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Nonselective antiviral drugs

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Nonselective antiviral drugs

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Nonselective antiviral drugs

  1. 1. Antiviral drugs Nonselective Antiviral drugs Anti-Hepatitis virus S. Parasuraman, M.Pharm., Ph.D., Associate Professor Faculty of Pharmacy AIMST University, Malaysia
  2. 2. Nonselective Antiviral drugs - Learning Outcomes • At the end of this session, the student would be able to: – classify nonselective antiviral drugs. (CLO1) – describe the mechanism of action, pharmacological actions, pharmacokinetic features, therapeutic uses, adverse effects, interaction and contraindications of nonselective antiviral drugs. (CLO1)
  3. 3. Nonselective Antiviral drugs • Several antiviral drugs are relatively virus nonselective and inhibit viruses belonging to different classes, includes – both DNA and RNA viruses.
  4. 4. Nonselective Antiviral drugs Classification of anti-Hepatitis virus/ Nonselective antiviral drugs • Primarily for hepatitis B: Lamivudine, Adefovir dipivoxil, Tenofovir • Primarily for hepatitis C: Ribavirin, Interferon α
  5. 5. Nonselective Antiviral drugs (for hepatitis B) • Lamivudine – Refer Anti-Retrovirus. • Adefovir dipivoxil: – Adefovir is a monophosphate analogue of AMP which is active against HBV and some other DNA as well as RNA viruses, but is used only for hepatitis caused by HBV. Adefovir dipivoxil is an oral prodrug of the nucleotide analogue adefovir. – Adefovir is indicated in chronic hepatitis B, including lamivudine-resistant cases and those having concurrent HIV infection. There is no cross resistance between adefovir and lamivudine. • Tenofovir – Refer Anti-Retrovirus.
  6. 6. Nonselective Antiviral drugs (for hepatitis C) • Ribavirin: – Ribavirin is a purine nucleoside analogue has broad- spectrum antiviral activity, including that against influenza A and B, respiratory syncytial virus and many other DNA and double stranded RNA viruses. – Administered orally or i.v. ribavirin has been used in severe influenza A/B and measles in immunosuppressed patients as well as for herpes virus infections, acute hepatitis, but is not a first line drug for any of these. – The most common therapeutic use of oral ribavirin is in chronic hepatitis C.
  7. 7. Nonselective Antiviral drugs (for hepatitis C) • Interferon α: – Interferon receptors are JAK-STAT tyrosine protein kinase receptors which on activation phosphorylate cellular proteins. – Three types of human IFNs (α, β and γ) are known to have antiviral activity. – Interferons (IFNs)are low molecular weight glycoprotein cytokines produced by host cells in response to viral infections, Tumor necrosis factor alpha (TNFα), and Interleukin-1 (IL-1).
  8. 8. Nonselective Antiviral drugs (for hepatitis C) • Interferon α: – Interferon α have nonspecific antiviral as well as other complex effects on immunity and cell proliferation. – Interferons bind to specific cell surface receptors and affect viral replication at multiple steps, viz. viral penetration, synthesis of viral mRNA, assembly of viral particles and their release.
  9. 9. Nonselective Antiviral drugs (for hepatitis C) • Antiviral spectrum of Interferon α: – Chronic hepatitis B: IFNα2Α 2.5−5 ΜU/m2 or IFNα2Β 5−10 ΜU given 3 times per week for 4–6 months causes disappearance of HBV-DNA from plasma and improvement in liver function tests/histology in nearly half of the patients. – Chronic hepatitis C: IFNα2Β 3ΜU 3 times weekly for 6– 12 months has produced remission in 50–70% patients. – Condyloma acuminata: caused by papilloma virus is usually treated with topical podophyllin.
  10. 10. Nonselective Antiviral drugs (for hepatitis C) • Antiviral spectrum of Interferon α: – AIDS-related Kaposi’s sarcoma: IFN is used to treat AIDS related Kaposi’s sarcoma, but not to treat HIV as such. However, interferon accentuates haematological toxicity of zidovudine. – H. simplex, H. zoster and CMV: For these infections in immunocompromised patients, interferon is inferior to acyclovir/ganciclovir. – Chronic myeloid: Interferons are also used in chronic myeloid leukaemia, follicular lymphoma, cutaneous T- cell lymphoma and multiple myeloma.
  11. 11. Nonselective Antiviral drugs (for hepatitis C) • Adverse effects of Interferon α: – Flu-like symptoms: fatigue, aches and pains, malaise, fever, dizziness, anorexia, nausea, taste and visual disturbances develop few hours after each injection, but become milder later. – Neurotoxicity: numbness, neuropathy, altered behaviour, mental depression, tremor, sleepiness, rarely convulsions. – Myelosuppression: dose dependent neutropenia, thrombocytopenia. – Thyroid dysfunction: (hypo as well as hyper). – Others: Hypotension, transient arrhythmias, alopecia and liver dysfunction.

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