Neuropsychiatric side effects of HCV therapy and their treatment: focus on IFNα-induced depression

OBJECTIVES: The systemic and cognitive side effects of hepatitis C virus (HCV) therapy may be incapacitating, necessitating dose reductions or abandonment of therapy. Oral cannabinoid-containing medications (OCs) ameliorate chemotherapy-induced nausea and vomiting, as well as AIDS wasting syndrome. The efficacy of OCs in managing HCV treatment-related side effects is unknown.METHODS: All patients who initiated interferon-ribavirin therapy at The Ottawa Hospital Viral Hepatitis Clinic (Ottawa, Ontario) between August 2003 and January 2007 were identified using a computerized clinical database. The baseline characteristics of OC recipients were compared with those of nonrecipients. The treatment-related side effect response to OC was assessed by χ2analysis. The key therapeutic outcomes related to weight, interferon dose reduction and treatment outcomes were assessed by Student’sttest and χ2analysis.RESULTS: Twenty-five of 191 patients (13%) initiated OC use. Recipients had similar characteristics to nonrecipients, aside from prior marijuana smoking history (24% versus 10%, respectively; P=0.04). The median time to OC initiation was seven weeks. The most common indications for initiation of OC were anorexia (72%) and nausea (32%). Sixty-four per cent of all patients who received OC experienced subjective improvement in symptoms. The median weight loss before OC initiation was 4.5 kg. A trend toward greater median weight loss was noted at week 4 in patients eventually initiating OC use (−1.4 kg), compared with those who did not (−1.0 kg). Weight loss stabilized one month after OC initiation (median 0.5 kg additional loss). Interferon dose reductions were rare and did not differ by OC use (8% of OC recipients versus 5% of nonrecipients). The proportions of patients completing a full course of HCV therapy and achieving a sustained virological response were greater in OC recipients.CONCLUSIONS: The present retrospective cohort analysis found that OC use is often effective in managing HCV treatment-related symptoms that contribute to weight loss, and may stabilize weight decline once initiated.

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Neuropsychiatric Side Effects of Drugs in the Elderly

The Journal of Nervous and Mental Disease ◽

10.1097/00005053-198207000-00015 ◽

1982 ◽

Vol 170 (7) ◽

pp. 433

Author(s):

Kenneth Solomon

Keyword(s):

Side Effects ◽

The Elderly ◽

Neuropsychiatric Side Effects

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Predictors of Discontinuation of Efavirenz as Treatment for HIV, Due to Neuropsychiatric Side Effects, in a Multi-Ethnic Sample in the United Kingdom

AIDS Research and Human Retroviruses ◽

10.1089/aid.2019.0193 ◽

2020 ◽

Vol 36 (6) ◽

pp. 459-466

Author(s):

Johnson Kai Chun Law ◽

Laurie T. Butler ◽

Matthew M. Hamill

Keyword(s):

United Kingdom ◽

Side Effects ◽

The United Kingdom ◽

Neuropsychiatric Side Effects

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Antimicrobial-induced cognitive side effects

Mental Health Clinician ◽

10.9740/mhc.2016.07.207 ◽

2016 ◽

Vol 6 (4) ◽

pp. 207-214 ◽

Cited By ~ 7

Author(s):

Amanda Warstler ◽

Jennifer Bean

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Side Effects ◽

Clinical Symptoms ◽

Case Reports ◽

Time Frame ◽

Drug Induced ◽

Pubmed Search ◽

Neuropsychiatric Side Effects ◽

Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

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