Contraindications
Contraindications associated with patients who are or may become pregnant, those with renal failure and those with mental health problems.
Quick links on this page
Pregnancy and risk of pregnancy
There are no studies on the effects of antiviral therapy on human pregnancy. Studies in animals have shown that ribavirin therapy, at well below the recommended human dose, causes malformations in the fetus. The incidence and severity of the teratogenic effects increased with escalation of the ribavirin dose. Survival of the fetus and the offspring was reduced.145 Further animal studies have shown abnormalities in sperm.145
There are no data on the use of pegylated IFN in pregnant women and it is not known whether pegylated IFN or ribavirin are excreted in human milk.
Good practice points
Pegylated IFN and ribavirin must not be prescribed to women who are pregnant.
Treatment with pegylated IFN and ribavirin should not be initiated until pregnancy has been excluded.
Couples, with one partner receiving pegylated IFN and ribavirin, should use two forms of contraception during treatment and for six months after therapy has ended.
Patients with renal failure
Ribavirin causes a dose-dependent haemolytic anaemia and the degree of haemolysis is dependent on the severity of the renal failure.146 Treatment with pegylated IFN2a monotherapy at a dose of 135 mcg subcutaneously per week for patients on haemodialysis may be considered but patients need to be closely monitored.147 1+ 3
Patients with CHC and renal failure may be treated with IFN monotherapy, with careful monitoring required.
Patients with mental health problems
Patients with mental health problems respond equally well to interferon and ribavirin therapy but their psychiatric symptoms should be managed carefully, particularly in the first four weeks of treatment.148, 149 2+ 3
Patients with stable mental health problems should not be excluded from treatment for CHC.
Patients with mental health problems should have their psychiatric symptoms monitored prior to and throughout IFN treatment.
Good practice points
Formal psychiatric assessment should be considered for selected patients if necessary.
