Managing patients’ Hepatitis C medicines on admission to hospital
Key messages:
- Most patients with Hepatitis C Virus (HCV) will be treated with oral direct-acting antiviral agents (DAAs) for 8-12 weeks
- DAAs should be continued during the hospital stay, unless the clinical condition of the patient precludes administration
- Check for drug interactions with any new medicines; a useful source is www.hep-druginteractions.org
- The HCV Pharmacy Team* can confirm the patient’s current regimen and provide clinical advice on safe/effective use of DAAs
- Where available, use the patient’s own drugs (PODs). See ‘Administration and supply’ section below for the process to follow if PODs are not available.
- At discharge, if the DAA regimen is dispensed in the community, contact the patient’s community pharmacy to ask them to resume supply
Introduction
Treatment of HCV has evolved rapidly over the last 5 years. Interferon is no longer prescribed for any patient with HCV. High cure rates can now be achieved for all HCV genotypes with oral DAAs, which are well tolerated with little to no on-treatment monitoring required. Current treatment options include:
- Maviret® (glecaprevir/pibrentasvir)
- Zepatier® (grazoprevir/elbasvir)
- Epclusa® (sofosbuvir/velpatasvir)
- Harvoni® (sofosbuvir/ledipasvir)
Vosevi® (sofosbuvir/velpatasvir/voxilaprevir) may be prescribed for patients failing first-line treatment regimens. Ribavirin is only used rarely (in combination with Epclusa® or Harvoni®) for patients with decompensated liver disease.
The World Health Organisation (WHO) has issued a global eradication strategy for HCV by 2030. However, in 2019, the Scottish Government set a more ambitious target of eliminating hepatitis C in Scotland by 2024.
Specialist HCV pharmacists prescribe DAAs for dispensing at the patient’s community pharmacy. To optimise adherence, DAAs are usually dispensed weekly or fortnightly. Patients who are also on opioid replacement therapy will usually be issued their DAA supply at the same time; some patients with HCV may consequently have daily supervised DAA therapy.
Medicines Reconciliation
- Patients with HCV may not be receiving treatment; always check the intended completion date for the DAA treatment
- For up-to-date information on the patient’s DAA regimen consider the following sources:
- Patient
- HCV Pharmacy Team*
- Community pharmacy
- PODs (check the date on the label to ensure current supply)
- Clinical Portal (details usually recorded in clinical notes section). For GRI HCV patients, these details are recorded in “pathways” in the clinical document tab.
- Specialist Liver Nurses
Please note: The patient’s ECS may list DAAs. However, as this is not always accurate it should not be used alone to confirm the HCV regimen.
- Confirm if supply in community is daily/weekly/supervised dispensing
Prescribing
- DAAs should be continued during the hospital stay, unless the clinical condition of the patient precludes administration, e.g. acute-on-chronic liver failure. The decision to discontinue DAA treatment should be discussed with the HCV specialist team. For patients with swallowing difficulties, please contact the HCV Pharmacy Team* for advice.
- Endorse the course completion date on the paper or electronic prescription chart (if known)
- Endorse the supply arrangements on the paper or electronic prescription chart e.g. “weekly supply in community”
- Check for drug interactions with any new medicines; a useful source is www.hep-druginteractions.org. If the medication is not listed here, please check with the HCV Pharmacy Team* for advice.
- Refer to your ward pharmacist or the HCV Pharmacy Team* for further advice on any of the above (if out of hours, contact the on-call pharmacist)
Administration and supply
- Where available, use PODs, ensuring that an adequate supply will be available for discharge
- It is important that all doses are administered. If PODs are not available, speak to your local pharmacy (do not order on the standard MPS order book), who will then liaise with the HCV Pharmacy Team*. Often, the process involves the transfer of a labelled supply from the patient’s community pharmacy.
- Order further supply well in advance, as most hospital dispensaries do not stock DAAs
- If supply is required out of hours:
- Mon-Thurs 5pm - 8.45am; requests should be made the next working day
- Friday after 5pm; request on Saturday morning
- Saturday/bank holiday after 12pm and Sundays; contact your on-call pharmacist via switchboard (who will arrange supply via the GGH site co-ordinator)
Discharge
- At discharge, contact the patient’s community pharmacy to ask them to resume supply (providing details of any changes to medicines and the number of days of DAAs supplied on discharge)
- If there is a delay anticipated with resuming supply via the community pharmacy, e.g. if the pharmacy is closed Sunday/bank holidays, please provide a labelled supply to the patient on discharge to avoid any missed doses until they can next attend their pharmacy
- If PODs are not available, contact your local pharmacy team to arrange supply
*Contact details for HCV Pharmacy Team:
0141 211 3367/0618 or hepatitisc.pharmacyteam@ggc.scot.nhs.uk
Published: 30/08/2021. Medicines update blogs are correct at the time of publication.