Treatment of Hepatitis C With Interferon-α and Ribavirine in a Patient With Long-Term Clozapine Treatment

Liukkonen, Timo; Sorjonen, Mirja; Jokelainen, Jari; Timonen, Markku

doi:10.1176/appi.psy.49.1.86-a

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Treatment with clozapine is further complicated during HCV therapy due to additive theoretical risks of agranulocytosis and neutropenia related specifically to IFNα effects. Therefore, clozapine monitoring protocols may need to be adjusted due to this risk and vigilant follow-up monitoring for signs of infection is recommended [82]. …”

Section: Resultsmentioning

confidence: 99%

Psychiatric treatment considerations with direct acting antivirals in hepatitis C

et al. 2013

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BackgroundDespite recent advances in hepatitis C (HCV) treatment, specifically the addition of direct acting antivirals (DAAs), pegylated interferon-alpha remains the backbone of HCV therapy. Therefore, the impact of DAAs on the management of co-morbid psychiatric illness and neuropsychiatric sequalae remains an ongoing concern during HCV therapy. This paper provides a review of the neuropsychiatric adverse effects of DAAs and drug-drug interactions (DDIs) between DAAs and psychiatric medications.MethodsWe conducted a Pubmed search using relevant search terms and hand searched reference lists of related review articles. In addition, we searched abstracts for major hepatology conferences and contacted respective pharmaceutical companies for additional studies.ResultsLimited data is available on the neuropsychiatric adverse effects of DAAs; however, data from major clinical trials suggest that DAAs have minimal neuropsychiatric risk. DAAs can potentially interact with a variety of psychotropic agents via cytochrome P450 and p-glycoprotein interactions. Triazolam, oral midazolam, St. John’s Wort, carbamazepine and pimozide, are contraindicated with DAAs. DDIs between DAAs and antidepressants, anxiolytics, hypnotics, mood stabilizers, antipsychotics and treatments for opioid dependence are summarized.ConclusionsAlthough DAAs do not add significant neuropsychiatric risk, the potential for DDIs is high. Consideration of DDIs is paramount to improving medication adherence and mitigating adverse effects during HCV therapy.

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Section: Resultsmentioning

confidence: 99%

Psychiatric treatment considerations with direct acting antivirals in hepatitis C

et al. 2013

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“…Leukopenia notwithstanding, the use of clozapine in patients with HCV and advanced liver disease must be carefully considered. Clozapine-induced sedation and constipation can precipitate hepatic encephalopathy (30), and interferon treatment shares with clozapine a risk of agranulocytosis (34). Using clozapine earlier in Mr. H's course of illness, however, might have had a positive impact on his prognosis given its effectiveness in treatmentrefractory schizophrenia and its potential benefit in reducing alcohol and other substance use (35).…”

Section: The Psychiatrist's Rolementioning

confidence: 99%