November 2003: Case Study 2

Published Online: Saturday, November 1, 2003

    DC, a pharmacy student currently on an infectious disease rotation, is asked to review the laboratory reports for the clinic patients. The 5 patients seen in the clinic today are infected with the hepatitis C virus and are receiving treatment with peginterferon alfa-2b and ribavirin. The unusual lab values for these 5 patients include the following:

    Patient 1 Hgb 9.5 g/dL

    Patient 2 Hgb 8.0 g/dL

    Patient 3 WBC 1.4 x 109/L

    Patient 4 Platelets 70 x 109/L

    Patient 5 Platelets 40 x 109/L

    The attending physician explains to DC that peginterferon and ribavirin must be dose-modified or discontinued based on hemoglobin, WBC (white blood count), neutrophil, and platelet values. He then asks DC to make recommendations pertaining to the patients? peginterferon and ribavirin.

    What recommendations should DC make pertaining to each patient?s therapy?

Click Here For The Answer -----------> [-]

The manufacturer recommends the following dose modifications due to hematologic toxicity:

Laboratory Values Peginterferon


Hgb <10.0 g/dL NA Decrease by 200 mg/day
Hgb <8.5 g/dL Discontinue Discontinue
WBC <1.5 x 109/L Decrease dose by 50% NA
WBC <1.0 x 109/L Discontinue Discontinue
Neutrophils <0.75 x 109/L Decrease dose by 50% NA
Neutrophils <0.5 x 109/L Discontinue Discontinue
Platelets <80 x 109/L Decrease dose by 50% NA
Platelets <50 x 109/L Discontinue Discontinue

The recommended adjustments for these 5 patients are:

    Patient 1 Decrease ribavirin dose by 200 mg/day

    Patient 2 Discontinue peginterferon and ribavirin permanently

    Patient 3 Reduce peginterferon dose by 50%

    Patient 4 Reduce peginterferon dose by 50%

    Patient 5 Discontinue peginterferon and ribavirin permanently

Latest Articles
A pharmacy robber not only left his fingerprints behind at a pharmacy—he also dropped his wallet containing his identification as he made his escape.
Janssen Research and Development LLC has submitted a new drug application to the FDA for canagliflozin and metformin hydrochloride extended release (Invokamet XR).
Treating chronic pulmonary obstructive disease with both inhaled corticosteroids and long-acting bronchodilators remains controversial, but new evidence suggests that this controller combination could reduce mortality risk.
Beverly Schaefer, RPh, of Katterman's Sand Point Pharmacy in Seattle, Washington, shares some fun tips on how to encourage patients who travel to come to your pharmacy for supplies.
Latest Issues