Bronchiolitis
▶BY INHALATION OF AEROSOL, OR BY INHALATION OF NEBULISED
SOLUTION
▶Child 1–23 months: Inhale a solution containing
20 mg/mL for 12–18 hours for at least 3 days, maximum
of 7 days, to be administered via small particle aerosol
generator
Life-threatening RSV, parainfluenza virus, and adenovirus
infection in immunocompromised children
(administered on expert advice)
▶BY INTRAVENOUS INFUSION
▶Child: 33 mg/kg for 1 dose, to be administered over
15 minutes, then 16 mg/kg every 6 hours for 4 days,
then 8 mg/kg every 8 hours for 3 days
COPEGUS ® TABLETS
Chronic hepatitis C (in combination with direct acting
antivirals, or interferon alfa 2a, or peginterferon alfa 2a
with or without direct acting antivirals)
▶BY MOUTH
▶Adult (body-weight up to 75 kg): 400 mg, dose to be taken
in the morning and 600 mg, dose to be taken in the
evening
▶Adult (body-weight 75 kg and above): 600 mg twice daily
Chronic hepatitis C (in combination with peginterferon
alfa 2b with or without direct acting antivirals)
▶BY MOUTH
▶Adult (body-weight up to 65 kg): 400 mg twice daily
▶Adult (body-weight 65–80 kg): 400 mg, to be taken in the
morning and 600 mg, to be taken in the evening
▶Adult (body-weight 81–105 kg): 600 mg twice daily
▶Adult (body-weight 106 kg and above): 600 mg, to be
taken in the morning and 800 mg, to be taken in the
evening
Chronic hepatitis C genotype 2 or 3 (not previously
treated), or patients infected with HIV and hepatitis C (in
combination with peginterferon alfa)
▶BY MOUTH
▶Adult: Usual dose 400 mg twice daily
REBETOL ® CAPSULES
Chronic hepatitis C (in combination with interferon alfa
2b, or peginterferon alfa 2b with or without boceprevir)
▶BY MOUTH
▶Adult (body-weight up to 65 kg): 400 mg twice daily
▶Adult (body-weight 65–80 kg): 400 mg, dose to be taken
in the morning and 600 mg, dose to be taken in the
evening
▶Adult (body-weight 81–104 kg): 600 mg twice daily
▶Adult (body-weight 105 kg and above): 600 mg, dose to be
taken in the morning and 800 mg, dose to be taken in
the evening
REBETOL ® ORAL SOLUTION
Chronic hepatitis C (in combination with interferon alfa
2b, or peginterferon alfa 2b with or without boceprevir)
▶BY MOUTH
▶Adult (body-weight up to 65 kg): 400 mg twice daily
▶Adult (body-weight 65–80 kg): 400 mg, dose to be taken
in the morning and 600 mg, dose to be taken in the
evening
▶Adult (body-weight 81–104 kg): 600 mg twice daily
▶Adult (body-weight 105 kg and above): 600 mg, dose to be
taken in the morning and 800 mg, dose to be taken in
the evening
l UNLICENSED USE
▶When used by inhalation in children Inhalation licensed for
use in children (age range not specified by manufacturer).
▶With intravenous use in children Intravenous preparation not
licensed.
PDF pages 684, 685
▶With systemic use consult product literature for specific
contra-indications when ribavirin used in combination
with other medicinal products. haemoglobinopathies.
severe cardiac disease (in adults). severe, uncontrolled
cardiac disease in children with chronic hepatitis C.
unstable or uncontrolled cardiac disease in previous
6 months (in adults)
PDF page 685
▶When used by inhalation maintain standard supportive
respiratory and fluid management therapy
▶With systemic use anaemia (haemoglobin concentration
should be monitored during the treatment and corrective
action taken) (in adults). cardiac disease (assessment
including ECG recommended before and during
treatment—discontinue if deterioration). consult product
Infection
literature for specific cautions when ribavirin used in
combination with other medicinal products. gout (in
adults). haemolysis (haemoglobin concentration should
be monitored during the treatment and corrective action
taken) (in adults). patients with a transplant—risk of
rejection. risk of growth retardation in children, the
reversibility of which is uncertain—if possible, consider
starting treatment after pubertal growth spurt. severe
dental disorders (in adults). severe ocular disorders (in
adults). severe periodontal disorders (in adults). severe
psychiatric effects (in adults)
PDF page 685
NICE decisions
▶Peginterferon alfa and ribavirin for mild chronic hepatitis C
(August 2006 and September 2010) NICE TA200
▶In adults The combination of peginterferon alfa and
ribavirin can be used for treating mild chronic hepatitis C
in patients over 18 years. Alternatively, treatment can be
delayed until the disease has reached a moderate stage
(‘watchful waiting’).
www.nice.org.uk/guidance/ta200
▶Peginterferon alfa, interferon alfa, and ribavirin for moderate
to severe chronic hepatitis C (January 2004 and September
2010) NICE TA200
▶In adults The combination of peginterferon alfa and
ribavirin should be used for treating moderate to severe
chronic hepatitis C in patients aged over 18 years:.
. not previously treated with interferon alfa or
peginterferon alfa;
. treated previously with interferon alfa alone or in
combination with ribavirin;
. whose condition did not respond to peginterferon alfa
alone or to a combination of peginterferon alfa and
ribavirin, or responded but subsequently relapsed;
. co-infected with HIV.
Peginterferon alfa alone should be used if ribavirin is
contra-indicated or not tolerated. Interferon alfa for either
monotherapy or combined therapy should be used only if
neutropenia and thrombocytopenia are a particular risk.
Patients receiving interferon alfa may be switched to
peginterferon alfa.
www.nice.org.uk/guidance/ta200
▶Peginterferon alfa and ribavirin for chronic hepatitis C
(November 2013) NICE TA300
▶In children Peginterferon alfa in combination with ribavirin
is recommended (within the marketing authorisation) as
an option for treating chronic hepatitis C in children.
www.nice.org.uk/guidance/ta300
l LESS SUITABLE FOR PRESCRIBING Ribavirin inhalation is
less suitable for prescribing.
PDF page 686
