Hepatitis C Virus Ebook

Alternative Hepatitis C Treatments

The therapeutic goals of Natural treatment for Hepatitis C are as follows: Decrease iral load Normalize liver enzyme levels. Enhance/regulate immune system function. Strengthen and promote healthy liver function. Protect the liver, prevent further damage. Virological response; i.e. viral clearance, viral reduction or elimination of the virus. Starve the virus by limiting levels of iron. Optimizing cellular levels of glutathione in the body, making detoxification of the liver possible and enhancing the immune system. Stimulate regeneration of the damaged liver cells. Use of antioxidants to combat the effects of free-radicals generated by the virus. Reduce inflammation. Slow viral replication. Replace all of the inflammation-damaged liver cells. Regulate immune function/prevent auto-immune problems. Cancer preventative measures. Reverse fibrosis to prevent and improve cirrhosis

Alternative Hepatitis C Treatments Summary


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Drugs Active Against Hepatitis C Virus

Metabolism Multisystem organ dysfunction and lactic acidemia occurred in two of 15 patients with HIV and hepatitis C infections who received interferon alfa and ribavirin (7c). They were also taking didanosine, and the evidence suggests that the combination of didanosine plus ribavirin increased the risk of lactic acido-sis. Hematologic The most common, dose-limiting adverse effect of ribavirin is anemia. A low pretreatment platelet count, the dose of interferon alfa, and the haptoglobin phenotype are risk factors, and the fall in hemoglobin is independent of dose (8c). In five patients with chronic hepatitis C on hemodialysis who received subcutaneous interferon alfa-2b and oral ribavirin for 40 weeks, the dose of ribavirin was titrated based on hemoglobin, with bone-marrow support by erythropoietin (9c). There was significant bone-marrow toxicity in all five. A dose of 200 mg day produced a steady-state AUC comparable to that obtained with 1000-1200 mg day in historical controls...

Combination vaccine against Hepatitis A and B

Sensory systems Optic neuritis has been attributed to immunization with hepatitis A and B (31A). A 21-year-old women developed acute irreversible loss of vision to 0.05 and a nasal visual field defect in the left eye 2 weeks after immunization with hepatitis A and B and yellow fever vaccine. An MRI scan showed hyperintense thickening of the optic nerve, and a diagnosis of optic neuritis was made. Vision acuity did not recover but the scotoma disappeared within 6 weeks.

Hepatitis A8 Influenza9

Hepatitis B vaccine (Hep B). All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge the first dose may also be given by age 2 months if the infant's mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for the birth dose. Monovalent or combination vaccine containing Hep B may be used to complete the series four doses of vaccine may be administered if combination vaccine is used. The second dose should be given at least 4 weeks after the first dose, except for Hib-containing vaccine which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months. Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of...

Human Hepatitis B Virus HBV

The Hepadnaviridae family is formed by a group of highly species-specific viruses that share the presence of an endogenous DNA polymerase with reverse transcrip-tase activity 123-125 and whose genome in the mature virions is formed by a circular partially double-stranded DNA (pdsDNA) in which both strands are held together by hydrogen bonding between the 5' ends of the two strands 126 . One member of this family, the human hepatitis B virus (HBV), is characterized by its high hepatotropism. This virus belongs to the genus Orthohepadnavirus and is not cytopathic itself, although it may cause acute fulminant hepatitis 127 or chronic 11.7.3 Human Hepatitis C Virus (HCV) Paeshuyse et al. 136 reported that the antimalarial drug artemisinin inhibits hepatitis C virus (HCV) replicon replication in a dose-dependent manner in two HCV subgenomic replicon constructs at concentrations ineffective toward Huh 5-2 host cells. Hemin, an iron donor, inhibits HCV replicon replication by inhibition of...

Hepatitis A vaccine

Hepatitis A infection is usually not more severe during pregnancy than at other times, and does not affect the outcome of pregnancy. There have been reports, however, of acute fulminate conditions in pregnant women during the third trimester, when there is also an increased risk of premature labor and fetal death. These events have occurred in women from developing countries, and may have been related to underlying malnutrition. The hepatitis A virus is rarely transmitted to the fetus, but this can occur during viremia or from fecal contamination at delivery (Tanaka 1995). Hepatitis A vaccine contains inactivated hepatitis A viruses that are cultivated from human cell cultures. Its use in pregnancy has EJ not been systematically investigated. However, there is no indica- tion of developmental toxicity. Recommendation. Pregnant women without immunity to hepatitis A need protection before traveling to developing countries. Based on the experience with other inactivated viral vaccines,...

Hepatitis B vaccine

A biotechnologically produced non-reproducible surface antigen is used as hepatitis B vaccine (HBV), It is therefore a non-infectious vaccine, and no risks to the fetus have been reported following vaccination of their mothers in pregnancy (ACOG 1993). Immunization of groups at risk is recommended if possible, it should be given after the twelfth week of pregnancy. Ayoola (1987) described a series of 72 pregnant Nigerians who were seronegative for hepatitis B and were given two intramuscular doses of vaccine in the third trimester. One month after the second dose, 84 were anti-HBs positive. No significant adverse effects were observed in the mothers or their newborns. Passive transfer of anti-HBs occurred in 59 of the newborns. The antibodies disappeared rapidly in these infants, and by 3 months only 23 had detectable antibodies (Ingardia 1999, Reddy 1994). No 11 BsAg carrier status developed in this g1 group. In contrast, the infants born to HBsAg-positive mothers had a cumulative...


Hepatitis is an inflammation of the liver caused by an infection, drugs, toxins, or parasites. The disease is characterized by an enlarged liver, jaundice, diminished appetite, nausea, and abdominal pain. There are several different forms of the disease. The most common is hepatitis A virus (HAV). Although all forms attack the liver to some extent, hepatitis B and C, which can cause liver cancer, are of special concern because they are the most deadly varieties. HAV is usually spread from person to person by contaminated food or water and personal contact. HAV has no long-term effects, but about 15 percent of people infected have prolonged or recurring symptoms over a six- to nine-month period. The greatest risk of acquiring HAV is through contact with infected persons. The best protection against hepatitis is a vaccine.

Hepatitis A

The successful propagation of hepatitis A virus in cell culture made the development of hepatitis A vaccines a realistic possibility. Various experimental hepatitis A vaccines have been tested in clinical trials. In December 1991, the first hepatitis A vaccine was licensed in Western European countries. Currently, two different hepatitis vaccines (prepared using different inactivation process) as well as vaccines for children (containing 720 enzyme-linked immunosorbent assay units per dose) and adults (containing 1440 units per dose) are commercially available and further products are under development. The results of safety and immu-nogenicity testing of hepatitis A vaccines developed by SmithKline-Beecham and by Merck Research Laboratories have been reviewed (SEDA-16, 384) (SEDA-17, 373) (SEDA-18, 333) (SEDA-21, 331). These vaccines were highly immunogenic. There were In a paper dealing mainly with indications for the use of hepatitis vaccine, the data on the hepatitis A vaccines...

Hepatitis B

Hepatitis B is only rarely transmitted via the placenta, In contrast, there is a great risk of infection during the birth. For this reason, newborns whose mothers carry hepatitis antigens (HBs-Ag and HBc-Ag), which indicate the possibility of infection, are simultaneously vaccinated immediately after birth. HBs-Ag has also been detected in mothers' milk (Boxall 1974). However, various studies have shown that there Is no increased risk of illness for infants when their mothers are only HBs-Ag carriers (Gonzalez 1995, Tseng 1988, Beasley 1975). No infection via breast milk was observed in the infants of 100 mothers with chronic hepatitis B. The infants had received simultaneous vaccination, and 11 mothers were HBc-Ag positive (Hill 2002). Nevertheless, the authors interpret their data with caution because of the small cohort of I lBe-Ag-positive mothers with potentially higher infection risk. Recommendation. Regardless of how the infant will be fed, every child born to a...

Hepatitis E

A study covering 93 pregnant women with hepatitis E (36 anti-It EV positive and 57 HEV-RNA positive) infection was confirmed in a colostrum specimen. However, parameters were significantly lower compared to maternal blood (Chibber 2004). Some of the infants of mothers with acute infection also developed liver symptoms. There was no indication that transmission occurred via breast milk. The authors concluded that breast feeding is probably safe, but stress the need to confirm their results by other studies, and the possibility that close contact between mother and child may facilitate transmission. Recommendation. There is no evidence yet that breastfeeding should be prohibited in cases of hepatitis E. However, experience is insufficient definitely to exclude any risk.

Hepatitis C

Hepatitis C is transmitted in a similar way to hepatitis B. Contaminated syringes and blood products are the most critical sources of infection, although the latter has become significantly less of a risk factor since 1993 due to mandatory testing of all blood donations. Hepatitis C infection is typically asymptomatic or mild. Drug addicts 4.15.5 Hepatitis C are not infrequently infected simultaneously with HIV. hepatitis B, and hepatitis C. Concomitant HIV infection is linked with higher risk of vertical (perinatal) HCV infection. Anti-HCV antibodies and HCV-KNA have been found in colostrum and breast milk (Grayson 1995, Ogasawara 1993). Transmission rates are similar between breastfed and non-breastfed infants however, many factors are uncontrolled (Zanetti 1995). A risk of infection for infants whose mothers are ill with only hepatitis C has not been observed as yet. The virus load in the mother's milk appears to be too low to transmit the illness (Lin 1995). In a further study,...

Occupational Safety and Health Administration Guidelines

Each year between 600,000 and 1 million health care workers experience sticks from conventional needles and sharps. Needle exposures can transmit hepatitis B, hepatitis C, and human immunodeficiency virus. Other infections, such as tuberculosis, syphilis, and malaria, also can be transmitted through needle sticks. More than 80 of needle stick injuries could be prevented with the use of safer needle devices. Nurses working at the bedside are the largest group of health care workers sustaining needle stick and sharps injuries.

Effect of Hepatic Disease on Drug Metabolism

P450 enzyme activities and gene expression can be profoundly altered in disease states. In general, the levels of affected cytochrome P450 enzymes are depressed by diseases causing potential and documented impairment of drug clearance causing drug toxicity (73). In one study, it was reported that hepatocellular carcinoma decreased expression of CYP2E1 (74). Trotter et al. reported that total mean tacrolimus dose in year one after transplant was lower by 39 in patients with hepatitis C compared with that in patients with no hepatitis C infection. The most likely explanation for these findings is decreased hepatic clearance of tacrolimus caused by mild hepatic injury from recurrent hepatitis C virus (75). Zimmermann et al. reported that oral dose clearance of sirolimus (rapamycin) was significantly decreased in subjects with mild to moderate hepatic impairment compared with that in controls, and authors stressed the need for careful monitoring of trough whole blood sirolimus...

Organs and Systems Liver

Of all the tricyclic antidepressants, amineptine appears to be the most likely to cause liver damage. More than 26 cases of toxic hepatitis have been reported in France (6). In most cases, hepatitis occurred within the usual dosage range and recurred on rechallenge. However, in several instances it was reported after overdosage. There are other reports of hepatotoxicity associated with aminep-tine (7,8).

General adverse effects

The commonest unwanted effects of ACE inhibitors are related to their pharmacological actions (that is inhibition of angiotensin-converting enzyme and kininase II) renal insufficiency, potassium retention, pronounced first-dose hypotension, cough, and the serious but less common angioedema. Skin rashes and taste disturbances are uncommon, but may be more likely with sulfhydryl-containing drugs, particularly captopril. Rare hypersensi-tivity reactions include rashes, bone-marrow suppression, hepatitis, and alveolitis. If administered in the second or third term of pregnancy, ACE inhibitors can cause a number of fetal anomalies, including growth retardation, renal impairment, oligohydramnios, hypocalvaria, fetal pulmonary hypoplasia, and fetal death. Neonatal anuria and neonatal death can also occur (17,18). Tumor-inducing effects have not been reported.

General adverse reactions

Hepatotoxicity is consistently the most common serious adverse reaction in patients taking antituberculosis drugs. Hepatic necrosis is the most important adverse effect of first-line antituberculosis drug therapy (2). Asymptomatic rises in transaminases are common and are not by themselves justification for withdrawing medication, since they settle spontaneously in most patients while treatment continues. All patients taking antituberculosis drugs should be told to report all new illnesses, especially when associated with vomiting. Hepatitis B carriers were no more likely to react adversely to antituberculosis drugs than non-carriers (7).

Susceptibility Factors Age

Increasing age predisposes to hepatotoxicity from antituberculosis drugs. Workers from Florida have reported a five-fold increase in the likelihood of drug-induced hepa-totoxicity in patients who are hepatitis C-positive and a four-fold increase in patients who are HIV-positive, compared with seronegative patients treated for tuberculosis (40). In all, 134 patients taking antituberculosis drugs were monitored for drug-induced hepatotoxicity, defined as an increase in aspartate transaminase and or alanine transaminase activity from normal to at least three times normal and or an increase in bilirubin above normal. Of the 22 patients who developed drug-induced hepatotoxicity, only six developed drug-induced hepatotoxicity on re-introduction of treatment after an interval in which the abnormalities had resolved. Four of the six had liver biopsies, which showed active inflammation, attributed (at least in part) to hepatitis C. These were then treated with interferon alfa, with improvement...

Observational studies

Maculopapular rash that resolved without withdrawal. There were no abnormalities in hematological parameters or renal function. Two patients had slightly raised serum bilirubin concentrations and one each had raised transaminase activities. Two other patients had mildly increased transaminase activities, but both were known to have chronic hepatitis B (SEDA-13, 828).

Elevated Free Anticonvulsant Levels in Hepatic Disease

Hepatic disease can alter pharmacokinetic parameters of valproic acid. Klotz et al. reported that alcoholic cirrhosis and viral hepatitis decreased valproic acid protein binding from 88.7 to 70.3 and 78.1 , respectively, with a significant increase in volume of distribution. Elimination half-life was also prolonged (81). An increase in unbound concentration of carbamazepine has been reported in patients with hepatic disease (82).

Placebocontrolled studies

In a randomized placebo-controlled study in 219 patients with histology-proven chronic hepatitis (44 HbsAg-posi-tive and 149 anti-HCV antibody-positive) and persistently raised transaminases, oral ursodeoxycholic acid 300 mg bd for 6 months produced significant improvement in clinical and biochemical markers (2). Apart from diarrhea, which was reported by a few patients, it was well tolerated. The combinations of oral ursodeoxycholic acid 13-15 mg kg day plus interferon (3 MU three times a week) and interferon plus placebo for 6 months have been compared in a randomized, placebo-controlled study in 91 patients with chronic hepatitis C resistant to interferon (3). Combined interferon plus ursodeoxycholic acid was more effective than interferon alone in terms of normalizing alanine transaminase at 6 months (but not at 12 months), but not in terms of virological response. The frequency of adverse effects was similar in the two groups. Diarrhea, which was reported by a few patients, was...

Contraindications Precautions And Interactions

Naltrexone is contraindicated in those with a hyper-sensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C). Naltrexone is used cautiously in those with a narcotic addiction in patients with cardiovascular disease, acute hepatitis, liver failure, or depression and in patients who are suicidal. Naltrexone is used cautiously during lactation.

Malaria and Tuberculosis

An interaction between these two conditions may be likely, but to the best of our knowledge the question of to what extent tuberculosis and malaria interact has so far not been addressed in clinical studies. In a seroepidemio-logical survey from Nigeria, serum samples from 197 patients with malaria, hepatitis B, or tuberculosis and from 166 healthy controls were screened in order to determine any disease interactions. With one patient being human immunodeficiency virus (HIV)-1 seropositive, a statistical association was found between the presence of malaria antibody titres and a diagnosis of tuberculosis (P< 0.05) (Adebajo et al. 1994). However, the significance of this finding remains unclear.

Pharmaceutical interest

Celosian Of particular interest is the fact that an aqueous extract of seeds of Celosia argentea L. given intraperitonneally to animals infected with colon 26-L5 carcinoma cells, reduces significantly liver metastasis through the induction of cytokins (Hayakawa Y et al., 1998). From this extract was characterized the celosian, which is an immunos-timulating and hepatoprotector acidic polysaccharide. Celosian inhibits the elevation of GPT, GOT and bilirubin in carbon tetrachloride-induced liver injury in rats and suppresses mortality on fulminant hepatitis caused by -D-galactosamine lipopolysaccharide or caused by Propionibacterium acnes (LP5) in mice. Dose-dependent protection against chemical and immunological hepatitis is observed (Hase K et a ., 1996). Celosian stimulates the production of tumor necrosis factor a (TNFa), 1 and nitric oxide in macrophage cell-line (1774-1) in a concentration-dependent manner, and promotes the secretion of interleukin 1 in human mononuclear cells....

Consideration of harm

The ACMD is required to examine harm associated with the drugs that it considers but, as DrugScope pointed out, there is no definition of harm provided in the Misuse of Drugs Act 1971.32 In addition, some have argued that the debate around harm too frequently focuses on the inherent harmfulness of the drug itself, rather than on the wider question of harm associated with misuse of the drug. For example, the risk of HIV or hepatitis infection is linked to drug injecting, as opposed to the abuse of a specific drug. Similarly, criminal behaviour may be driven by the need to maintain a supply of drugs to feed an addiction rather than to the misuse of any particular drug.

General Information

Severe complications connected with cholera (or combined) immunization are extremely rare and the causal relation is always doubtful. However, when they do occur they constitute a contraindication to further administration. There are occasional reports of neurological and psychiatric reactions (SED-8,706) (SEDA-1, 246), Guillain-Barre syndrome (SEDA-1, 246), myocarditis (6,7), myocardial infarction (SEDA-3, 261), a syndrome similar to immune complex disease (8), acute renal insufficiency accompanied by hepatitis (9), and pancreatitis (10).

IL12 Knockout and Transgenic Mice

IL-12 has entered clinical trials for cancer (538-541), chronic hepatitis C (542), and asthma (543). Preliminary analysis shows some positive benefit in patients with cutaneous T-cell lymphoma (541). To avoid severe toxicity, an 1L-12 pretreatment regimen appears to be necessary (544).

Hypericum japonicum Thunb

Uses In China, Hypericum japonicum Thunb. is used to treat skin infection, infectious hepatitis, gastrointestinal disorders, and tumors, to counteract poisoning, soothe inflammation, and to heal abscesses. In Vietnam, the plant is used to heal wounds and leech bites. New Guinea Hypericum japonicum Thunb. is part of a remedy used to treat malaria.

Drug Administration Drug contamination

In the past, plasma factor VIII products have exposed patients with hemophilia to foreign proteins as well as blood-borne viruses, including hepatitis B, hepatitis C, human parvovirus B19, and human immunodeficiency virus (11,12). Before the introduction of heat-treated concentrates in 1985, about 20 of patients with hemophilia in the UK became infected with HIV (13) and virtually all patients with hemophilia who were exposed to large-pool coagulation factor concentrates before the introduction of viral inactivation procedures developed hepatitis C (14). Studies using a second-generation enzyme-linked immuno-sorbent assay showed 89 anti-HCV positivity in a heterogeneous group of patients in the USA and in 98 of Dutch patients with hemophilia who had been exposed to large-pool, non-virally inactivated coagulation factor concentrates (14). In the UK and the Netherlands increased mortality due to liver disease in patients with hemophilia has been reported (14). In patients co-infected...

Drug Drug Interactions Alcohol

Reports of liver complications after cocaine use are infrequent. However, fulminant hepatitis with acute renal insufficiency requiring liver transplantation occurred after the use of cocaine and alcohol (270). A 33-year-old chronic alcoholic with hepatitis C developed acute liver and renal insufficiency with grade III encephalopathy. Hemodialysis was begun and emergency liver transplantation was performed. The explanted liver showed marked diffuse macrovesicular steatosis with massive coagulative-type necrosis. The postoperative course included a persistently raised gamma-glutamyltransferase, but he recovered fully after 60 days.

Public Health Prevails in Washington DC

In Washington, D.C., injecting drugs is the leading means of HIV AIDS transmission among women and the second-leading means among men. Overwhelming scientific evidence indicates that sterile syringe programs - syringe exchange, pharmacy sales and physician prescription - decrease needle sharing without increasing drug use and are highly effective in reducing transmission of HIV AIDS and hepatitis. These programs also increase the safe disposal of used syringes, significantly reduce the incidence of needle-stick injuries to police officers, and connect people who use drugs to treatment, detoxification, primary health care and other services.

Expanding HIVPrevention in California

Since its creation by statewide legislation in 2004, counties throughout California have also implemented a critical state harm-prevention initiative, the Disease Prevention Demonstration Project (DPDP), which allows adults to purchase up to 10 syringes without a prescription from a participating pharmacy. Los Angeles County, where an estimated 135,000 people are infected with hepatitis C, became the latest to initiate a DPDP. With support from the California Endowment, DPA helped enroll approximately 300 L.A. County pharmacies, including all Longs, Rite Aid and Walgreens drugstores, in this effort. As the DPDP nears its review and reauthorization in 2010, DPA will keep working hard to generate the community support and advocacy that are essential to promoting this lifesaving program and ensuring its effective implementation.

See appendix B for a cample of the predrug questionnaire

Conditions which would have been grounds for rejection of a volunteer were cardiac impairment sufficient to limit exercise or contraindicate emotional strain, liver enlargement or history of liver disease (e.g., hepatitis or Jaundice), history of psychosis, present psychological imbalance (especially depression), or current intensive psychotherapy or analysis for severe psychological problems. No volunteer needed to be rejected on these grounds.

Combinations of vaccines

Four-, five- and six-component combination vaccines based on DTaP or DTwP vaccine, and including other antigens such as hepatitis B or Hib or IPV, will play an important role in future worldwide immunization programs. The first hexavalent combination vaccines (DTaP-IPV-HB-Hib) were licensed in Germany two hexavalent vaccines are available, manufactured by SmithKline Beecham and Aventis Pasteur. The Hexavalent Study Group has compared the immu-nogenicity and safety of a new liquid hexavalent vaccine against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and Hib (DTP + IPV + HB + Hib vaccine, manufactured by Aventis Pasteur MSD, Lyon, France) with two reference vaccines, the pentavalent DTP + IPV + Hib vaccine and the monovalent hepatitis B vaccine, administrated separately at the same visit (10). Infants were randomized to receive either the hexavalent vaccine (n 423) or (administered at different local sites) the pentavalent and the HB vaccine (n 425) at 2, 4, and 6...

Other Than with the Human Immunodeficiency Virus

In contrast, there are reports that cannabinoids and marijuana exert deleterious effects on immune function and host resistance. Juel-Jensen (1972) indicated anec-dotally that individuals infected with HSV who were marijuana smokers had an increased recurrence of genital viral lesions. Also, Harkess et al. (1989) reported on six unrelated outbreaks of hepatitis A among users of marijuana and intravenously administered methamphetamine. Although the exact mode of transmission could not be determined, it was indicated that practices associated with illicit drug use could have facilitated transmission of hepatitis A. Gross et al. (1991) reported that marijuana use altered responsiveness of human papillomavirus to systemic recombinant IFN- 2a treatment and suggested that THC could be a cofactor influencing the outcome of infection. Liauet al. (2002) investigated the association between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases and condom...

Effects Related to Infection with Human Immunodeficiency Virus and AIDS

Difranco et al. (1996), through the San Francisco Men's Health Study (SFMHS), evaluated in a 6-year follow-up study the association of specific recreational drugs and alcohol with laboratory predictors of AIDS. No association with progression to AIDS was observed for marijuana use. Wallace et al. (1998) examined risk factors and outcomes associated with identification of Aspergillus in respiratory specimens from individuals with HIV disease as part of a study to evaluate pulmonary complications of HIV infection. Cigarette and marijuana use was found not to be associated with Aspergillus respiratory infection. Persaud et al. (1999) conducted a cross-sectional survey among 124 street- and brothel-based female commercial sex workers in Georgetown, Guyana, to determine the seroprevalence of HIV infection and describe the sexual practices and drug use patterns. No statistically significant association was found between HIV infection and marijuana use. Miller and Goodridge (2000) evaluated...

Drug Administration Drug additives

To increase immunogenicity, the hepatitis A vaccines commercially available are coupled to adjuvant aluminium phosphate or aluminium hydroxide. However, alum precipitates provoke inflammatory responses at the injection site. Immunostimulating reconstituted influenza virosomes have therefore been used as an alternative adjuvant. In 1994, a hepatitis A vaccine using the new adjuvant was licensed in Switzerland, and it was later approved for use in other countries the vaccine was well tolerated and highly immunogenic (SEDA-20,290) (SEDA-22,344). Nine people with a history of ocular sensitivity were immunized with hepatitis B, without untoward reactions. However, this result in such a small series should not be overestimated (75). There have been reports of three cases of inflammatory nodular reactions after hepatitis B immunization aluminium allergy was confirmed (76-78). Four cases of reactions to thiomersal in hepatitis B vaccines (both plasma-derived and recombinant) have been...

Drug dosage regimens

Revaccination is sometimes necessary because only 5070 of immunocompromised persons, especially dialysis patients, develop antibodies, and the anti-HBs titers in these cases are low. In revaccinated non-responders to primary hepatitis immunization using either 20 mg of plasma-derived vaccine or 10 mg of recombinant vaccine, depending on the vaccine used for previous doses, the revaccinations were well tolerated (81,82). Only 6.6 of the vaccinees reported slight irritation at the injection site, tenderness, minimal pain, or swelling lasting for a few hours up to 2 days.

Drug administration route

Aiming at cost reduction of hepatitis B immunization programs, the administration of low doses (2 micrograms) of vaccine given intradermally had by 1987 been evaluated in clinical trials in health-care workers (83) and children (84). The resulting seroconversion rates were 96 and over 90 , respectively. A minimum of local side effects occurred. In a comparison of antibody responses and adverse effects after intradermal or subcutaneous administration of 2 micrograms of a plasma-derived hepatitis B vaccine and intramuscular administration of 20 mg, the intradermal and intramuscular routes gave the highest seroconversion rates (100 and 96 , respectively) and the highest mean titers of anti-HBs (85). The aluminium adjuvant in the vaccine was assumed to cause a substantial number of local reactions (37 discoloration, 17 itching, and 13 nodule formation) after intradermal administration other routes of administration showed adverse effects only rarely. Correct intradermal deposition of the...

Comparative studies

Interferon alfa, in combination with ribavirin, is currently first-line therapy for patients with chronic hepatitis C and compensated liver disease, and its use has been extensively reviewed (6). A meta-analysis of trials in patients who were In a randomized comparison of recombinant interferon alfa-2b and interferon alfa n-3 (9 MU week for 1 year) in 168 naive patients with chronic hepatitis C, there was no significant difference in clinical outcomes and the incidence or type of adverse effects between the groups (9). There was a non-significant trend toward more severe leukopenia and a higher incidence of severe thyroid disorders in patients who received recombinant interferon alfa-2b. Pegylated interferon alfa-2a is a modified form of interferon alfa it produces higher serum concentrations and has greater efficacy. In 1530 patients with chronic hepatitis C, pegylated interferon alfa-2b had a similar profile of adverse effects to unmodified interferon alfa-2b, but with more frequent...

Interaction Of Kava With Drugs

Heavy consumption of kava has been associated with increased concentrations of 7-glutamyltransferase suggesting potential hepatotoxicity. Escher et al. described a case in which severe hepatitis was associated with kava use. A 50-year-old man took three to four kava capsules daily for 2 months (maximum recommended dose three capsules). Liver function tests showed 60-fold to 70-fold increases in AST and ALT. Tests for viral hepatitis were all negative as were tests for cytomegalovirus and HIV. The patient eventually received a liver transplant (85). Humberston et al. (86) also reported a case of acute hepatitis induced by kava-kava. Other cases of hepatotoxicity due to the use of kava have been documented (87). In January 2003, kava extracts were banned in the entire European Union, Canada and also in the United States (the FDA strongly cautioned against using kava). There are at least 11 cases of serious hepatic failure and four deaths directly linked to kava extract consumption, and...

Neuromuscular function

A number of reports have confirmed that interferon alfa can induce or unmask underlying silent myasthenia gravis (SED-13, 1097) (SEDA-20, 327) (SEDA-21, 370). The diagnostic criteria for myasthenia gravis were clearly fulfilled in these reports, and an autoimmune reaction was the most likely mechanism, as each patient had positive serum anti-acetylcholine receptor antibodies and required permanent anticholinesterase drugs long after interferon alfa withdrawal. Myasthenia gravis developed in two patients treated with interferon alfa-2b for chronic hepatitis C, one of whom also took ribavirin (76,77). Both had an increase in acetylcholine receptor antibody titers and required permanent pyridostigmine and immunosuppres-sant treatment. These findings suggest that interferon alfa does not cause myasthenia gravis but unmasks it.

Second Generation Effects Teratogenicity

In experimental models there has been no evidence of mutagenic or teratogenic effects of interferon alfa, and placental transfer is unlikely or very low (387). Immediately after delivery, interferon alfa concentrations in the breast milk or in the sera of two newborns were very low compared with maternal serum concentrations (388). Uncomplicated and successful pregnancies have been detailed in several patients treated for hematological malignancies or chronic hepatitis C, with interferon alfa exposure during the first trimester or even the whole of pregnancy (SED-13, 1098) (SEDA-20, 331) (389-392). In only three cases have premature delivery or moderate intrauterine growth retardation been observed, and any direct causal relation to interferon alfa treatment is doubtful. One report mentioned transient and moderate thrombocytopenia in a neonate born to a woman who had received interferon alfa throughout pregnancy (391).

Drug Administration Drug formulations

The FDA has expanded the indications for a combination product to include patients with chronic hepatitis C who have not been treated with interferon alfa. This product, Rebetron Combination Therapy (Schering), contains recombinant interferon alfa-2b for injection (Intron A) plus ribavirin (Rebetol) in capsules, and was previously only approved for patients who had relapsed after treatment with interferon alone (401). Serious adverse effects, such as depression, suicidal ideation, and suicide, have occurred with this regimen and patients should be closely monitored.

Long Term Effects Drug tolerance

The incidence of viral resistance to lamivudine increases with the duration of therapy in patients with chronic hepatitis B (11). However, the effect of viral resistance on hepatic synthetic function has not been well defined. In 38 patients (26 with cirrhosis) in an open study there was an initial antiviral response in all patients (hepatitis B virus DNA became undetectable by a hybridization assay), and nine of 22 (41 ) hepatitis B e antigen-positive patients underwent hepatitis B e antigen seroconversion. In 29 patients with undetectable serum hepatitis B viral DNA at the end of the study, the mean serum albumin concentration rose from 40 to 43 g l, corresponding to a yearly increase of 1.85 g l this was largely attributable to an increase in the cirrhotic patients. Resistance to lamivudine developed in nine patients. Suppression of viral replication by lamivudine improves hepatic synthetic function in chronic hepatitis B patients, but emergence of drug resistance is associated...

Methods for Assessing Antiviral Activity

In addition to antibacterial and antifungal activity, researchers are also investigating the use of plant extracts for antiviral activity of particular interest is activity against herpes simplex virus (HSV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV). Standard cytopathic assays are used to determine antiviral activity with activity both pre- and post-infection evaluated. As these assays are performed in an aqueous environment the problems of solubility that have been discussed at length previously are also an issue in these assays. These assays also require expertise in cell culture and appropriate laboratory containment facilities for working with viruses these two features make these assays more expensive and labor intensive than other assays. However as viruses require a cell host this assay has the added benefit of being able to assess cell toxicity of the test substance as part of the antiviral assay protocol. This means that those extracts with significant...

Brief History Of Vaccination

It would take another hundred years before French chemist Dr. Louis Pasteur formally determined how the injection of weakened germs into the body could protect against a disease normally caused by those germs. Thus was born the modern technique of vaccination intentionally injecting people with weakened or dead pathogens, and thereby triggering their immune system to produce antibodies against the injected virus. Before long, pharmaceutical companies were in the business of actually creating these weakened viruses and selling them in the form of vaccines. By the mid-twentieth century, vaccines existed for a host of infectious diseases including polio, measles, mumps, rubella, hepatitis B and Hemophilus type B. acquired immunodeficiency syndrome (AIDS), hepatitis B, hepatitis C, and tuberculosis. Increasing numbers of such cases are being reported among the partners of intravenous drug users. Most HIV-infected newborns have mothers who acquired this disease through their own drug use...

Russian Federation

State action that impedes people from protecting themselves from a deadly epidemic is blatant interference with the right of Russians to the highest obtainable standard of health. There is no dispute as to the effectiveness of sterile syringes for preventing HIV, hepatitis C and other blood-borne infections. Public health experts are virtually unanimous in the view that providing access to sterile syringes neither encourages drug use nor dissuades drug users from entering drug treatment programs. In reality, the near absence of humane treatment programs for drug addiction in Russia and the very nature of drug use guarantee that there will always be people who either cannot or will not stop using drugs. Impeding this population from obtaining or using sterile syringes amounts to prescribing death as a punishment for illicit drug use.

Its Really Hard to Lose a Friend

HIV infection is not the only health risk associated with sharing needles. Other blood-borne diseases that can be transmitted by sharing injection drugs include hepatitis B and C. Hepatitis attacks the liver, causing a variety of symptoms, including fever, headache, nausea, loss of appetite, skin rashes, and the yellowing of eyes and skin referred to as jaundice. Over time, hepatitis can cause serious persistent liver infections and chronic (long-term) liver disease, which may result in liver cancer and death. The risk of AIDS or hepatitis is not a side effect of heroin or other injection drugs. Instead it is the result of sharing infected needles. Whenever someone injects a substance into his or her body, blood is always deposited on, and possibly in, the needle. Unless the needles are cleaned thoroughly with bleach, that blood will be injected into the next person who uses the needle. The use of new needles, or the cleaning of used ones, could reduce HIV transmission and hepatitis...

Pneumococcal conjugated polysaccharide vaccines

In 2000, the first heptavalent conjugated pneumococ-cal vaccine, Prevnar, which contains polysaccharides of pneumococcal serotypes 4, 6B, 9V, 14, 19F, and 23F, and oligosaccharide of serotype 18C, conjugated to the protein carrier CRM 197 (non-toxic variant of diphtheria toxin), was licensed in the USA (covering 90 of pneumococcal serotypes found in young children in the USA) and in all EU member states, as well as in selected other countries in 2001. In a randomized, double-blind study, 302 healthy infants in the Northern California Kaiser Permanente Health Plan received either the pneumococcal vaccine or meningococcal group C conjugate vaccine as a control at 2, 4, and 6 months of age and a booster at 12-15 months of age (10). The immunogenicity and safety of simultaneous administration of vaccines used in the routine immunization program of children (DTwP or DTaP, Hib and OPV or hepatitis B vaccine) were also evaluated. Local reactions after pneumococcal, DTwP-Hib, and DTaP plus...

Maternal immunization

Immunized, using standard recommended doses for adults, against measles, mumps, rubella, tetanus, diphtheria, pertussis, influenza, streptococcus pneumoniae, neisseria meningitis, hepatitis A, hepatitis B, and varicella. Often it is the need to travel to endemic countries that raises the issue.

Organs and Systems Hematologic

Ribavirin accumulates in erythrocytes, resulting in hemolysis by an unknown mechanism, perhaps related to oxidative damage to the erythrocyte membrane. Time-dependent and dose-dependent hemolytic anemia (eventually associated with hyperbilirubinemia and a high reticulocyte count) is the only major toxic effect associated with oral or intravenous ribavirin and is reversible on withdrawal. There was a fall in hemoglobin concentrations below 10.0 g dl in 9 of patients with hepatitis C treated with ribavirin and interferon alfa (6,7). In 140 patients with Nipah virus infection there was no difference in the incidence of adverse effects between those who elected to have ribavirin treatment and those who refused (12). Dosing was based on recommendations used to achieve the same approximate concentrations as those seen with 100-1200 mg day in the treatment of hepatitis C. Anemia occurred in 37 of the ribavirin-treated patients and in the same number of controls, suggesting that ribavirin was...

Other features of the patient

Disease about half of the patients were advanced alcoholics and almost all the cases of hepatitis came from this group (91). Most of those with pretreatment abnormalities of liver function had abnormalities in liver biopsies, not attributable to alcohol. In one patient, active chronic hepatitis was attributed to rifampicin.

Recombinant DNA technology using Vaccinia virus

One attempt to develop safe and efficacious live recombinant vaccines is the use of low neurovirulent strains of vaccinia virus LC 16 m O (m O) or LC 16 m 8 (m 8). A recombinant Vaccinia virus vaccine (RVV) expressing hepatitis B surface antigen likely to form the basis of a safe live RV vaccine against hepatitis B has been constructed (11).

Clinical Trials in Humans

In a hepatitis B clinical trial Phyllanthus amarus extract eliminated detectable HBV antigen from the sera of 59 treated human carriers as compared to 4 of placebo controls 13, 128 . A review of randomized trials on Phyllanthus in chronic HBV patients by Liu et al. 129 showed Phyllanthus species had a positive effect on the clearance of serum HBsAg compared with placebo or no intervention, and is better than nonspecific or other herbal treatment. It appears from these studies that some Phyllanthus species have positive effects on HBV and liver biochemistry in chronic hepatitis infection. Another review on randomized clinical trials showed that the aqueous extract of the Chinese herb Sophorae flavescentis (matrine) had anti-HBV activity with protective effects on liver function in chronic HBV patients. However, Phyllanthus or matrine cannot be recommended for routine clinical use due to low methodological quality and variations in the herbal preparations 130 . Martin and Ernst 131...

See also Nonsteroidal antiinflammatory drugs General Information

Skin disorders are frequent (40 of all reported effects), and fixed drug eruption has occurred (SEDA-18, 107). Diarrhea (10 ) and upper gastrointestinal symptoms (including dyspepsia, nausea, vomiting, gastric pain, and ulcer) (6 ) are common (SEDA-19, 98). Hepatitis has been described with positive rechallenge. Six patients with pulmonary infiltrates, possibly caused by tolfenamic acid, were reported to the Finnish National Centre for Adverse Drug Reaction Monitoring over a 12-year period. In some patients with hemolytic anemia, a positive Coombs' test and antinuclear antibodies suggested an immunological mechanism (SEDA-13, 83).

Drugs For Treating Amebiasis

Amebiasis is an infection of the body by the protozoa Entamoeba histolytica, which most often affects the large intestine, although they can also affect the lungs, liver, brain, and other organs. This disease can attack the gastrointestinal tract without any clinical symptoms, with moderately expressed clinical symptoms (diarrhea, cramps, meteorism), as well as with symptoms of acute ameba dysentery, which is accompanied by bloody diarrhea, vomiting, fever, and dehydration. The presence of the protozoan microorganisms E. his-tolytica in other organs can cause liver death, ameba hepatitis, and lung abscess. Cases of heart damage (causing pericarditis) and brain damage (leading to brain abscess) have been described.

See also Individual agents General Information

However, during the last two decades rapid increases in immunization coverage have been reported worldwide globally, 5-10 billion injections are now given each year, mainly for treatment of illness but also for prophylactic purposes such as immunization. Unavoidably, the growth of WHO's Expanded Program on Immunization has sometimes resulted in extension of immunization work into areas of the developing world where logistic support and training programs have not been adequate. In such circumstances, avoidable faults have been made, involving variously improper or inadequate sterilization, incorrect doses and routes of vaccine administration, or substitution of drugs for diluents or vaccines (SEDA-15, 340). The use of unsterilized or improperly sterilized needles and syringes is particularly common in these regions and contributes largely to the spread of hepatitis B and C as well as to the spread of human immunodeficiency virus (HIV) and other blood-borne pathogens. The WHO recognizes...

National compensation programs for vaccinerelated injuries

In the USA, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program as a federal no-fault compensation system for individuals who may have been injured by specific vaccines. This compensation program relies on a Vaccine Injury Table that lists the vaccines that are covered by the program, as well as injuries, disabilities, illnesses, and conditions (including death) for which compensation may be awarded. To better reflect current scientific knowledge about vaccine injuries, the Vaccine Injury Table was revised in 1995 and has been subsequently further modified. The latest modification, which became effective on December 1, 2004, is shown in Table 7. This revision took into account a review of the literature on specific adverse consequences of pertussis and rubella vaccines performed and published by the IOM (SED-12, 817) (SED-12, 825). In addition to the seven vaccines (diphtheria, pertussis, tetanus, measles, mumps, rubella, and...

General adverse effects after immunization

The reports of the Institute of Medicine, National Academy of Sciences, Washington (on adverse events after pertussis and rubella immunization (SED-12, 817) (SED-12, 825) and on adverse events after immunization against tetanus, diphtheria, measles, mumps, poliomyelitis, H. influenzae type b, and hepatitis B (SEDA-18, 325) have provided useful reviews (13,14). The 1996 ''Update on vaccine side effects, adverse reactions, contraindications,

Prescription cost compliance

Parenteral treatment is always more costly than oral treatment. The price of the drug itself is higher for an equal dose of active ingredient. It requires costly disposable material. It exposes patients to complications due to poorly tolerated products (abscesses, necrosis due to IM quinine injections or antibacterials, etc.) or badly performed injection techniques (symptoms of overdose after a IV injection given too rapidly, sciatic nerve damage, etc.). If disposable injection supplies are re-used, there is a risk of bacterial or viral contamination (tetanus, hepatitis, HIV, etc.).

Routes Of Exposure And Duration Of Effects

When meth in crystalline powder form is heated, it easily dissolves in water or alcohol and can then be injected. Meth injection is as risky as using any other intravenous drug. Sharing needles can spread HIV, the virus that causes AIDS (acquired immunodeficiency syndrome), as well as hepatitis B and C.11, 13, 16

Phenolics and Polyphenols

Plants of southern mainland China, showed anti-HSV-1 activity, while the Peruvian plant Stylogne cauliflora had anti-HCV NS3 protease activity due to oligophe-nols 50 . On the other hand, polyphenols extracted from Blumea laciniata, Elephan-topus scaber, and Scutellaria indica exhibited anti-RSV activity 51 .

Tetravalent pentavalent and hexavalent immunization

DTaP or DTwP vaccine can be combined with other antigens, such as Haemophilus influenzae type b (Hib), inactivated poliovaccine (IPV), and hepatitis B vaccine. In children DTaP or DTwP vaccines are the basis for such combinations, while in adults it is mostly Td or Tdap vaccine combined with inactivated poliovaccine (IPV). Current safety concerns regarding combination vaccines have been defined and reviewed (7). The author concluded that there is no evidence that adding vaccines to combination products increases the burden on the immune system, which can respond to many millions of antigens. Combining antigens usually does not increase adverse effects, but it can lead to an overall reduction in adverse events. Before licensure, combination vaccines undergo extensive testing to assure that the new products are safe and effective. The Hexavalent Study Group has compared the immunogenicity and safety of a new liquid hexavalent vaccine against diphtheria, tetanus, pertussis,...

Physical And Emotional Contraindications

There are some indications that individuals with severe liver damage have a tendency to prolonged LSD reactions, because the liver plays an important role in detoxifying LSD and excreting it from the body. Some researchers therefore tended in the past to screen out persons with insufficient liver function associated with cirrhosis, a history of hepatitis, or other pathological conditions. Our experience with chronic alcoholics and cancer patients, many of whom had considerable liver damage, indicated that this factor is negligible unless the dysfunction is of a critical degree.

Phenobarbital sodium Natrium5thyl5phenylbarbiturat

Needle-sharing The use of syringes or other injecting instruments (e.g. droppers) by more than one person, particularly as a method of administration of drugs.This confers the risk of transmission of viruses (such as human immunodeficiency virus and hepatitis B and bacteria (e.g. Staphylococcus aureus).Many interventions such as methadone maintenance and needle syringe exchanges are designed partly or wholly to eliminate needle-sharing. Needle-shy Colloquial term for an addict who prefers not to inject. Needslag Norwegian colloquial term for a house seach (for drugs). Nefertal Dextropropoxyphene. Neftimin Meprobamate. Negadol Thebacon or Thebacon hydrochlo-ride.

Orthosiphon stamineus

Uses Orthosiphon stamineus Bth. is principally used to promote urination. In Indonesia and Malaysia, a decoction of leaves is drunk to alleviate bladder and kidneys discomfort, as well as to treat arteriosclerosis, gout and rheumatism. In Vietnam, an infusion of 15g-40g of the plant is drunk to promote urination, treat edema, control eruptive fever, and to treat influenza, rheumatism, hepatitis, jaundice and biliary lithiasis. In India, the plant is mixed with Andrographis paniculata Nees to treat diabetes.

Cigarro grueso de marijuana Colloquial

A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells. It can result from alcohol abuse, nutritional deprivation, or infection especially by the hepatitis virus. Cirrhosis can result in gastrointestinal disturbances, emaciation, jaundice, and edema. It is irreversible, but supportive treatment includes diet control, vitamins, diuretics (to remove accumulated fluid), and beta blockers (to control gastrointestinal bleeding). Cirrhosis is a common cause of death. 2. Chronic interstitial inflammation of any tissue or organ. New Latin Greek kirros, tawny (from the color of the diseased liver) + -OSIS. Cisco Colloquial term for alcoholic beverage which contains 20 alcohol by volume - apparently bottled like wine coolers to be deceptive -caused alcohol poisoning in many youths.

Vaccinium macrocarpon cranberry

A systematic review of all adverse events associated with acupuncture in the Japanese medical literature located 124 cases (67m). These included 25 cases of pneumothorax, 18 cases of spinal cord injury, 11 cases of hepatitis B, and 10 cases of localized argyria. 57. Escher M, Desmeules J, Giostra E. Hepatitis associated with kava, a herbal remedy for anxiety. Br Med J 2001 322 139. 58. Park GJ-H, Mann SP, Ngu MC. Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001 16 115-17.

Warning The plant is extremely toxic Curculigo latifolia Dryand

Pharmaceutical interest The sweet taste of the fruit of Curculigo latifolia Dryand. is attributed to curculin, which has a sweetening, taste-modifying non-functional mannose-binding lectin (Yamashita H et al., 1995). The invigorating property of Curculigo latifolia Dryand. could be due to the immuno-logical reinforcement mediated by a number of cycloartane saponins, since curculigosaponin G and curculoside experimentally display thymotrophic and immunostimulating properties (Xu JP etal., 1992 Yamusaki K etal., 1994). In vitro, an extract of rhizome inhibits the proliferation of the Hepatitis B Virus (Fan T et al, 1996), thereby substantiating the traditional use of this plant for the treatment of jaundice.

Alcoholic amblyopia See Amblyopia Alcoholic amnesia See Blackout

Alcoholic hallucinosis See Hallucinosis. Alcoholic hepatitis A disorder of the liver characterised by liver cell necrosis and inflammation following chronic consumption of hazardous levels of alcohol. It is a well documented precursor of alcoholic cirrhosis, particularly in those whose alcohol intake re Although the diagnosis is, strictly speaking, a-histological one, it is often made on the basis of clinical and biochemical evidence, even if confirmation by biopsy is not possible. The diagnosis is suggested on clinical grounds by the presence of jaundice (which may be deep) and tender hepatomegaly, and sometimes as-cites and haemorrhage. Alcoholic hepatitis has ICD-10 diagnos K70.1. Alcoholic insanity See Alcoholic psychosis. Alcoholic jealousy A type of chronic, alcohol-induced psychotic disorder, characterised by delusions that the marital or sexual partner is unfaithful. The delusion is typically accompanied by intense searching for evidence of infidelity and direct accusations...

Acyclovir antiretroviral drugs and other virustatics

Breastfeeding may continue when acyclovir or valaciclovir are administered externally or systemically. The other virustatics and antiretroviral substances, if really indicated, require an individual decision about continuing breastfeeding. In the case of drugs developed for HIV infection, an additional consideration is the risk of virus transmission via the mother's milk (see Chapter 4.15) here, guidelines only clearly recommend exclusive breastfeeding in those regions where lack of clean water for preparing infant formula and feeding equipment would pose a greater risk for the infant. If chronic hepatitis B requires lamivudin therapy, breastfeeding might be tolerable after active plus passive vaccination of the child.

Conventional Medicines for Liver Disorders

Immunoglobulin (Ig) is quite effective against hepatitis A when administered to anyone exposed to the virus as soon as possible or within two weeks after jaundice appears. Vaccines for hepatitis are now a common feature of immunization programs the world over. Treatment for acute hepatitis consists of rest and small, nourishing meals, fluids, and sometimes antinausea drugs such as trimethobenza-mide (Tigan). Chronic cases of hepatitis B and C are treated with interferon. The problem of gallstones is usually solved by surgical operation. Chenodiol, a recently available drug that dissolves gallstones is an alternative to surgery, but troublesome side-effects have been reported. Despite advancements in modern medicine, no hepatoprotective medicine is available. Treatment options for cirrhosis, fatty liver, and chronic hepatitis are limited as well as problematic. The conventional drugs used in such treatments are corticosteroids, interferon, colchicine, penicillamine, and antiviral and...

Herbal Medicines Potential Therapeutic Agents with Minimal Side Effects

Indigenous medicines, especially of plant origin, are used extensively for the treatment of various diseases. With lack of safe and effective treatment for liver diseases, researchers have been looking for alternative therapies that curb symptoms with minimum adverse effects on patients. Silybum marianum (milk-thistle) 15 and its extracts have been used since the times of ancient Greece for medicinal purposes. It is now currently used widely in Europe for liver disease, and is readily available in the United States from alternative medicine outlets and outdoor markets. Studies on effect of silymarin, an extract of milk-thistle, in preventing complications of chronic hepatitis virus infection at a dose of 140 mg three times daily suggest there is a need for optimization (e.g. single dosage, dose doubling), as efficacy could not be established. Silymarin may benefit the liver by promoting the growth of certain types of liver cells, demonstrating a protective effect, inhibiting...

Diphtheriatetanus or diphtheria tetanuspertussis vaccines in combination with other vaccines

DTaP or DTwP vaccine can be combined with other antigens, such as Hemophilus influenzae type b (Hib), inactivated poliovirus (IPV), and hepatitis B vaccine. In children DTaP or DTwP vaccines are the basis for such combinations, while in adults it is mostly Td vaccine, Current safety concerns regarding combination vaccines have been defined and reviewed (17r). The author concluded that there is no evidence that adding vaccines to combination products increases the burden on the immune system, which can respond to many millions of antigens. Combining antigens usually does not increase adverse effects, but it can lead to an overall reduction in adverse events. Before licensure, combination vaccines undergo extensive testing to assure that the new products are safe and effective.

Peristrophe roxburghiana Schult Bremek

Uses In Malaysia, the pounded leaves of Peristrophe roxburghiana (Schult.) Bremek are used to soothe swollen parts, painful sprain and to treat skin diseases. The plant is used to treat pulmonary tuberculosis, hepatitis and to stop haemoptysis. The therapeutic potential of Peristrophe roxburghiana (Schult.) Bremek remains unexplored.

Positive Direct Coomb Test And Intrahepatic Cholestasis

14. van den Broek JW, Buennemeyer BL, Stricker BH. Cholestatische hepatitis door de combinatic amoxicilline en clavulaanzuur (Augmentin). Cholestatic hepatitis caused by a combination of amoxicillin and clavulanic acid (Augmentin). Ned Tijdschr Geneeskd 1988 132(32) 1495-7. 16. Stricker BH, Van den Broek JW, Keuning J, Eberhardt W, Houben HG, Johnson M, Blok AP. Cholestatic hepatitis due to antibacterial combination of amoxicillin and clavu-lanic acid (Augmentin) Dig Dis Sci 1989 34(10) 1576-80 18. Reddy KR, Schiff ER. Hepatitis and Augmentin. Dig Dis Sci 1990 35(8) 1045-6. 19. Verhamme M, Ramboer C, Van de Bruaene P, Inderadjaja N. Cholestatic hepatitis due to an amoxycillin clavulanic acid preparation. J Hepatol 1989 9(2) 260-4. 21. Schneider JE, Kleinman MS, Kupiec JW. Cholestatic hepatitis after therapy with amoxicillin clavulanate potassium. NY State J Med 1989 89(6) 355-6. 23. Larrey D, Vial T, Micaleff A, Babany G, Morichau-Beauchant M, Michel H, Benhamou JP. Hepatitis...

Medical And Behavioral Toxicity Overview

That an increased amount of the drug is required to produce the same effects) and physiologic (physical) dependence, so that a withdrawal syndrome is associated with sudden cessation of drug use. Drug users who use hypodermic needles and syringes (injecting drug users IDUs ) are at risk for blood-borne diseases associated with the use of contaminated equipment, such as Hepatitis B and C and human immunodeficiency virus (HIV 1 and 2, the viruses responsible for acquired immunodeficiency syndrome AIDS ). Milder forms of these disorders are also detectable with neuropsychologic testing or brain imaging techniques (computed tomography CT scans magnetic resonance imaging MRI ). Studies of detoxified alcoholics (without other evidence of organic brain damage) reveal that 50 to 70 percent have impairments in neuropsychologic assessment (Eckardt & Martin, 1986). In most of these cases there is reversibility with abstinence from alcohol. Severe liver disease (e.g., acute hepatitis, advanced...

Display 544 Example of Passive Immunity

An example of passive immunity is the administration of immune globulins (see Summary Drug Table Agents for Passive Immunity), such as hepatitis B immune globulin. Administration of this vaccine is an attempt to prevent hepatitis B after the individual has been exposed to the virus.

Saussurea lappa C B Clarke

Antigen in Human hepatoma Hep3B cells, but have little effect on the viability of the cells. Both costunolide and dehydrocostus lactone suppress the hepatitis B surface antigen production by Hep3B cells dose-dependently with IC50 of 1 fiM and 2 M, respectively. Northern blotting analysis show that the suppression of hepatitis B surface antigen gene expression by both costunolide and dehydrocostus lactone are principally at the mRNA level. Furthermore, the suppressive effect of costunolide and dehydrocostus lactone on hepatitis B surface antigen and hepatitis B antigen, a marker for hepatitis B viral genome replication in Human liver cells, is observed in another Human hepatoma cell-line HepA2 which was derived from HepG2 cells by transfecting a tandem repeat Hepatitis B Virus DNA. Similarly, the mRNA of hepatitis B surface antigen in HepA2 cells is suppressed by these compounds. These findings suggest that costunolide and dehydrocostus lactone might hold some potential for the...

Drug Drug Interactions

An interaction of nelfinavir with the macrolide immunosuppressant tacrolimus has been reported in a patient co-infected with HIV and hepatitis C virus who had undergone orthotopic liver transplantation (18). The dose of tacrolimus had to be reduced to a 70th of the normal dose to avoid adverse effects. Nelfinavir serum concentrations were not affected by tacrolimus. The authors suggested that this effect had resulted from inhibition of the metabolism of tacrolimus, because both compounds are substrates of CYP3A4.

Babasol No 2 1 Barbital 2 Barbital sodium

Backtrack Colloquial term for allow blood to flow back into the needle and syringe during injection of drugs to repeat and prolonge the kick feeling. The habit practiced by some intravenous drug users involves increased risks of spreading aids and hepatitis. Backup 1. Colloquial term for prepare vein for injection. 2. Colloquial term for permitting blood to back up into a syringe to ensure the needle is in a vein or to repeat and prolong the drug kick. This habit is a risk for spreading aids and hepatitis.

Psychedelics And Society

Themselves to intravenous injection, and when used heavily usually lead to bodily damage and frequently to death. Intravenous injection of anything under unsterile conditions is a bad idea, since it will almost invariably lead eventually to tetanus, hepatitis, bacterial or fungal infection of the heart and arteries, partial paralysis, etc. The death rate among intravenous addicts is extremely high (a recent English study found the rate for smack heads thirty times higher than for a control group) and the best that can be said for these drugs is that they are a rather expensive and unreliable way of committing suicide.

Artemisinin A Versatile Weapon from Traditional Chinese Medicine

Joachim Stadler

Abstract Traditional Chinese medicine (TCM) commands a unique position among all traditional medicines because of its 5000 years of tradition. Our own interest in natural products from TCM was triggered in the 1990s by sesquiterpene lactones of the artemisinin type from Artemisia annua L. The first description of the Chinese herb Artemisia annua L. (qinghao, Sweet wormwood) dates back to 168 B.C.E. Artemisinin (qinghaosu) was identified in 1972 as the active antimalarial constituent of Artemisia annua L. Artemisinin and its derivatives are used for the treatment of malaria. As shown in recent years, this class of compounds also shows activity against cancer cells, schistosomiasis, and certain viruses, i.e., human cytomegalovirus, hepatitis B anc C virus, and bovine viral diarrhea virus. Interestingly, the bioactivity of artemisinin seems to be even broader and also includes the inhibition of other protozaons such as Leishmania, Trypanosoma, and Toxoplasma gondii, as well as some...

Organs and Systems Nervous system

Hepatitis A Hepatitis B Neuralgic amyotrophy (12), febrile convulsions (13), and Guillain-Barre syndrome (14) have been attributed to hepatitis B vaccine. Fatal inflammatory polyradiculo-neuropathy has been reported in temporal relation to hepatitis B administration (15). Two patients developed neurological symptoms and signs of central nervous system demyelination 6 weeks after administration of recombinant hepatitis B vaccine (16). Acute myelitis occurred in a 56-year-old man 3 weeks after hepatitis B immunization (17). Optic neuritis has been attributed to hepatitis B vaccine (18). Transverse myelitis developed 3 weeks after the first dose of hepatitis B vaccine in an 11-year-old girl (19). Guillain-Barre syndrome occurred in a 7-year-old girl after the administration of recombinant hepatitis vaccine (20). The author noted that several other such incidents had been reported after the use of recombinant vaccines, two involving optic neuritis and one Guillain-Barre syndrome. Eight...

The Long Term Health Effects of Methamphetamine

Health Effects Methamphetamine

The temporary physical and psychological effects from meth can turn into long-term, permanent effects that last a lifetime. For instance, meth dramatically affects a person's decision-making abilities. The temporary effect of increased libido leads meth users to engage in risky, unprotected sex. A recent study of 19,000 men in Los Angles showed that new HIV infections were three times higher among methamphetamine users than among nonusers.28 Also, HIV and other infectious diseases like hepatitis B and C are spread among injection drug users mainly by sharing syringes and needles. Multiple injections also scar the skin and the veins. Because of the eventual reversal of meth's effects, long-term meth-amphetamine use is associated with decreased sexual functioning and libido, at least in men.9, 11

Symptoms and toxic and fatal concentrations

MDMA causes increased catecholamine (including serotonin) release and blockade of reuptake resulting in cardiac and central nervous system effects 15 . The effects of MDMA vary depending on its doses, frequency and duration of use not only acute effects but also chronic (long-term) effects have been studied 16 . Acute and chronic symptoms provoked by MDMA are summarized in > Table 7.2 15 . The effects of chronic MDMA use have not been well studied, but appear to include both toxic hepatitis and damages of the serotoninergic neural pathways 17, 18 . The acute MDMA toxicities are similar to those noted with other amphetamines they are tachycardia, hypertension, seizures, hyperthermia, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation and death 19, 20 . A detailed review by Kalant 16 revealed that 87 MDAs-related fatalities were associated with hyperpyrexia, rhabdomyolysis, in-travascular coagulopathy, hepatic necrosis, cardiac arrhythmias, cerebrovascular...

Case 9 Self Medication for Depression Antidepressants Legal and Illegal

Unmask latent depression, or cause depression in themselves. The drugs raise clinical dilemmas in medical practice about whether to add an antidepressant to a patient's treatment or instead to back off on the original therapeutic regimen. Interferon used to treat hepatitis C is associated with depression, for example, and drugs that intensify or cause depression can be found in other areas as well. Alcohol also inhibits the central nervous system and can complicate depression so can common OTC drugs such as antihistamines. Some religious-use drugs, such as the hallucinogens, are psychoactive and can exacerbate preexisting psychiatric disease, including depression. Steroids used in sports enhancement, including androgenic steroids like nandrolone, can cause severe depressive reactions. Barbiturates and benzodiazepines such as Phenobarbital and Valium, known on the street as downers are also highly associated with depression.

Medications for Opiate Dependence

A pragmatic drawback of methadone maintenance is that regulations stipulate that it can only be administered at specially licensed clinics that require frequent attendance (daily at the outset) and that are not even available in many geographic regions. This can be a practical constraint or a disincentive for many patients. On the other hand, it has been shown that the effectiveness of methadone maintenance depends upon regular counseling in conjunction with the medication, which is a requirement of methadone clinics, and more severely dysfunctional patients probably benefit from the structure imposed by clinic rules. Furthermore, many of the better methadone clinics offer primary medical and psychiatric care, which is important since chronic opiate-dependent patients often have multiple medical problems (e.g., hepatitis B and C, HIV) and psychiatric problems (e.g., depression, PTSD).

Cannabis for spasticity and neurological disorders Now we know why

(Lioresal) to relax muscles, benzodiazapines like diazepam (Valium), sedatives and tranquilizers. Common side effects of these drugs range from minimal to incapacitating. Dantrolene can cause drooling, sweating, and pleural effusions, hepatitis and tachycardia. Xanax can cause nausea, constipation, drowsiness, benzodiazepine dependence headache and dry mouth. As with many pharmaceutical regimens, the dosage of the drug is increased as the severity of the disease increases. Thus, patients who suffer from the severest functional and sensory effects of MS also suffer from the worst effects of pharmaceuticals. The other basic line of treatment for MS involves exercise and physical therapy. Lack of mobility increases many problems and can lead to skin breakdown, gastrointestinal problems, contractures and muscle wasting. Physical therapy strengthens muscles, increases rang-of-motion, stimulates heart and lung function and decreases contractures and skin breakdown. Exercise should be...

Adverse effects of the chemically modified tetracyclines CMTs

Immunologic Several drugs have been reported to cause a lupus-like syndrome. In a recent review of relevant American and European literature, hepatitis and drug-induced lupus were reported in 66 cases after minocy-cline therapy, mostly after long-term treatment for acne (45R ). It should be recognized that in many countries long-term minocycline is a very common therapy for acne.

Medications for Alcohol Dependence

Naltrexone combined with structured psychosocial treatment has been associated with improvements in complete abstinence, less craving for alcohol when the patient was abstinent, and less drinking once drinking began. Psychosocial treatments that have proven particularly effective in combination with naltrexone are those, such as cognitive behavioral relapse prevention, that emphasize coping skills for handling various sources of relapse risk. The recommended dose is 50 mg per day. This agent differs from disulfiram in that there is no added ill effect once drinking begins. It may limit the severity of binges and diminish preoccupation with alcohol in abstinent alcoholics. Nausea has been a common side effect early in naltrexone treatment for alcoholism, but is generally mild and clears with continued use. Naltrexone can produce liver toxicity, which is dose dependent, has mainly been observed at much higher doses (200 or 300 mg per day), and resolves with dose reduction. Elevated...

Polio vaccines as a possible cause of AIDS

The hypothesis is based on the following facts and assumptions. In 1957 and 1958, Koprowski, from the Wistar Institute in Philadelphia, was administering oral polio vaccine in Africa (pre-licensure field trials in Burundi, Rwanda, and the North-East Congo) near Stanleyville (now Kisangani) in Congo. Not far from the base, chimpanzees for use in medical research were housed in Camp Lindi and might have carried a primate immunodeficiency virus (PIV). Chimpanzee kidneys for hepatitis research were shipped from Camp Lindi to the Virological Department of the Children Hospital in Philadelphia in 1958 and 1959. Hooper suggests that it could be that kidneys from these chimpanzees ended up at the Wistar'', the laboratory in Philadelphia where polio vaccines were manufactured, where they contaminated vaccines with PIV. The polio vaccine that was supposed to be contaminated with PIV was then used in the Congo, transmitting the virus that evolved into HIV-1, the starting point of the worldwide...

Efficacy of immunization in breastfed infants

4.5.3 Hepatitis A vaccine Hepatitis A vaccine is available in two preparations which are prepared from cell culture-adapted hepatitis A virus which has in turn been cultured in human fibroblasts and inactivated. It has not been studied in breastfeeding or in children under 2 years of age. Recommendation. Hepatitis A vaccine is unlikely to present a problem during lactation and Is not contraindicated. 4.5,4 Hepatitis B vaccine Hepatitis B vaccine is a highly effective and safe vaccine which is produced by recombinant DNA technology. The vaccine is an inactivated non-infectious hepatitis B surface antigen vaccine, and contains between 10 and 40pg of HB3Ag protein per ml with apparently similar rates of seroconversion. Pediatric vaccines contain no thimerosal. The vaccine is given to newborns at birth. Hepatitis B vaccine is also combined with other vaccines, and can be given concurrently with other vaccines but via a separate syringe and at another site. A total of three injections is...

Conjugated meningococcal vaccines

The results of a randomized, double-blind trial of safety, immunogenicity, and induction of immunological memory in 182 healthy infants has been published (8). The infants received either conjugated meningococcal vaccine (conjugated to CRM197, a non-toxic mutant of diphtheria toxin) of lot 1 (60 infants) or lot 2 (60 infants) or hepatitis B vaccine as a control vaccine. Diphtheria and tetanus tox-oids and whole cell pertussis (DTP) vaccine reconstituted with Hib-tetanus conjugate was co-administered in the other leg. Polio vaccine was given orally. According to the UK immunization schedule, these vaccines were given at 2, 3, and 4 months of age. At 12 months the children received either meningococcal A and C polysac-charide vaccine or conjugated meningococcal serogroup C vaccine. The conjugated meningococcal vaccines were generally well tolerated and resulted in less tenderness and induration than the routine vaccines (DTP-Hib and hepatitis B) administered in the opposite leg. There...

Types of Cancer Vaccines

With preventive vaccines targeted against infectious agents that are known to cause cancer (e.g., hepatitis B and HPV), the activated B cells produce antibodies that bind to the infectious agents and interfere with their ability to infect cells. Because the agents must infect cells to transform them, this lowers the chance of

Marijuana is Not As It Seems

Snorting cocaine can damage the lining of the nose, cause sinus infection, and impact the sense of smell. Smoking or freebasing cocaine can cause liver and lung damage. Cocaine can also burn uncontrollably when exposed to fire, and accidents involving free-basing have resulted in serious burns. Injecting cocaine carries the negative consequences of injecting any drug, the most serious being HIV infection (a virus that attacks the body's immune system and causes AIDS) and hepatitis (infectious disease that can cause serious liver damage). In addition, cocaine is often mixed, or cut with other chemicals, including other stimulants, that can have adverse effects of their own.

Proposing a New National Policy for Methamphetamine

Similar to the widespread anxiety about the rise in and dangers of crack cocaine use in the 1980s and '90s, methamphetamine is a source of growing concern for many communities. DPA's new national report on methamphetamine policy, A Four-Pillars Approach to Methamphetamine Policies for Effective Drug Prevention, Treatment, Policing and Harm Reduction, released in March 2008, advances a strategy that embodies the best principles of harm reduction applied to this specific area of drug misuse and enforcement. The report evaluates current state and federal methamphetamine policies, recommends major reforms and is the first in the U.S. to lay out a four pillars approach - the Swiss national model -to addressing methamphetamine abuse. Already in use in countries including Australia, Canada and Germany, this approach has resulted in dramatic reductions in street drug use, overdose deaths and HIV AIDS and hepatitis infection rates. The DPA report was featured at a well-attended forum for...

Amphetamine Class

Amphetamines stimulate the central nervous system (the brain and associated anatomy). At one time evidence of damage to nerve cells was not clear enough to satisfy some credible researchers that such a hazard exists, despite any theoretical reasons for concern, but in the 1990s evidence was becoming persuasive. Among other things, researchers have found that persons who continually abuse amphetamines and persons with a certain type of organic brain injury (focal damage to orbitofrontal PFC prefrontal cortex ) have similar problems in making decisions.4 Severity correlates to length of amphetamine abuse. Nonprescription sales have long been banned in Sweden due to kidney system damage, and amphetamines are suspects in liver damage involving hepatitis. Amphetamines also excite the heart, increasing pulse rate and blood pressure. Normally cardiac effects are unharmful but can be risky at high doses. To a lesser extent, amphetamines help to open air pathways in the lungs while stimulating...


Danazol is a weak androgen and also has a series of other hormonal and anti-hormonal properties. It inhibits pituitary gonadotropin and has been used in the treatment of endometriosis, fibrocystic disease of the breast, idiopathic thrombocytopenic purpura, and hereditary angioedema. Its hepatotoxic effects include reversible rises in serum transaminases and cholestatic hepatitis a few cases of hepatocellular tumors have been reported.


Effects A good source of lecithin and choline, both of which are beneficial to memory, plus the antioxidant carotenoids lutein and violaxanthin. It may be helpful in treating constipation, fever, gout, hepatitis, insomnia, stiff joints, liver disorders, and chronic rheumatism.