Parameters:
(1) hemoglobin level
(2) status of any cardiac disease
(3) status of any renal disease
(4) current dose of Copegus in mg/day
Copegus should be discontinued if:
(1) there is deterioration of concurrent heart disease
(2) if the hemoglobin stays < 12 g/dL despite 4 weeks at a reduced dose AND if the patient has stable heart disease
(3) if the hemoglobin is < 8.5 g/dL AND if the patient does not have heart disease
(4) if the creatinine clearance drops < 50 mL/min
If the patient has no heart disease and if the hemoglobin is 8.5 - 9.9 g/dL, then reduce the daily dose of Copegus to 600 mg/day (200 mg AM, 400 mg PM, dispensing 200 mg tablets) (Roche Pharmaceuticals).
If the patient has stable heart disease and if the hemoglobin is drops >= 2 g/dL during any 4 week period, then reduce the daily dose of Copegus to 600 mg/day (200 mg AM, 400 mg PM, dispensing 200 mg tablets).
where:
• There could be situations where the rule for no heart disease may fire yet the rule with stable heart disease might not (for example, if the initial hemoglobin was 10.5 and dropped to 9.5). In the implementation I let either rule fire if stable heart disease is present.
• Transfusion therapy would confound change in hemoglobin values.
