Treatment Agreement for: Interferon/Ribavirin Therapy
Interferon is given by injection under the skin, and some local pain or redness may occur at the site of the injection. The most common side effects of interferon are flu-likesymptoms, especially fever, fatigue, chills, nausea, headache, poor appetite, and muscle and joint pains. These symptoms usually begin to occur two-eight hours after the injection. These side effects occur in nearly all patients within the first one-three doses of interferon, but these side effects often go away or decrease considerably over the duration of therapy. Patients taking daily or increased doses of interferon are likely to suffer more side effects. Taking Tylenol usually helps to lessen the side effects. Lethargy and fatigue can persist throughout therapy along with the above listed side effects.
Interferon treatment can also lead to decreases in the white blood cell count and in platelets (particles in the blood that help the blood clot). This is usually not serious and is quickly reversible once interferon treatment is stopped. Because of the drops in blood count, it is crucial that you have your blood monitored on a regular basis. If you cannot make your appointments, therapy will be discontinued. Also, temporary mild skin rashes may occur, and any pre-existing psoriasis or dermatitis may get worse while
on treatment. Interferon treatment can also make pre-existingautoimmune diseases worse such as diabetes or rheumatoidarthritis. Depression is often seen on interferon/ribavirin and on interferon alone. This depression can be severe and suicidal
thoughts and even suicide attempts have been reported. This occurs in both patients with and without previous psychiatric illness.
Less common side effects that are seen with interferon treatmentinclude diarrhea, vomiting, temporary hair loss, nervousness,
dizziness, confusion, and increased irritability.
There are also several rare side effects that may occur while oninterferon treatment. These include lung problems, such asirritation or pneumonia, and severe liver disease, possibly resulting
in death. Other rare effects include numbness or tingling in thehands and feet, visual disturbances, retinal hemorrhages (bleedingin the retina of the eye), and irregular heart rhythms. Diabetesmellitus and hyperglycemia (high blood sugar levels) have alsobeen observed in patients on treatment with interferon.
Interferon treatment can lead to thyroid problems (eitheroveractivity or underactivity of the thyroid) in a small percentageof patients. These thyroid problems can be controlled bymedication, but the treatment may have to be life-long.
If at any time during treatment you are not able to tolerate theseside effects, the interferon dose will be reduced, interrupted, ordiscontinued. Ribavirin is taken in addition to interferon. It is taken orally and is generally well-tolerated. The most common side effect of ribavirin is hemolytic anemia. As a result there are less cells that carry oxygen to the tissues in your body. This condition is more common in older than in younger patients. The anemia is usually
mild and improves with dose reduction of ribavirin. Anemia resolves once ribavirin therapy is discontinued. You may experience some increased shortness of breath on exertion.
The anemia can be serious in patients who have kidney and/orheart problems. Heart and/or lung problems associated withanemia occur in a small percentage of patients on ribavirin
therapy. Frequent blood tests are crucial to evaluate this anemia.
Other side effects that are common with ribavirin therapy includepruritis (localized or generalized itching), increased cough, andmuscle pain. These effects are not considered serious and usually
return to normal after the ribavirin is discontinued.
Side effects that occur rarely with ribavirin include gout (disease
associated with increased amounts if uric acid in the blood andpainful inflammation of the joints) and effects on the nervoussystem such as depression, nervousness, insomnia (difficulty insleeping), and dizziness. If at any time during treatment you are not able to tolerate these side effects, the ribavirin dose will reduced, interrupted, or discontinued.
Studies in animals have shown that when ribavirin is given topregnant females, malformations in the offspring or death of thedeveloping embryo may occur. This therapy must not be used by women or male partners of women who are or may become pregnant during therapy and during the six months after stopping therapy. It is important that both men and women on ribavirin use effective contraception or remain sexually abstinent during treatment and for six months after completion of treatment so that pregnancy does not occur.
During the treatment and follow-up periods, lab tests and medicalvisits are regular. These visits are very important in order to checkyour blood chemistry, pregnancy status, liver, heart, and thyroidfunction. Ongoing evaluation for depression and other mood
disturbances while on treatment is vital.
________ I have read the information on the side effects ofpegylated interferon alfa 2a/ribavirin therapy, and desire to pursue
________ I have had a chance to ask questions regarding the risks
and benefits of this therapy, and these questions have beenanswered to my satisfaction.
________ I understand the importance and expectation of frequentfollow up visits and blood draws to evaluate my tolerance andresponse to this therapy.
________ I understand this therapy must not be used by women ormale partners of women who are or may become pregnant duringtherapy and six months after stopping therapy. I have beencounseled on the importance that both men and women on
ribavirin use 2 forms of birth control or remain sexually abstinentduring treatment and for six months after completion of treatmentso that pregnancy does not occur.
________ I understand the importance of maintaining alcohol anddrug abstinence and agree to do so. Periodic urine toxicologyscreening may be done while on treatment. I am aware of this andagreeable to this screening.
_______________________________ ____________Signature of Patient Date
_______________________________ _____________Health Care Provider Date
John the Gospel A Self Study Outline The Author From the evidence found in the gospel, we may learn several things about the author. (1) That he was a Jew . This is seen in his evident knowledge of Jewish opinions concerning such subjects as the Messiah, and his knowledge of their customs, such as the purification. (2) He was an eye-witness to most of what he relates . Th
ARTÍCULO DE REVISIÓN Inducción de la pubertad en el síndrome de Turner MARCELA MENÉNDEZ A.1, KARIME RUMIE C.2, HERNÁN GARCÍA B.31. Ginecóloga Infanto-juvenil, Departamento de Pediatría, Unidad de Endocrinología Pediátrica, Pontificia Universidad Católica de Chile. 2. Endocrinóloga Pediatra, Departamento de Pediatría, Unidad de Endocrinología Pediátrica, Pontificia Universi