|peginterferon alfa-2a and ribavirin
|peginterferon alfa-2b and ribavirin
||Pegintron/Rebetol Combo Pack
How It Works
Combination antiviral therapy helps
prevent the virus that causes
hepatitis C from reproducing in the body. Peginterferon and ribavirin are combined to give the best response to treatment. A protease inhibitor (such as boceprevir or telaprevir) also may be given along with peginterferon and ribavirin.
Peginterferon is given as a shot once a week. Ribavirin is taken as a
pill 2 times a day. During the course of your treatment, your doctor frequently
may adjust the amount of medicine you are taking.
The length of
your treatment depends on what hepatitis C genotype you have. Genotype 1
generally is treated for 1 year and genotypes 2 and 3 generally are treated for
6 months. If you have genotype 1 and your viral load does not improve after 3
months of treatment, your treatment may be stopped.
Why It Is Used
Combination antiviral therapy is
prescribed for people who have ongoing (chronic) hepatitis C infection. It may
be given to people who have never had treatment or when interferon alone has
failed to control the disease.
How Well It Works
How well treatment works is measured by
whether you still have the virus in your blood 6 months after treatment.
Treatment usually works better if you have genotype 2 or 3 than if you have
genotype 1. Most studies have shown that treatment with peginterferon and
ribavirin works for up to 50 out of 100 people with genotype 1 or 4 and up to 80 out of 100 people
with genotype 2 or 3.1
Combination antiviral therapy is more likely to
be effective if you:
- Have a low level of the hepatitis C virus in
your blood when treatment starts.
- Are infected with genotype 2 or
- Have a low amount of liver damage when treatment starts.
Many things affect the decision about
who should receive antiviral treatment for hepatitis C.2 For example, treatment may be recommended for
people who are at least 18 years old, have detectable levels of the virus in
their blood, and have significant liver damage confirmed by a
- Hepatitis C: Should I Take Antiviral Medicine?
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call911or other emergency services right away if you have:
Call your doctor if you have:
Common side effects of this medicine include:
Fatigue, headache, muscle and joint aches,
fever, or chills.
Nausea, loss of appetite, or weight
insomnia, or confusion.
Hair loss or skin rash.
- Low levels of red
cells, white cells, and platelets in your blood.
If you develop
anemia as a result of taking ribavirin, your doctor
may prescribe a medicine called erythropoietin to help your body create more
red blood cells.
See Drug Reference for a full list of side effects.
(Drug Reference is not available in all systems.)
What To Think About
You will need regular follow-up
visits with a liver specialist during treatment. The specialist will order
blood tests to check your liver enzyme levels and to see whether the virus is
Peginterferon and other interferons may be given
without ribavirin if you have anemia or heart or kidney problems.
People with normal or slightly elevated liver
enzyme levels but whose
liver biopsy shows little or no liver damage may
choose not to have antiviral treatment. Instead, a doctor can monitor the
condition with periodic
liver function tests and a liver biopsy every 3 to 5
Even if the initial treatment does not eliminate the virus,
your doctor may advise you to continue antiviral treatment, because it may
inflammation. For some people with significant liver
damage, antiviral therapy may slow the progression of liver damage or make
liver cancer less likely.3, 4 If you already have
cirrhosis, some studies show that antiviral therapy
can help you live longer.5
Only a few clinical trials have tested antiviral medicines in children.
The results suggest that they work about as well in children as in adults.
Combination therapy using interferon and ribavirin is now approved by the U.S.
Food and Drug Administration for use in children ages 3 to 17 years.
If you are obese or have poorly controlled diabetes, you may need to delay treatment until you get your
weight or blood sugar under control.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Pregnancy advice for women and men
If you need to take this medicine, talk to your doctor about how you can prevent pregnancy.
For women: Do not use this medicine if you are pregnant or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Pawlotsky JM, McHutchinson J (2012). Chronic
viral and autoimmune hepatitis. In L Goldman, A Shafer, eds.,
Goldman's Cecil Medicine, 24th ed., pp.
973–979. Philadelphia: Saunders.
Ghany MG, et al. (2009). Diagnosis, management, and treatment of hepatitis C: An update. Hepatology, 49(4): 1335–1374. Also available online: http://onlinelibrary.wiley.com/doi/10.1002/hep.22759/full.
Singal AK, et al. (2010). Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis, Clinical Gastroenterology and Hepatology, 8(2): 192–199.
Morgan RL, et al. (2013). Eradication of hepatitis C Virus infection and the development of
hepatocellular carcinoma: A meta-analysis of observational studies. Annals of Internal Medicine, 158(5, Part 1): 329–337.
Dienstag JL (2010). Chronic viral hepatitis. In GL
Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp.
1593–1670. Philadelphia: Churchill Livingstone Elsevier.
Primary Medical Reviewer
||E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
||W. Thomas London, MD - Hepatology
Current as of
||June 27, 2013