Managing the neuropsychiatric adverse effects of interferon treatment.
Patients who receive interferons are vulnerable to a wide variety of neuropsychiatric adverse effects which can seriously compromise otherwise effective therapy. The nature and severity of the adverse effects are, in part, dose dependent, though there is significant variability. Effective treatment of interferon adverse effects is hindered by the absence of an identified mechanism of toxicity and lack of controlled intervention trials. Successful management of adverse effects is facilitated by a multimodal approach, starting with pre-treatment screening and discussion. Behavioural techniques help maintain daily function. Dose reduction or drug holidays may be required. Pharmacological treatment is based largely on clinical experience, though formal studies are underway. Familiarity with several classes of psychotropic medications is required, including antidepressants, anxiolytics, antipsychotics and psychostimulants. Together, these interventions may be used to reduce severity of interferon behavioural adverse effects to tolerable levels.
Valentine
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AD
Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. avalenti@notes.mdacc.tmc.edu