyspepsia (6%), xerostomia (6%), constipation (1%)

Hematologic & oncologic: Thrombocytopenia (7%), neutropenia (6%)

Hepatic: Increased serum alanine aminotransferase (10%), hepatomegaly (6%)

Immunologic: Antibody development (neutralizing: 2%)

Local: Pain at injection site (2% to 3%)

Ophthalmic: Conjunctivitis (4%), blurred vision (2%)

Respiratory: Pharyngitis (10%), cough (8%), sinusitis (7%), dyspnea (4%), rhinitis (2%)

Antineoplastic:

>10%:

Central nervous system: Fatigue (94%), headache (70%), chills (63%), depression (59%), dizziness (35%), neuropathy (olfactory) (23%), paresthesia (21%)

Dermatologic: Exfoliative dermatitis (36%), alopecia (34%)

Endocrine & metabolic: Weight loss (11%)

Gastrointestinal: Anorexia (69%), nausea (64%), dysgeusia (38%), diarrhea (37%), vomiting (26%)

Hepatic: Increased serum alanine aminotransferase (≤77%), increased serum aspartate aminotransferase (≤77%), increased serum alkaline phosphatase (23%)

Immunologic: Antibody development (binding antibodies: 35%)

Local: Injection site reaction (62%)

Neuromuscular & skeletal: Myalgia (68%), arthralgia (51%)

Miscellaneous: Fever (75%)

1% to 10%:

Cardiovascular: Bundle branch block (≤4%), myocardial infarction (≤4%), supraventricular cardiac arrhythmia (≤4%), ventricular tachycardia (≤4%)

Endocrine & metabolic: Increased gamma-glutamyl transferase (8%)

Genitourinary: Proteinuria (7%)

Hematologic & oncologic: Anemia (6%)

Respiratory: Dyspnea (6%), cough (5%)

<1%, postmarketing, and/or case reports: Aggressive behavior, amnesia, anaphylaxis, angina pectoris, angioedema, aphthous stomatitis, aplastic anemia, auditory impairment, bacterial infection, bipolar mood disorder, brain disease (including exacerbations), bronchiolitis obliterans, bronchoconstriction, cardiac arrest, cardiac arrhythmia, cardiomyopathy, cerebrovascular accident, colitis, cytopenia, dehydration, diabetes mellitus, diabetic ketoacidosis, drug dependence (including relapse), drug overdose, dysgeusia, erythema multiforme, exacerbation of autoimmune disease, fungal infection, hallucination, hearing loss, hemorrhagic colitis, homicidal ideation, hyperglycemia, hypersensitivity reaction, hypertension, hypertriglyceridemia, hypotension, immune thrombocytopenia, interstitial nephritis, interstitial pneumonitis, ischemic colitis, leukopenia, lupus-like syndrome, macular edema, mania, migraine, myositis, optic neuritis, palpitations, pancreatitis, papilledema, paresthesia, pericarditis, peripheral neuropathy, pneumonia, psoriasis, pulmonary fibrosis, pulmonary hypertension, pulmonary infiltrates, pure red cell aplasia, reactivation of HBV, renal failure syndrome, renal insufficiency (includes increases in serum creatinine), retinal cotton-wool spot, retinal detachment, retinal hemorrhage, retinal thrombosis, retinopathy, rhabdomyolysis, rheumatoid arthritis, sarcoidosis, seizure, sepsis, Stevens-Johnson syndrome, systemic lupus erythematosus, tachycardia, thrombotic thrombocytopenic purpura, thyroiditis, tongue discoloration, toxic epidermal necrolysis, ulcerative colitis, urticaria, vertigo, vision loss, visual disturbance, Vogt-Koyanagi-Harada syndrome

Contraindications

Hypersensitivity (including urticaria, angioedema, bronchoconstriction, anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis) to peginterferon alfa-2b, interferon alfa-2b, other alfa interferons, or any component of the formulation; autoimmune hepatitis; decompensated liver disease (Child-Pugh score >6, classes B and C)

Combination therapy with peginterferon alfa-2b and ribavirin is also contraindicated in pregnancy, females who may become pregnant, males with pregnant partners; hemoglobinopathies (eg, thalassemia major, sickle-cell anemia); renal dysfunction (CrCl <50 mL/minute)

Warnings/Precautions

Concerns related to adverse effects:

• Bone marrow suppression: Causes bone marrow suppression, including potentially severe cytopenias; alfa interferons may (rarely) cause aplastic anemia. Use with caution in patients who are chronically immunosuppressed, with low peripheral blood counts or myelosuppression, including concurrent use of myelosuppressive therapy. Dosage modification may be necessary for hematologic toxicity. Combination therapy with ribavirin may potentiate the neutropenic effects of alfa interferons. When used in combination with ribavirin, an increased incidence of anemia was observed when using ribavirin weight-based dosing, as compared to flat-dose ribavirin.

• Colitis: Ulcerative or hemorrhagic/ischemic colitis has been observed with alfa interferons (within 12 weeks of initiation); discontinue therapy if signs of colitis (abdominal pain, bloody diarrhea, fever) develop; symptoms typically resolve within 1 to 3 weeks.

• Dental/periodontal disorders: Have been reported with combination therapy; dry mouth may affect teeth and mucous membranes. Instruct patients to brush teeth twice daily; encourage regular dental exams. Rinse mouth thoroughly after vomiting.

• Flu-like symptoms: Interferons are commonly associated with flu-like symptoms. Use with caution in patients with debilitating conditions.

• Hypersensitivity: Acute hypersensitivity reactions (eg, urticaria, angioedema, bronchoconstriction, anaphylaxis) and cutaneous reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported (rarely) with alfa interferons; prompt discontinuation and management is recommended. Transient rashes do not require interruption of therapy.

• Hypertriglyceridemia: Has been reported (may result in pancreatitis); periodically monitor and manage with appropriate treatment; consider discontinuing peginterferon if persistent and severe (triglycerides >1000 mg/dL), particularly if combined with symptoms of pancreatitis.

• Neuropsychiatric disorders: [US Boxed Warning]: May cause or aggravate severe depression or other neuropsychiatric adverse events (including suicide and suicidal ideation) in patients with and without a history of psychiatric disorder; monitor closely with clinical evaluations (periodic). Discontinue treatment with worsening or persistently severe signs/symptoms of neuropsychiatric disorders (eg, depression, encephalopathy, psychosis). Many cases resolve upon discontinuation, although some cases may persist. Substance use disorder relapse, aggression, depression, homicidal ideation and suicidal behavior/ideation have been observed with peginterferon alfa-2b; bipolar disorder, encephalopathy, hallucinations, mania, and psychosis have been observed with other alfa interferons. Onset may be delayed (up to 6 months after discontinuation). Higher doses may be associated with the development of encephalopathy (higher risk in elderly patients). Use with caution in patients with a history of psychiatric disorders, including depression or substance abuse history. New or exacerbated neuropsychiatric or substance abuse disorders are best managed with early intervention. Drug screening and periodic health evaluation (including monitoring of psychiatric symptoms) is recommended if initiating treatment in patients with coexisting psychiatric condition or substance abuse disorders. Monitor all patients for evidence of depression and other psychiatric symptoms; patients being treated for melanoma should be monitored for depression and psychiatric symptoms every 3 weeks during the first 8 weeks of treatment and every 6 months thereafter and permanently discontinue treatment if psychiatric symptoms persist, worsen or if suicidal behavior develops. Patients should continue to be monitored for 6 months after completion of therapy.

• Ophthalmic effects: Ophthalmologic disorders (including decreased visual acuity, blindness, macular edema, retinal hemorrhages, optic neuritis, papilledema, cotton wool spots, retinal detachment [serous], and retinal artery or vein thrombosis) have occurred with peginterferon alfa-2b and/or with other alfa interferons. Prior to start of therapy, ophthalmic exams are recommended for all patients; patients with diabetic or hypertensive retinopathy should have periodic ophthalmic exams during treatment; a complete eye exam should be done promptly in patients who develop ocular symptoms. Permanently discontinue treatment with new or worsening ophthalmic disorder.

• Pancreatitis: Pancreatitis, including fatal cases, has been observed with alfa interferon therapy; withhold treatment for suspected pancreatitis; discontinue therapy for known pancreatitis.

• Pulmonary effects: May cause or aggravate dyspnea, pulmonary infiltrates, pneumonia, bronchiolitis obliterans, interstitial pneumonitis, pulmonary hypertension, and sarcoidosis which may result in respiratory failure; may recur upon rechallenge with treatment; monitor closely. Use with caution in patients with existing pulmonary disease (eg, chronic obstructive pulmonary disease). Withhold combination therapy with ribavirin for development of pulmonary infiltrate or pulmonary function impairment.

Disease-related concerns:

• Autoimmune disease: [US Boxed Warning]: May cause or exacerbate autoimmune disorders; monitor closely with clinical and lab evaluations (periodic); discontinue treatment in patients with worsening or persistently severe signs/symptoms of autoimmune disease; may resolve with discontinuation. Thyroiditis, thrombotic microangiopathy, immune thrombocytopenia, rheumatoid arthritis, interstitial nephritis, systemic lupus erythematosus, and psoriasis have been reported with therapy; use with caution in patients with autoimmune disorders.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease or a history of cardiovascular disease; hypotension, arrhythmia, bundle branch block, tachycardia, cardiomyopathy, angina pectoris and MI have been observed with treatment. Patients with pre-existing cardiac abnormalities should have baseline ECGs prior to combination treatment with ribavirin; closely monitor patients with a history of MI or arrhythmia. Patients with a history of significant or unstable cardiac disease should not receive combination treatment with ribavirin. Discontinue treatment (permanently) for new-onset ventricular arrhythmia or cardiovascular decompensation.

• Diabetes: Diabetes mellitus (including new-onset type I diabetes) and hyperglycemia have been reported; discontinue if diabetes cannot be effectively managed with medication. Use with caution in patients with a history of diabetes mellitus, particularly if prone to DKA.

• Hepatic impairment: Use is contraindicated in patients with hepatic decompensation or autoimmune hepatitis. Discontinue treatment immediately with hepatic decompensation (Child Pugh score >6) or evidence of severe hepatic injury. Patients with chronic hepatitis C (CHC) with cirrhosis and patients coinfected with human immunodeficiency virus (HIV) receiving antiretroviral therapy are at increased risk for hepatic decompensation; monitor closely. A transient increase in ALT (2 to 5 times above baseline) which is not associated with liver dysfunction may occur with peginterferon alfa-2b use (for the treatment of chronic hepatitis C); may continue treatment with close monitoring. Instruct patients to avoid alcohol; may increase hepatic effects.

• Infectious disorders: [US Boxed Warning]: May cause or aggravate infectious disorders; monitor closely with clinical and lab evaluations (periodic); discontinue treatment in patients with worsening or persistently severe signs/symptoms of infectious disorders; may resolve with discontinuation. Interferon therapy is commonly associated with flu-like symptoms, including fever; rule out other causes/infection with persistent or high fever.

• Ischemic disorders: [US Boxed Warning]: May cause or aggravate ischemic and hemorrhagic cerebrovascular events; monitor closely with clinical and lab evaluations (periodic); discontinue treatment in patients with worsening or persistent ischemia; may resolve with discontinuation. Have been reported in patients without risk factors for stroke.

• Renal impairment: Use with caution in patients with renal impairment (CrCl <50 mL/minute); monitor closely for signs of interferon toxicity. For the treatment of chronic hepatitis C, dosage adjustments are recommended with monotherapy in patients with moderate to severe impairment; do not use combination therapy with ribavirin in adults with renal dysfunction (CrCl <50 mL/minute); discontinue if serum creatinine >2 mg/dL in children. Dosage adjustment is also recommended when used for the treatment of melanoma. Serum creatinine increases have been reported in patients with renal insufficiency.

• Thyroid disorders: Use with caution in patients with thyroid disorders; may cause or aggravate hyper- or hypothyroidism. Discontinue use in patients with thyroid disease who cannot be controlled with medication.

Concurrent drug therapy issues:

• Combination therapy with ribavirin: Ribavirin causes hemolytic anemia; the anemia associated with ribavirin therapy may result in a worsening of cardiac disease. Additional risks are associated with combination therapy; if used in combination with ribavirin, all warnings and precautions related to the use of ribavirin should be followed.

• Telbivudine: Peripheral neuropathy has been reported with alpha interferons when used in combination with telbivudine.

Special populations:

• Older adult: Use with caution in elderly patients; the potential adverse effects (eg, neuropsychiatric events, cardiac events, systemic effects) may be more pronounced. Encephalopathy has also been observed in primarily elderly patients treated with higher doses of peginterferon alfa-2b. For the treatment of hepatitis, elderly patients generally do not respond to interferon treatment as well as younger patients. When used in combination with ribavirin, closely monitor adults >50 years of age for the development of anemia.

• Pediatric: Growth velocity (height and weight) was decreased in children on combination treatment with ribavirin, during the length of treatment. In clinical studies, decreases were noted in weight and height for age z-scores and normative growth curve percentiles. Severely inhibited growth velocity has been noted. Following treatment, rebound growth and weight gain occurred in most patients; however, a small percentage did not. Long-term follow-up data indicate that combination therapy may inhibit growth, resulting in reduced adult height in some patients. Growth should be closely monitored in pediatric patients during therapy and posttreatment until growth catch-up has occurred.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

• Product variability: Due to differences in dosage, patients should not change brands of interferon.

Other warnings/precautions:

• Appropriate use: Combination therapy with ribavirin or monotherapy for the treatment of chronic hepatitis C is not a recommended treatment regimen (AASLD/IDSA 2021). Safety and efficacy have not been established in patients who have received organ transplants or are coinfected with HIV or hepatitis B. Patients with significant bridging fibrosis or cirrhosis, genotype 1 infection or who have not responded to prior therapy, including previous pegylated interferon treatment are less likely to benefit from combination therapy with peginterferon alfa-2b and ribavirin.

Warnings: Additional Pediatric Considerations

Suicidal ideation or attempts may occur more frequently in pediatric patients as compared to adults (2.4% vs 1%, respectively).

Severe inhibition of growth velocity, <3rd percentile and affecting height and weight, was reported in 70% of pediatric patients during clinical trials on combination therapy; monitor closely; dosage adjustment may be required. After therapy, 20% continued to have severely inhibited growth; however, in majority of patients, growth velocity rates increased such that by 6 months post-treatment, weight gain stabilized to 53rd percentile (similar to predicted based on average baseline weight: 57th percentile) and height gain stabilized to 44th percentile (less than predicted based on average baseline height: 51st percentile).

A higher incidence of some adverse effects has been reported in children compared to adults, including fever (80% vs 46%) and vomiting (27% vs 14%).

Product Availability

PegIntron 80 mcg, 120 mcg, and 150 mcg vials have been discontinued in the US for more than 1 year. PegIntron 50 mcg vials remain available in limited quantities; based on current demand, Merck anticipates product should continue to be available through May 2021. Contact the Merck National Service Center for additional information: 800-672-6372.

Sylatron 600 mcg vials will be discontinued on or near December 2018. Sylatron 200 mcg and 300 mcg vials will be discontinued on or near December 2019. Contact the Merck National Service Center for additional information: 800-672-6372.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Kit, Subcutaneous [preservative free]:

PegIntron: 50 mcg/0.5 mL [DSC] [contains polysorbate 80]

Generic Equivalent Available: US

No

Pricing: US

Kit (PegIntron Subcutaneous)

50 mcg/0.5 mL (per each): $902.60

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

For SubQ administration; rotate injection site. The weekly dose may be administered at bedtime to reduce flu-like symptoms.

Administration: Pediatric

SubQ: Rotate injection site; thigh, outer surface of upper arm, and abdomen are preferred injection sites; do not inject near navel or waistline; patients who are thin should only use thigh or upper arm. Do not inject into bruised, infected, irritated, red, or scarred skin. The weekly dose may be administered at bedtime to reduce flu-like symptoms. Administration volume depends on the patient's weight and peginterferon concentration used.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

PegIntron: https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/103949s5313lbl.pdf#page=29

Sylatron: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/103949s5312lbl.pdf#page=13

Use: Labeled Indications

Melanoma (adjuvant therapy): Sylatron: Adjuvant treatment of melanoma (with microscopic or gross nodal involvement within 84 days of definitive surgical resection, including complete lymphadenectomy). Note: Indications in the manufacturer's labeling may not reflect current clinical practices.

Medication Safety Issues
Sound-alike/look-alike issues:

Peginterferon alfa-2b may be confused with interferon alfa-2a, interferon alfa-2b, interferon alfa-n3, peginterferon alfa-2a, peginterferon beta-1a

PegIntron may be confused with Intron A, Pegasys

International issues:

Peginterferon alfa-2b may be confused with interferon alpha multi-subtype which is available in international markets

Metabolism/Transport Effects

Inhibits CYP1A2 (weak)

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Aldesleukin: Interferons (Alfa) may enhance the adverse/toxic effect of Aldesleukin. In particular, risks of myocardial and renal toxicity may be increased by this combination. Management: Consider using lower doses to minimize toxicity of this combination. Only coadminister aldesleukin and interferons (alfa) in patients in whom potential benefits outweigh the risk of severe toxicity. Monitor renal and cardiac function closely if combined. Risk D: Consider therapy modification

BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy

Chloramphenicol (Systemic): Myelosuppressive Agents may enhance the myelosuppressive effect of Chloramphenicol (Systemic). Risk X: Avoid combination

Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination

CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy

CloZAPine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of CloZAPine. Risk C: Monitor therapy

CYP2D6 Substrates (High risk with Inhibitors): Peginterferon Alfa-2b may decrease the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification

Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination

Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination

Fezolinetant: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Fezolinetant. Risk X: Avoid combination

Fluorouracil Products: Interferons (Alfa) may increase the serum concentration of Fluorouracil Products. Risk C: Monitor therapy

Methadone: Interferons (Alfa) may increase the serum concentration of Methadone. Risk C: Monitor therapy

Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy

Pegloticase: May diminish the therapeutic effect of PEGylated Drug Products. Risk C: Monitor therapy

Pegvaliase: PEGylated Drug Products may enhance the adverse/toxic effect of Pegvaliase. Specifically, the risk of anaphylaxis or hypersensitivity reactions may be increased. Risk C: Monitor therapy

Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy

Ribavirin (Oral Inhalation): Interferons (Alfa) may enhance the adverse/toxic effect of Ribavirin (Oral Inhalation). Hemolytic anemia has been observed. Risk C: Monitor therapy

Ribavirin (Systemic): Interferons (Alfa) may enhance the adverse/toxic effect of Ribavirin (Systemic). Hemolytic anemia has been observed. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification

Telbivudine: Interferons (Alfa) may enhance the adverse/toxic effect of Telbivudine. Specifically, the risk of peripheral neuropathy may be increased. Risk C: Monitor therapy

Theophylline Derivatives: CYP1A2 Inhibitors (Weak) may increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy

TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Interferons (Alfa) may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Zidovudine: Interferons may enhance the adverse/toxic effect of Zidovudine. Interferons may decrease the metabolism of Zidovudine. Risk C: Monitor therapy

Reproductive Considerations

Verify pregnancy status prior to administration in patients who could become pregnant. Disruption of the normal menstrual cycle was observed in animal studies. Patients who could become pregnant should use effective contraception during treatment and for ≥10 days after the last peginterferon alfa-2b dose.

If used in combination with ribavirin, all warnings related to the use of ribavirin and contraception should be followed. Refer to the ribavirin monograph for additional information.

Pregnancy Considerations

Alfa interferon is endogenous to normal amniotic fluid (Lebon 1982); however, placenta perfusion studies note exogenous interferon alfa does not cross the placenta (Waysbort 1993). The US Department of Health and Human Services perinatal HIV guidelines recommend against the use of peginterferon-alfa during pregnancy because of its antigrowth and antiproliferative effects (HHS [perinatal] 2023). Animal reproduction studies have demonstrated abortifacient effects.

Peginterferon alfa-2b in combination with ribavirin is contraindicated in pregnant patients and patients with partners who are pregnant. Combination therapy with ribavirin may cause birth defects and death in an unborn child. If used in combination with ribavirin, all warnings related to the use of ribavirin and pregnancy should be followed. Refer to the ribavirin monograph for additional information.

Breastfeeding Considerations

Interferon alfa is endogenous to breast milk.

Breast milk samples obtained from a lactating mother prior to and after administration of interferon alfa-2b showed that interferon alfa is present in breast milk and administration of the medication did not significantly affect endogenous levels (Kumar 2000).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

If used in combination with ribavirin, all warnings related to the use of ribavirin and breastfeeding should be followed. Refer to the ribavirin monograph for additional information.

Monitoring Parameters

Manufacturer's labeling:

Baseline and periodic TSH (for patients being treated for melanoma, obtain baseline within 4 weeks prior to treatment initiation, and then at 3 and 6 months, and every 6 months thereafter during treatment); CBC with differential and platelets; serum chemistries, liver function tests (for patients with melanoma, monitor serum bilirubin, ALT, AST, alkaline phosphatase, and LDH at 2 and 8 weeks, and 2 and 3 months following initiation, then every 6 months during therapy), renal function, triglycerides; serum glucose or HbA1c (for patients with diabetes mellitus). Evaluate pregnancy status prior to use (in females of reproductive potential) regardless of indication.

Evaluate for depression and other psychiatric symptoms before and after initiation of therapy; patients being treated for melanoma should be monitored for depression and psychiatric symptoms every 3 weeks during the first eight weeks of treatment and every 6 months thereafter, and continued monitoring for 6 months after the last dose; baseline ophthalmic eye examination; periodic ophthalmic exam in patients with diabetic or hypertensive retinopathy; baseline ECG in patients with cardiac disease; serum glucose or HbA1c (for patients with diabetes mellitus).

Oncology uses: The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.

Mechanism of Action

Alpha interferons are a family of proteins, produced by nucleated cells, that have antiviral, antiproliferative, and immune-regulating activity. There are 16 known subtypes of alpha interferons. Interferons interact with cells through high affinity cell surface receptors. Following activation, multiple effects can be detected including induction of gene transcription. Inhibits cellular growth, alters the state of cellular differentiation, interferes with oncogene expression, alters cell surface antigen expression, increases phagocytic activity of macrophages, and augments cytotoxicity of lymphocytes for target cells.

Pharmacokinetics (Adult Data Unless Noted)

Bioavailability: Increases with chronic dosing

Half-life elimination: CHC: ~40 hours (range: 22 to 60 hours); Melanoma: ~43 to 51 hours

Time to peak: CHC: 15 to 44 hours

Excretion: Urine (~30%); clearance reduced in renal impairment by 17% in moderate dysfunction, 44% in severe dysfunction

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Mean exposure is increased 1.4-fold in patients with moderate impairment and by 2.1-fold in patients with severe renal impairment (including ESRD on dialysis) following a single 4.5 mcg/kg dose. Reduce dose in patients with moderate or severe renal impairment.

Pediatric: In children receiving peginterferon alfa-2b (PegIntron) 60 mcg/m2/week, exposure may be ~50% higher than that observed in adults receiving 1.5 mcg/kg/week.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Pegintron;
  • (AR) Argentina: Intron a peg;
  • (AT) Austria: Pegintron;
  • (AU) Australia: Peg intron;
  • (BE) Belgium: Pegintron;
  • (BG) Bulgaria: Pegintron;
  • (BR) Brazil: Pegintron;
  • (CH) Switzerland: Cylatron | Pegintron;
  • (CL) Chile: Cylatron | Peg intron;
  • (CN) China: Peg intron;
  • (CO) Colombia: Cylatron | Jakstat c | Peg intron;
  • (CZ) Czech Republic: Pegintron;
  • (DE) Germany: Pegintron | Viraferon peg;
  • (DO) Dominican Republic: Peg intron;
  • (EC) Ecuador: Peg intron;
  • (EE) Estonia: Pegintron;
  • (EG) Egypt: Pegintron;
  • (ES) Spain: Pegintron;
  • (FI) Finland: Pegintron;
  • (FR) France: Viraferonpeg;
  • (GB) United Kingdom: Peginterf a 2b | Pegintron | Viraferonpeg;
  • (GR) Greece: Pegintron;
  • (HK) Hong Kong: Peg intron;
  • (HR) Croatia: Pegintron;
  • (HU) Hungary: Pegintron;
  • (ID) Indonesia: Peg intron;
  • (IE) Ireland: Peg intron | Viraferon peg;
  • (IL) Israel: Pegintron;
  • (IN) India: Pegihep | Pegliton | Pegvir | Viraferonpeg;
  • (IS) Iceland: Pegintron;
  • (IT) Italy: Pegintron;
  • (JO) Jordan: Peg intron;
  • (JP) Japan: Pegintron;
  • (KE) Kenya: Vipeg;
  • (KR) Korea, Republic of: Peg intron;
  • (KW) Kuwait: Peg intron;
  • (LB) Lebanon: Peg intron;
  • (LT) Lithuania: Pegintron;
  • (LU) Luxembourg: Pegintron;
  • (LV) Latvia: Pegintron;
  • (MA) Morocco: Viraferon peg;
  • (MX) Mexico: Pegtron;
  • (MY) Malaysia: Peg intron;
  • (NL) Netherlands: Pegintron;
  • (NO) Norway: Pegintron;
  • (NZ) New Zealand: Peg intron;
  • (PE) Peru: Cylatron | Pegintron;
  • (PH) Philippines: Peg intron;
  • (PK) Pakistan: Cell aid | Peg heb | Peg intron;
  • (PL) Poland: Pegintron;
  • (PR) Puerto Rico: Peg intron | Pegintron | Sylatron;
  • (PT) Portugal: Pegintron;
  • (QA) Qatar: Peg-Intron;
  • (RU) Russian Federation: Pegaltevir | Peginferon | Peginterferon alfa 2b | Pegintron;
  • (SA) Saudi Arabia: Peg intron;
  • (SE) Sweden: Pegintron | Viraferonpeg;
  • (SG) Singapore: Peg intron;
  • (SI) Slovenia: Pegintron;
  • (SK) Slovakia: Pegintron | Viraferonpeg;
  • (TH) Thailand: Peg intron;
  • (TN) Tunisia: Viraferonpeg;
  • (TR) Turkey: Pegintron;
  • (TW) Taiwan: Peg intron;
  • (UA) Ukraine: Alphapeg | Alphapeg c | Pegintron | Unitron;
  • (VE) Venezuela, Bolivarian Republic of: Peg intron;
  • (ZA) South Africa: Peg intron;
  • (ZM) Zambia: Peg intron
  1. Alade SL, Brown RE, Paquet A Jr. Polysorbate 80 and E-Ferol toxicity. Pediatrics. 1986;77(4):593-597. [PubMed 3960626]
  2. American Association for the Study of Liver Diseases/Infectious Diseases Society of America (AASLD/IDSA). Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Updated October 5, 2021. Accessed May 18, 2022.
  3. American Association for the Study of Liver Diseases/Infectious Diseases Society of America (AASLD/IDSA). Recommendations for testing, managing, and treating hepatitis C: HCV in Children. https://www.hcvguidelines.org/unique-populations/children. Updated December 10, 2019. Accessed March 17, 2020.
  4. Bouwhuis MG, Suciu S, Testori A, et al. Phase III trial comparing adjuvant treatment with pegylated interferon Alfa-2b versus observation: prognostic significance of autoantibodies--EORTC 18991. J Clin Oncol. 2010;28(14):2460-2466. doi: 10.1200/JCO.2009.24.6264. [PubMed 20385998]
  5. Centers for Disease Control (CDC). Unusual syndrome with fatalities among premature infants: association with a new intravenous vitamin E product. MMWR Morb Mortal Wkly Rep. 1984;33(14):198-199. http://www.cdc.gov/mmwr/preview/mmwrhtml/00000319.htm. [PubMed 6423951]
  6. Dienstag JL, McHutchison JG. American Gastroenterological Association medical position statement on the management of hepatitis C [published correction appears in Gastroenterology. 2006;130(3):1018. Gastroenterology. 2006;131(3):979.]. Gastroenterology. 2006;130(1):225-230. [PubMed 16401485]
  7. Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335-1374. doi: 10.1002/hep.22759. [PubMed 19330875]
  8. Hamnvik OP, Larsen PR, Marqusee E. Thyroid dysfunction from antineoplastic agents. J Natl Cancer Inst. 2011;103(21):1572-1587. doi: 10.1093/jnci/djr373. [PubMed 22010182]
  9. Heathcote EJ, Shiffman ML, Cooksley WG, et al. Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis. N Engl J Med. 2000;343(23):1673-1680. [PubMed 11106716]
  10. Hughes BL, Page CM, Kuller JA; Society for Maternal-Fetal Medicine (SMFM). Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol. 2017;217(5):B2-B12. doi:10.1016/j.ajog.2017.07.039. [PubMed 28782502]
  11. Hwang JP, Feld JJ, Hammond SP, et al. Hepatitis B virus screening and management for patients with cancer prior to therapy: ASCO provisional clinical opinion update. J Clin Oncol. 2020;38(31):3698-3715. doi:10.1200/JCO.20.01757 [PubMed 32716741]
  12. Isaksson M, Jansson L. Contact allergy to Tween 80 in an inhalation suspension. Contact Dermatitis. 2002;47(5):312-313. [PubMed 12534540]
  13. Kumar AR, Hale TW, Mock RE. Transfer of interferon alfa into human breast milk. J Hum Lact. 2000;16(3):226-228. [PubMed 11153157]
  14. Lebon P, Girard S, Thépot F, Chany C. The presence of alpha-interferon in human amniotic fluid. J Gen Virol. 1982;59(pt 2):393-396. doi: 10.1099/0022-1317-59-2-393. [PubMed 6176680]
  15. Lucente P, Iorizzo M, Pazzaglia M. Contact sensitivity to Tween 80 in a child. Contact Dermatitis. 2000;43(3):172. [PubMed 10985636]
  16. McHutchison JG, Lawitz EJ, Shiffman ML, et al; IDEAL Study Team. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection [published correction appears in N Engl J Med. 2009:361(10):1027]. N Engl J Med. 2009;361(6):580-593. doi: 10.1056/NEJMoa0808010. [PubMed 19625712]
  17. PegIntron (peginterferon alfa-2b) [prescribing information]. Whitehouse Station, NJ: Merck & Co Inc; August 2019.
  18. Poynard T, Colombo M, Bruix J, et al; Epic Study Group. Peginterferon alfa-2b and ribavirin: effective in patients with hepatitis C who failed interferon alfa/ribavirin therapy. Gastroenterology. 2009;136(5):1618-1628.e2. doi: 10.1053/j.gastro.2009.01.039. [PubMed 19208349]
  19. Shelley WB, Talanin N, Shelley ED. Polysorbate 80 hypersensitivity. Lancet. 1995;345(8980):1312-1313. [PubMed 7746084]
  20. Sylatron (peginterferon alfa-2b) [prescribing information]. Whitehouse Station, NJ: Merck & Co, Inc; August 2019.
  21. US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/whats-new. Accessed May 4, 2020.
  22. US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/whats-new. Accessed May 7, 2013.
  23. US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. November 2013. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/pediatric-oi/tables-pediatric-oi.pdf.
  24. US Department of Health and Human Services (HHS) Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new. Updated January 31, 2023. Accessed February 23, 2023.
  25. Waysbort A, Giroux M, Mansat V, Teixeira M, Dumas JC, Puel J. Experimental study of transplacental passage of alpha interferon by two assay techniques. Antimicrob Agents Chemother. 1993;37(6):1232-1237. doi: 10.1128/aac.37.6.1232. [PubMed 8328774]
  26. World Health Organization (WHO). Guidelines for the care and treatment of persons diagnosed with chronic hepatitis c virus infection. https://apps.who.int/iris/bitstream/handle/10665/273174/9789241550345-eng.pdf?ua=1. Published July 2018. Accessed April 29, 2019.
Topic 9976 Version 303.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟