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Neuropsychiatric side effects associated with interferon-alfa plus ribavirin therapy: Treatment and prevention

Authors
Charles L Raison, MD
Nezam H Afdhal, MD, FRCPI
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Few well designed studies are available to provide definitive guidance on preventing or alleviating the many neuropsychiatric side effects associated with interferon-alfa (IFN-alfa) plus ribavirin. Fortunately, several placebo-controlled studies confirm clinical experience by demonstrating that side effects can be managed effectively in many patients. Nonetheless, the recommendations that follow are based mainly upon observational studies and experience in treatment of psychiatric syndromes in other settings.

The guidelines found on product information sheets (ie, dosage reduction of IFN-alfa as a treatment for depression) are not sufficiently comprehensive to address the clinical issues that arise during treatment. They do not adequately consider the tradeoff between managing depression and the reduction in efficacy of treatment associated with a dose reduction, especially early in the course of therapy. In addition, the effectiveness of dose-reduction in resolving treatment-emergent neuropsychiatric side effects remains to be conclusively determined.

We believe that a better strategy is to use all techniques at our disposal (pharmacological and psychosocial) to allow patients to tolerate full doses of IFN-alfa/ribavirin for an appropriate period while minimizing negative impact on emotional and physical well-being and daily functioning.

This topic review will summarize the treatment and prevention of neuropsychiatric side effects in patients receiving IFN-alfa plus ribavirin for hepatitis C virus infection. Recognition and risk factors are presented separately. (See "Neuropsychiatric side effects associated with interferon plus ribavirin for treatment of hepatitis C: Recognition and risk factors".)

PSYCHIATRIC CONSULTATION

Patients who are candidates for interferon-alfa (IFN-alfa) are often referred to psychiatrists to evaluate the risk of adverse psychiatric outcomes [1]. The role of the psychiatrist includes:

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 29 00:00:00 GMT+00:00 2016.
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