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Sofosbuvir علاج فيرس سي

علاج فيرس سي المحتمل نزوله الشهر المقبل بمصر بتكلمفة 900 دولار لمدة 12 اسبوع 

FDA Approves Sovaldi ®
- On 6th December 2013, The U.S .
Food and Drug Administration
(FDA) has approved Sovaldi ® (sofosbuvir) 400 mg tablets, a once-daily oral nucleotide analogue polymerase inhibitor for the treatment of chronic hepatitis C (CHC) infection as a component of a combination antiviral treatment regimen.
Efficacy
- Efficacy has been established in subjects with hepatitis C virus (HCV) genotypes 1, 2, 3 or 4 infections, and to treat HCV and HIV co-infected patients.
- The combination therapy includes either ribavirin (RBV) alone or Ribavirin and peg-interferon (PEG-IFN) alfa.
Drug category
 
- Sofosbuvir acts against HCV and is categorized as a Direct-Acting Antiviral agent (DAA).
HCV genotypes 
- Hepatitis C virus (HCV) is a major cause of chronic liver disease, with an estimated 170 million people infected worldwide.
- Hepatitis C is divided into six distinct genotypes throughout the world with multiple subtypes in each genotype class.
- A genotype is a classification of a virus based on the genetic material in the RNA strands of the virus.
- Generally, patients are only infected with one genotype.
- Each genotype has the ability to mutate very quickly and become immune to current treatments, which explains why chronic Hepatitis C is so difficult to treat.
- Genotype 1 is the most common type of Hepatitis C genotype in the United States and the most difficult to treat.
Dose
 
- One 400 mg tablet taken once daily with or without food.
- Should be used in combination with ribavirin or in combination with peg-interferon and ribavirin for the treatment of CHC.
- If you miss a dose, take the missed dose as soon as you remember the same day. Do not take more than one tablet (400 mg) in a day. Take your next dose at your regular time the next day
Recommended combination therapy


Genotype 1 or 4  Sovaldi + peg-interferon alfa + ribavirin 12 weeks 
Genotype 2 Sovaldi + ribavirin 12 weeks
Genotype 3 Sovaldi + ribavirin 24 weeks 
 Pharmacokinetics
- Sofosbuvir is a prodrug that is metabolized by the liver to the active antiviral agent (Active triphosphate catabolite).
- Given orally (Once daily).
- Maximum plasma concentration in about 0.5 to 2 hours.
- Plasma protein binding amount of 61-65%.
- eliminated by three routes: urine (80%), feces (14%), and respiration (2.5%). 
Mechanism of action 
 Sofosbuvir is an inhibitor of the HCV NS5B RNA-dependent RNA polymerase, which is essential for viral replication.
- Sofosbuvir is a nucleotide prodrug that undergoes intracellular metabolism to form the
pharmacologically active uridine analogue triphosphate, which can be
incorporated into HCV RNA by the NS5B polymerase and acts as a chain terminator.
 Side effects

- The most common side effects (greater than or equal to 20%, all grades) observed with Sovaldi ®
in combination with ribavirin:
- Fatigue
- Headache.
- The most common side effects observed with Sovaldi ®
in combination with peg-interferon alfa and ribavirin:
- Fatigue
- Headache
- Nausea
- Insomnia
- Anemia 

Warning and recaution
- Pregnancy:
- Ribavirin may cause birth defects and fetal death and animal studies have shown interferons have abortifacient effects.
- Avoid pregnancy in female patients and female partners of male patients.
- Patients must have a negative pregnancy test prior to initiating therapy.
- Females and males must use two effective forms of birth control during treatment and for the 6 months after treatment.

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أنواع المحاليل الوريدية Types of I.V

  المغذيات السوائل الوريديه  المحاليل الوريدية iv solution أنواع المحاليل الوريدية Types of I.V  اولا Normal saline (N/S • يتكون من كلوريد الصوديوم + ماء نقي . %0.9 حجمه الكلي هو 500cc. الاستعمال : هبوط الضغط ولارتفاع السكر مع الانسولين وحالات الحوادث RTA او النزف والتقيء الشديد والاسهال لمنع الجفاف. وغالبا تعطى فيال ceftriaxone مع 100 سيسي نورمل سلاين. أنواع المحاليل الوريدية Types of I.V # ثانيا :-(  Glucose water (G/W يتكون من dextrose + ماء نقي. %5 ، %10 حجمه الكلي 500cc يعطى في حالة :- يستعمل في حالات مابعد العملية او الاسهال او هبوط السكر ولحالة فقدان الشهية لانه يعتبر مصدر رئيسي للطاقة مثل جماعة التهاب الزائدة او لاعطاء امبولات معه مثل الامينوفلين والH.C لجماعة الربو وتحسس الصدر او حالات الاغماء مثل هبوط مستوى السكر hypoglycemia مع امبولة هايبر تونك HT. أنواع المحاليل الوريدية Types of I.V # ثالثا :-(Glucose saline (G/S يتكون من Nacl+ dextrose + ماء نقي %0،4.5/2.5 الحجم الكلي 500cc يعطى في حالة:- هبوط السكر والضغط ويعطى معة امبولة مثل البلاسيل لحالة التقيئ ولمنع الجفاف ويعطى في

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