Page 907 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 49 Antiviral Agents 893

RIBAVIRIN for RSV in treated patients, as well as decreases in the need for
supplemental oxygen, the illness severity score, and need for
In addition to oral administration for HCV infection in combi- intensive care. Although resistant strains have been isolated in the
nation with interferon alfa (see Antihepatitis Agents), aerosolized laboratory, no resistant clinical isolates have yet been identified.
ribavirin is administered by nebulizer (20 mg/mL for 12–18 Potential adverse effects include upper respiratory tract infection,
hours continuously per day) to children and infants with severe fever, rhinitis, rash, diarrhea, vomiting, cough, otitis media, and
respiratory syncytial virus (RSV) bronchiolitis or pneumonia to elevation in serum aminotransferase levels.
reduce the severity and duration of illness. Systemic absorption Agents under investigation for the treatment or prophylaxis
is low (<1%). Aerosolized ribavirin may cause conjunctival or of patients with RSV infection include small molecule inhibitors
bronchial irritation and the aerosolized drug may precipitate on that interfere with RSV fusion through interaction with the F
contact lenses. Ribavirin is teratogenic and embryotoxic. Health protein of RSV (e.g., GS-5806) and the oral nucleoside analog
care workers and pregnant women should be protected against ALS-008176.
extended inhalation exposure.
Ribavirin has in vitro activity against a number of viruses,
including Lassa, West Nile, measles, influenza, and parainfluenza. IMIQUIMOD
However, clinical data regarding effectiveness are lacking.
Imiquimod is an immune response modifier shown to be effec-
tive in the topical treatment of external genital and perianal warts
PALIVIZUMAB (ie, condyloma acuminatum; see Chapter 61). The 5% cream
is applied three times weekly and washed off 6–10 hours after
Palivizumab is a humanized monoclonal antibody directed against each application. Recurrences appear to be less common than
an epitope in the A antigen site on the F surface protein of RSV. after ablative therapies. Imiquimod may also be effective against
It is licensed for the prevention of RSV infection in high-risk molluscum contagiosum but is not licensed in the USA for this
infants and children, such as premature infants and those with indication. Local skin reactions are the most common adverse
bronchopulmonary dysplasia or congenital heart disease. A pla- effect; these tend to resolve within weeks after therapy. However,
cebo-controlled trial using once-monthly intramuscular injections pigmentary skin changes may persist. Systemic adverse effects
(15 mg/kg) for 5 months beginning at the start of the RSV sea- such as fatigue and influenza-like syndrome have occasionally
son demonstrated a 55% reduction in the risk of hospitalization been reported.

PREP AR A TIONS A V AIL ABLE

GENERIC NAME AVAILABLE AS GENERIC NAME AVAILABLE AS
Abacavir Generic, Ziagen Etravirine Intelence
Abacavir/lamivudine Epzicom Famciclovir Generic, Famvir
Abacavir/lamivudine/zidovudine Trizivir Fosamprenavir Lexiva
Acyclovir Generic, Zovirax Foscarnet Generic, Foscavir
Adefovir Generic, Hepsera Ganciclovir Generic, Cytovene
Amantadine Generic, Symmetrel Imiquimod Generic, Aldara, others
Atazanavir Reyataz Indinavir Crixivan
Boceprevir Victrelis Interferon alfa-2a Roferon-A
Cidofovir Generic, Vistide Interferon alfa-2b Intron-A
Darunavir Prezista (must be taken with Interferon alfa-2b/ribavirin Rebetron
ritonavir) Interferon alfa-n3 Alferon N
Delavirdine Rescriptor Interferon alfacon-1 Infergen
Didanosine (dideoxyinosine, ddI) Generic, Videx, Videx-EC Lamivudine Generic, Epivir, Epivir-HBV
Docosanol Abreva (over-the-counter) Lamivudine/zidovudine Combivir
Efavirenz Sustiva Lamivudine/abacavir/zidovudine Trizivir
Emtricitabine Emtriva Lopinavir/ritonavir Kaletra
Emtricitabine/tenofovir Truvada Maraviroc Selzentry
Emtricitabine/tenofovir/efavirenz Atripla Nelfinavir Viracept
Enfuvirtide Fuzeon Nevirapine Generic, Viramune
Entecavir Baraclude Oseltamivir Tamiflu
(continued)