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United States Department of Veterans Affairs
National Hepatitis C Program
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Clinical Manual

Pharmaceutical Options for Managing Viral Hepatitis and Cirrhosis Complications in the VA Health Care System

Tables:

bulletHepatitis B
bulletHepatitis C
bulletSide Effects
bulletCirrhosis Management
bulletPrevention

Hepatitis B
Use may be restricted to Gastroenterology and Infectious Disease Services.
Adefovir (Hepsera)PBM monograph (PDF) (VA Intranet only)
Entecavir (Baraclude)PBM monograph (PDF)
Lamivudine (Epivir-HBV, 3TC)
Peginterferon alfa (PegIFN-a)*
*Note: PegIFN-a2a is the only peginterferon currently approved for the treatment of chronic hepatitis B in the United States. Refer to Chronic hepatitis B. (AASLD Practice Guidelines) [Lok AS and McMahon BJ. Hepatology. 2007 Feb;45(2):507-39] for detailed information, place in therapy and dosing of peg-IFN a in hepatitis B, or consult with your local VA pharmacist.
Hepatitis C
Use may be restricted to Gastroenterology and Infectious Disease Services.
Peginterferon alfa-2a (PegIFN-a2a, Pegasys)PBM monograph (PDF)
Peginterferon alfa-2b (PegIFN-a2b, PEG-Intron)PBM monograph (PDF)
Ribavirin (Rebetol, Copegus)
See also: VA Hepatitis C Treatment Recommendations
Side Effects
Use may be restricted to Gastroenterology, Infectious Disease and Hematology/Oncology Services.
Hematological
Granulocyte Colony Stimulating Factor
(GCSF, Neupogen, Filgrastim)		PBM monograph (PDF)
Epoetin alfa (Epogen, Procrit)PBM monograph (PDF)
Other Side Effects
For expanded information and options to consider for management of other side effects, see The Hepatitis C Treatment Side Effect Management Chart.
Cirrhosis Management
Ascites
Furosemide (Lasix)
Spironolactone (Aldactone)
Encephalopathy
Lactulose (Enulose)
Rifaximin (Xifaxan)
Portal Hypertension and Varices
Propranolol (Inderal)
Nadolol (Corgard)
Spontaneous Bacterial Peritonitis (SBP) Prophylaxis and Treatment
Trimethoprim-sulfamethoxazole (Bactrim DS; Bactrim; Septra DS; Septra)
Fluoroquinolones (Ciprofloxacin; Norfloxacin; Levofloxacin; Ofloxacin; Gatifloxacin and others)
Note: Antibiotics may include sulfamethoxazole/trimethoprim or fluoroquinolones. Selection should depend on local antibiotic susceptibility patterns. Consult with your local VA pharmacy for the preferred antibiotic in your area.
Prevention
Influenza vaccination
Pneumococcal vaccination
Hepatitis A vaccination
Hepatitis B vaccination
For detailed information on the administration of hepatitis A and B vaccination, please refer to the Vaccination Pocket Card.

For additional information on these agents, refer to the Pharmacy Benefits Management Website.

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