Pharmaceutical Treatments for Hepatitis in Glendale, CA
Hepatitis is the inflammation of your liver caused by viruses, alcohol abuse, or autoimmune disorders. There are many pharmaceuticals (medications) available for most forms of hepatitis that can prevent the spread of the disease, reduce liver inflammation, and prevent complications of hepatitis like a liver transplant.
Immunosuppressants, biological response modifiers, direct-acting antivirals, and corticosteroids are commonly used to treat symptoms of alcoholic hepatitis , autoimmune hepatitis, hepatitis B , hepatitis C , hepatitis D, and hepatitis E .
The hepatitis vaccine is a good way to protect yourself against hepatitis A and hepatitis B. Visit hepatitis A and hepatitis B to learn more about the side effects of hepatitis vaccines. Getting vaccinated for hepatitis B protects against hepatitis D. Research in this area is ongoing for a hepatitis C vaccine.
To find a hepatitis specialist in Glendale, call (424) 365-1800 or contact Dr. Jeremy Fischer online.
As with any medical treatment, results of hepatitis medications will vary from patient to patient depending on age, genetics, general health, condition severity, follow-up care, and environmental factors. The following pharmaceutical treatments may also present contraindications with one another, and/or with other medical conditions. Always consult your healthcare provider before deciding which treatment to try first.
Hepatitis B & C Treatment
Antivirals & Biological Response Modifiers (BRMs)
Antiviral medications can treat symptoms for over 95% of patients with hepatitis C. They can also help reduce the risk of liver disease and the development of hepatocellular carcinoma (the most common form of liver cancer), and can even reverse scarring in the liver.4 However, they do present significant side effects.
Interferon alfa-2b with ribavirin
This common combination has been traditionally administered for decades.
Interferons are proteins secreted by the cells when a virus like hepatitis B, C, or D attacks your body. Injections of genetically engineered interferon stop the hepatitis virus from replicating and boosts the immune system.
Peginterferon is a combination of interferon and polyethylene glycol. Polyethylene glycol allows the interferon to remain in the body longer. Peginterferon injections clear the virus in around 50% of hepatitis patients.
Interferon alfa-2b cannot be taken by patients with autoimmune hepatitis or severe liver problems from causes other than hepatitis B or C.
Ribavirin is a nucleoside analog that stops the virus that causes hepatitis C from spreading by causing gene mutations in the virus, preventing your RNA from replicating it. Hepatitis c medication doesn't cure the virus, but it does reduce the symptoms and prevents liver disease, liver failure, and liver cancer.
Some of ribavirin's side effects are included in the FDA's most serious "boxed warning":
- hemolytic anemia
- worsened heart disease
- birth defects in fetuses
- vision loss
- macular edema
- mood changes
- increased infection
- decreased growth in children
Side effects of peginterferon and ribavirin combination therapy are observed in almost 80% of patients receiving for chronic hepatitis C virus and include nausea, diarrhea, stomach pain, headache, dizziness, fatigue, irritability, and blurred vision.
This antiviral drug prevents the virus's DNA from replicating. Side effects include a cough, sore throat, headache, tiredness, dizziness, muscle aches, fever, vomiting, diarrhea, itching, and joint or back pain.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
This decreases the amount of the hepatitis B virus in the blood, which in turn keeps the immune response at bay. It will not cure hepatitis B, may not prevent complications of the disease such as cirrhosis of the liver or liver cancer, and will not prevent the spread of the virus to others. Side effects include nausea, liver problems, kidney failure, and weak bones.
This antiviral drug prevents hepatitis B from replicating in your body by blocking reverse transcription (DNA creation from RNA templates). Side effects include a headache, tiredness, muscle pain, limb numbness or coldness, breathing difficulties, stomach pain, and uneven heart rate.
This blocks the enzyme reverse transcriptase in the hepatitis B virus; reverse transcriptase allows DNA to be created from an RNA template, and thus replicate the virus. Side effects include weakness, headache, fever, stomach pain, vomiting, and diarrhea.
Direct-Acting Antivirals (DAAs)
To avoid the serious side effects of interferons, researchers developed DAAs to target RNA proteins and enzymes to prevent replication of the hepatitis virus.
In preliminary trial results, these relatively new but expensive interventions for hepatitis C have shown they may eradicate hepatitis C virus from the blood with less adverse effects.
DAAs may reduce the number of people with the detectable virus in their blood, but we do not have sufficient evidence from randomized trials that enables us to understand how SVR affects long-term outcomes. DAAs have been known to cause depression that usually resolves within weeks. Other mild side effects include fatigue, headache, vomiting, abdominal pain, diarrhea, and breathing difficulties.
Sometimes ledipasvir-sofosbuvir is added for faster results. This drug blocks both a protein (NS5A) and an enzyme (RNA polymerase) which are vital to the replication of the virus. Trials since 2014 when it was approved show patients tolerate it well. Mild side effects include fatigue, headache, nausea, diarrhea, insomnia, weakness, and (rarely) a slow heart rate of fewer than 60 beats per minute (bradycardia).
Alcoholic Hepatitis: corticosteroids and anti-inflammatories
Alcoholic hepatitis is treated with corticosteroids and pentoxifylline; both medications for alcoholic hepatitis reduce inflammation.
Studies found that corticosteroids improve the short-term mortality in those with severe alcoholic hepatitis, but only in severe hepatitis. That's why pentoxifylline is prescribed for initial treatment.2
Steroids work by reducing the production of chemicals that cause inflammation. These chemicals are produced by immune system cells; corticosteroids enter these cells and turn off the gene that releases these inflammatory chemicals, suppressing inflammation.2
However, corticosteroids can cause these serious long-term effects:
- an enlarged liver
- an increased amount of liver fat
- glycogen storage disease, which affects the liver's ability to break down glycogen (a type of sugar)
- the progression of nonalcoholic fatty liver disease into nonalcoholic steatohepatitis
- the intensification of chronic viral hepatitis
Withdrawing from corticosteroids or administering large doses of them in fragmented patterns (pulse therapy) can reactivate a hepatitis B infection or worsen autoimmune hepatitis. High doses of corticosteroids can also cause liver injury, leading to acute liver failure and death.
Pentoxifylline inhibits the production of the inflammation protein TNF-? (elevated in alcoholic hepatitis) by altering its gene transcription. Studies suggest that pentoxifylline may help decrease the risk of hepatorenal syndrome in patients with severe acute alcoholic hepatitis, though may not significantly affect survival rate. Side effects include vomiting, bloating, diarrhea, and dizziness.
- azathioprine: this immune system suppressor causes disease remission and improved survival rates for patients via suppressing nucleic acid synthesis, which in turn controls DNA replication. Side effects include a cough, black stools, bleeding gums, fever, chills, and swollen glands.
- prednisone: another immune system suppressor that has been to shown to reduce side effects of azathioprine when used in conjunction for autoimmune hepatitis. Side effects include a headache, dizziness, sleeping trouble, acne, and mood swings.
- budesonide: this steroid decreases your immune system response and reduces inflammation by preventing certain enzymes from flowing through your blood vessels side effects include. Side effects include a headache, nausea, stomach pain, tiredness, joint pain, acne, stuffy nose, and sneezing.
- mycophenolate mofetil: this immunosuppressant drug suppresses inflammation by selectively hindering DNA replication in the white blood cells T cells and B cells. Side effects include fatigue, irregular heartbeat, muscle weakness, easy bleeding or bruising, swollen feet or ankles, and mood changes.
- rituximab: this antibody controls your immune system by binding to the CD-20 antigen on B cells to cause the cell's death. Side effects include abdominal pain, black stools, bleeding gums, swelling, bloody urine, blurred vision, and chest pain.
Other possible side effects of this autoimmune hepatitis medication are:
- kidney damage (nephrotoxicity)
- high blood pressure
- an increase in blood fats
- insulin resistance
- bone thinning (osteoporosis), if long-term use of steroids is part of your treatment
While they do treat symptoms and cause remission, immunosuppressants can interfere with the production of other types of blood cells in the bone marrow. Having fewer red blood cells can lead to anemia and a slow-down in the production of platelets can cause problems with blood clotting. That's why your doctor will check levels of all your blood cells during treatment.
Hepatitis E, B, and D
There is no pharmaceutical therapy specifically developed for acute hepatitis E, though patients with chronic hepatitis E can take ribavirin to prevent liver transplantation.6
Virus Entry Inhibitors
Proanthocyanidin is a virus entry inhibitor that prevents the hepatitis B virus from entering cells and infecting the host by targeting the virus' large surface protein.3 This medication can treat hepatitis D, which cannot exist without a previous hepatitis B infection.
This new class of anti-HBV medications could contribute to the development of a potent, well-tolerated, and broadly active inhibitor of HBV infection. Side effects of proanthocyanidin include nausea, vomiting, and diarrhea.
Do not take these medications if you are pregnant, breastfeeding, have recently had surgery, or have a history of the following conditions:
- bleeding conditions
- eye problems
- pancreas issues
- liver failure
- heart disease
- high blood pressure
- rheumatoid arthritis
- kidney disease
- ulcerative colitis
- crohn's disease
- low bone density
- breathing problems
Drugs that interact with these medications include warfarin, stavudine, tenofovir, ibuprofen, antacids, orlistat, and zalcitabine.
Reserve your appointment
If you have hepatitis, there are many different medications and vaccines available that can treat the condition and prevent infection respectfully. To find a hepatitis specialist in Glendale, call (424) 365-1800 or contact Dr. Jeremy Fischer online.
1. Gandhi, Rajesh T."Tenofovir Alafenamide for Treatment of Hepatitis B Virus." NEJM Journal Watch (2016): n pag. Web. p Oct. 2018.
2. Liang, Randy et al. "Advances in Alcoholic Liver Disease: An Update on Alcoholic Hepatitis." World Journal of Gastroenterology 21.42 (2015): 11893?11903. PMC. Web. 6 Sept. 2018.
3. S, Tsukuda, et al. "A new class of hepatitis B and D virus entry inhibitors, proanthocyanidin and its analogs, that directly act on the viral large surface proteins." Hepatology (Baltimore, Md.) 65.4 (2017): 1104-1116. Web. 6 Sept. 2018.
4. Sundaram, Vinay, and Kris Kowdley. "Management of chronic hepatitis B infection." BMJ 351 (2015): n. pag. Web. 6 Sept. 2018.
5. Terziroli Beretta-Piccoli, Benedetta, Giorgina Mieli-Vergani, and Diego Vergani. "Autoimmune Hepatitis: Standard Treatment and Systematic Review of Alternative Treatments." World Journal of Gastroenterology 23.33 (2017): 6030?6048. PMC. Web. 6 Sept. 2018.
6. W, Hui, et al. "Treatment of Hepatitis E." Advances in experimental medicine and biology 948 (2016): 211-221. Web. 6 Sept. 2018.
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