McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 7  Immune modulators

TABLE 17.1

DRUGS IN FOCUS Immune stimulants

Drug name

Dosage/route

Usual indications

Interferons interferon alfa-2a (Roferon-A)

Individualised; dose varies widely

Treatment of leukaemias, Kaposi’s sarcoma, non-Hodgkin’s lymphoma, chronic hepatitis C Treatment of leukaemias, Kaposi’s sarcoma, warts, hepatitis B, malignant melanoma Treatment of multiple sclerosis in adults

Adult: dose varies widely based on indication

interferon alfa-2b (Intron-A)

interferon beta-1a (Avonex) interferon beta-1b (Betaferon) interferon gamma-1b (Imukin)

30 mcg IM once a week

Individualised; dose varies widely

Treatment of multiple sclerosis in adults

Individualised; dose varies widely

Treatment of serious, chronic granulomatous disease in adults; delaying time to disease progression in severe, malignant osteopetrosis

peginterferon alfa-2a (Pegasys) peginterferon alfa-2b (Peg-Intron)

180 mcg SC once weekly

Treatment of chronic hepatitis B, C

0.5 mcg/kg SC weekly for 6 months

Treatment of chronic hepatitis C in adults

Interleukins

Two 5-day cycles of 600,000 IU/kg IV q 8 hours given over 15 minutes

Treatment of specific renal carcinomas in adults; also, drug is being investigated for use in the treatment of AIDS and AIDS- related disorders

aldesleukin (Proleukin)

Adverse effects The adverse effects associated with the use of interfer- ons are related to the immune or inflammatory reaction that is being stimulated (stimulating the immune and inflammatory response causes a flu-like syndrome with Prototype summary: Interferon alfa-2b Indications: Hairy cell leukaemia, malignant melanoma, AIDS-related Kaposi’s sarcoma, chronic hepatitis B and C, intralesional treatment of condylomata acuminata in individuals 18 years of age or older. Actions: Inhibits the growth of tumour cells and enhances the immune response. Pharmacokinetics: Route Onset Peak IM, SC Rapid 3–12 hours IV Rapid End of infusion T 1/2 : 2 to 3 hours; metabolised in the kidney, excretion is unknown. Adverse effects: Dizziness, confusion, rash, dry skin, anorexia, nausea, bone marrow suppression, flu-like syndrome.

lethargy, myalgia, arthralgia, anorexia, nausea). Other commonly seen adverse effects include headache, dizzi- ness, bone marrow depression, depression and suicidal ideation, photosensitivity and liver impairment. Clinically important drug–drug interactions There are no reported clinically important drug–drug interactions with the interferons. I nterleukins Interleukins are synthetic compounds much like endogenous interleukins; they communicate between lymphocytes, which stimulate cellular immunity and inhibit tumour growth. Interleukin-2 stimulates cellular immunity by increasing the activity of natural killer cells, platelets and cytokines. Not available in Australia, one interleukin preparation is available for use in New Zealand. Aldesleukin ( Proleukin ) is a human interleukin produced by recombinant DNA technology using E. coli bacteria (see Table 17.1). Therapeutic actions and indications Natural interleukin-2 is produced by various lymphocytes to activate cellular immunity and inhibit tumour growth by increasing lymphocyte numbers and their activity.