To tell you common hepatitis B antiviral drug adverse reactions

As we all know, the world has approved for the treatment of chronic hepatitis B drugs include two main categories: nucleoside (acid) analogu


As we all know, the world has approved for the treatment of chronic hepatitis B drugs include two main categories: nucleoside (acid) analogues and interferon (interferon, IFN) drugs. Interferon mechanism: IFN is a broad-spectrum antiviral agent, does not directly kill or inhibit the virus, but mainly through cell surface receptors causes cells to produce antiviral protein, thereby inhibiting the replication of the hepatitis B virus, its type is divided into three categories, alpha (white blood cells) and beta (fibroblasts). Gamma (lymphocytes); can also enhance the natural killer cells (NK cells), macrophage and T lymphocyte activity, which plays a role in immune regulation, and enhance the antiviral ability. Nucleoside (acid) mechanisms: nucleoside (acid) anti HBV drugs by simulating natural nucleoside (acid) structure, ATP and ATP loci competitively with DNA polymerase and reverse transcriptase HBV, embedded is synthesis of viral DNA chain termination, DNA chain elongation, inhibits HBV DNA polymerase and reverse transcriptase the final enzyme replication, inhibition of virus replication. Nucleoside (acid) analogues are now the most widely used anti HBV drugs commonly used in clinical with lamivudine, telbivudine and entecavir and tenofovir or adefovir dipivoxil etc.. Today we have adverse reactions and drug interferon, lamivudine, entecavir, telbivudine 4 antiviral drug interactions to tell you, for you to pay attention to these problems in the application. Adverse reactions of interferon are common in the early stage of treatment, but usually decrease with further treatment. The most common adverse reactions observed is flu like syndrome (have a fever, chills, joint pain, discomfort, sweating, headache or muscle pain) and injection site reactions, which is mainly caused by the pharmacological action of the drug and injection site reaction. It usually causes redness, swelling, discoloration, inflammation, pain, Chao Min, and necrosis at the injection site. Abnormal blood and lymphatic system: rare anemia, thrombocytopenia, neutropenia, rare lymph node disease. Abnormal immune system: rare allergic reaction. Endocrine abnormalities: rare hyperthyroidism, hypothyroidism, thyroid dysfunction. Metabolic and nutritional abnormalities: elevated serum triglycerides, anorexia. Mental disorders: rare depression, rare mental confusion, anxiety, mood swings, suicide attempts. Nervous system abnormalities: rare convulsions. Cardiac abnormalities: rare cardiomyopathy, tachycardia, palpitation. Rare vascular abnormalities. Respiratory, thoracic and mediastinal abnormalities: rare bronchospasm, dyspnea. Gastrointestinal abnormalities: rare vomiting, nausea, rare pancreatitis. Hepatobiliary abnormalities: a rare increase in alanine aminotransferase, aspartate aminotransferase increased, a rare increase in bilirubin, - glutamyl aminotransferase elevated, hepatitis. Skin and subcutaneous tissue abnormalities: rare urticaria, rash, itching, hair loss, rare skin discoloration. Skeletal muscle, connective tissue and bone abnormalities: rare myalgia, hypertonia. Reproduction and breast abnormalities: rare menstrual disorders. The body and the injection site abnormal: very common pain with flu like symptoms, have a fever, chills, injection site reactions, injection site inflammation, injection site necrosis, common injection site, rare chest pain, discomfort, sweating. Check: rare weight loss. Clinical trial according to frequency. Drug interactions: prednisone or other corticosteroids have reduced interferon biological activity should be noted. It has been reported that when the CYP1A2 substrate (such as theophylline) is used in conjunction with other alpha interferon, the clearance is reduced by 50%. So when this product is used in conjunction with CYP1A2 metabolism, pay attention. If the patient is infected with HIV at the same time and receive high - effective antiretroviral therapy (HAART), will increase the possibility of lactic acidosis. If you use this product and theophylline at the same time, theophylline serum concentration should be monitored and adjusted the dosage of theophylline. The maximum interaction between theophylline and this product was estimated after 4 weeks of treatment. Leigh Bhave Lin: azathioprine can inhibit the single hypoxanthine dehydrogenase, which interfere with azathioprine metabolism and results in a 6 - methyl hypoxanthine sulfur single phosphate (6 MTIMP) and the accumulation of azathioprine in the treatment of patients with bone marrow toxicity. Adverse reactions to lamivudine: the most common adverse events were fatigue, respiratory infections, headache, abdominal discomfort and pain, nausea, vomiting, and diarrhea. Clinical adverse reactions occasionally: digestive system: gastritis; endocrine and metabolism: high blood sugar; body: weakness; the blood and lymphatic system: anemia, pure red cell aplasia, lymphadenopathy, splenomegaly. Liver and pancreas: lactic acidosis and fatty degeneration, pancreatitis, after treatment of hepatitis aggravation; allergy: allergic reaction, rubella; musculoskeletal: Rhabdomyolysis; nervous system: abnormal sensation, peripheral neuropathy; respiratory system: abnormal respiratory sounds / wheezing. Skin: hair loss, itching, rash. Drug interactions: Based on the research in lamivudine or interferon monotherapy in patients with interferon alpha and lamivudine treated patients compared to that received interferon alpha therapy in patients with adverse reactions occurred more in all received interferon therapy for patients in about 2/3 " influenza like " side effects. The combination of lamivudine and interferon did not improve the incidence of interferon alpha. Lamivudine is mainly in the form of active organic cations. At the same time and in the use of drugs with the same discharge mechanism, especially when the main way is to clear the drug through active renal organic cation transporter secretion (such as trimethoprim), should consider its interaction. Lamivudine and trimethoprim / sulfamethoxazole (160mg) (800mg) at the same time after taking the exposure of lamivudine increased 40%. Lamivudine and lamivudine (zalcitabine) may inhibit the phosphorylation of the latter in cells. Therefore, it is recommended not to use these two drugs at the same time. The adverse reaction of entecavir entecavir and lamivudine: in study group, entecavir and lamivudine adverse events and laboratory abnormalities were similar. The research conducted in foreign countries, the most common adverse events were headache, fatigue, dizziness, nausea, dizziness, fatigue, increased ALI, nausea, abdominal pain, abdominal discomfort, abdominal pain, liver discomfort, muscle pain, insomnia and rubella. Most of these adverse events were mild to moderate. Immune system disorders: anaphylactoid reactions. Adverse reactions of skin and subcutaneous tissue: alopecia, rash. Metabolic and nutritional disorders: reports of lactic acidosis are associated with decompensated liver disease or other serious illness or drug exposure. Patients with decompensated liver disease are at higher risk of lactic acidosis. Hepatobiliary system abnormalities: elevated transaminase. Drug interactions due to entecavir are cleared by the kidneys, with reduced kidney function or competition by active secretion of glomerular drug at the same time, taking entecavir may increase the blood concentration of the two drugs. Study on the interaction of not taking entecavir and other effects of renal function by renal clearance or known drugs, close monitoring of adverse reactions that need to happen. The adverse reactions of telbivudine: telbivudine group the most common adverse events leading to discontinuation included nausea, diarrhea, increased CK, fatigue, myalgia and myopathy. During the treatment, ALT rebound ALT, which is ALT > 10 x ULN and higher than the baseline level of 2 times, is recommended to detect liver function during the treatment of chronic hepatitis B. Skeletal muscle, connective tissue: Rhabdomyolysis (case). Nervous system: peripheral neuropathy. Nutritional disorders: lactic acidosis and other drug interactions due to individual differences in drug concentration of PEG alpha -2a turbulent disturbance, therefore does not affect the pharmacokinetics of telbivudine for pegylated interferon -2a to make definite conclusions. An exploratory clinical study suggests that the combined use of telbivudine and 600mg daily weekly subcutaneous injection of pegylated interferon alpha -2a180 g will increase the risk of peripheral neuropathy. Source: adaptation of the medical channel infection

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