interferon alfa

CLINICAL USE

1. Hairy cell leukaemia2. AIDS related Kaposi’s sarcoma3. Chronic myelogenous leukaemia4. Cutaneous T-cell lymphoma5. Chronic hepatitis B6. Chronic hepatitis C7. Follicular non-Hodgkin’s lymphoma8. Advanced renal cell carcinoma9. Malignant melanoma

DOSE IN NORMAL RENAL FUNCTION

1. Hairy cell leukaemia: 1.5–3 million IU daily or 3 times per week2. AIDS related Kaposi’s sarcoma: 3–36 million IU daily or 3 times per week3. Chronic myelogenous leukaemia: 3–9 million IU daily or 3 times per week4. Cutaneous T-cell lymphoma: 3–18 million IU daily or 3 times per week5. Chronic hepatitis B: 2.5–5 million IU/m2 3 times per week6. Chronic hepatitis C: 3–6 million IU 3 times per week7. Follicular non-Hodgkin’s lymphoma: 6 million IU/m2 on days 22–26 of each 28 day cycle8. Advanced renal cell carcinoma: 9–18 million IU 3 times per week9. Malignant melanoma: 1.5–3 million IU 3 times a week

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :19 000

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :0

%Excreted unchanged in urine &nbsp &nbsp : Negligible

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.4

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :3.7–8.5/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function Monitor renal function closely

10 to 20 &nbsp &nbsp : Dose as in normal renal function Monitor renal function closely

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Use with great caution.

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsImmunosuppressants, e.g. ciclosporin, tacrolimus, sirolimus may have an antagonistic effect

ADMINISTRATION

Reconstition

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Route

SC, IM

Rate of Administration

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Comments

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OTHER INFORMATION

Interferon up-regulates the cell surface presentation of class II histocompatibility antigens, which raises the possibility of drug-induced allograft rejection. There are numerous clinical reports of allograft rejection, acute renal failure and graft loss after interferon therapy. Hence extreme care should be exercised in the use of interferon after renal transplantationInterferon is metabolised primarily in the kidney. It is excreted in the urine, but is reabsorbed by the tubules where it undergoes lysosomal degradation. In patients undergoing haemodialysis, the interferon molecule may accumulate as it is too large to be dialysed and will not undergo renal degradation. Hence, the dose may need to be adjusted

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