What are the antiviral drugs? How much do you know about using it?

Author: High Lili is a class of antiviral drugs inhibit viral reproduction, the host immune system against viruses, repair damaged tissue, or mitigate disease and other drugs.

It can be divided into broad-spectrum antiviral drugs, anti-influenza virus drugs, anti-herpes virus drugs, anti-hepatitis virus drugs, anti-retroviral drugs, etc.
according to different functions.

Broad-spectrum antiviral drugs Broad-spectrum antiviral drugs can inhibit the growth and reproduction of a variety of viruses, such as ribavirin and arbidol.

 1.
Ribavirin Ribavirin is a broad-spectrum antiviral drug, which has a certain inhibitory effect on RNA and DNA viruses.
It has a certain inhibitory effect on respiratory syncytial virus, influenza virus, hepatitis A virus, parainfluenza virus, and measles virus.
, Hepatitis C virus, Adenovirus, Japanese encephalitis virus, Paramyxovirus and other viruses have an inhibitory effect on the growth.

It can be clinically used for viral pneumonia and bronchitis caused by respiratory syncytial virus (RSV), especially infants and immunosuppressed patients, or patients with skin herpes virus infection and chronic hepatitis C in the compensatory liver function.

 (1) Precautions ① Adverse reactions include leukopenia, hemolytic anemia, dizziness, muscle pain, joint pain, liver damage, abnormal taste, fatigue, headache, fetal malformations, etc.

Large doses can cause heart damage, and patients with respiratory diseases (chronic obstructive pulmonary disease or asthma) can cause breathing difficulties, chest pain, etc.

 ②It is contraindicated in patients with unstable and uncontrolled heart disease, abnormal hemoglobin, severe liver dysfunction or decompensated liver cirrhosis, uncontrollable severe mental disorder, and severe childhood mental illness within the first 6 months of treatment.

 (2) Interaction with other drugs ① Combined with nucleoside analogs and didanosine, it can cause lactic acidosis.

②Ribavirin can inhibit the transformation of zidovudine into active zidovudine phosphate, and it has antagonistic effect when used at the same time.
2.
Arbidol Arbidol is a hemagglutinin inhibitor and a broad-spectrum anti Viral drugs have an effect on both non-enveloped and enveloped viruses.
They play an antiviral effect by inhibiting the early membrane fusion of virus replication.
The effect of anti-RNA virus is more pronounced than that of anti-DNA virus, and it can also induce interferon.
By regulating the immune function of the body and shortening the course of the disease, it can be used for adult influenza A and B.

(1) Matters needing attention Adverse reactions are mainly nausea, diarrhea, dizziness, and elevated serum transaminases.

The significance of sinus node disease or dysfunction is not clear.
It is recommended that this type of population should be used with caution.

 (2) Interaction with other drugs ① The same use with aluminum-containing preparations can affect the absorption of Arbidol.
It is recommended that the interval is 1-2h.

②Combination with probenecid can prolong the half-life of Arbidol.

③Combined with theophylline, the blood concentration of theophylline can increase.

 3.
Interferon Interferon has a broad-spectrum antiviral effect, inhibiting protein synthesis is its main effect on many viruses, and has an immunomodulatory effect.

 (1) Matters needing attention Adverse reactions include flu-like syndromes such as fever, chills, headache, fatigue, etc.
, temporary suppression of bone marrow, skin rash, low blood pressure, etc.

 (2) Interaction with other drugs Combining theophylline with theophylline may cause theophylline poisoning because it inhibits the activity of CYP1A2.

Anti-influenza virus drugs Anti-influenza virus drugs can be used to prevent and treat influenza, such as neuraminidase inhibitors (NAI).

 1.
Oseltamivir (oral) can be used for the treatment of influenza A and B in adults and children.
There is limited evidence for prevention and treatment of complications and suppression of virus transmission.
Beware of transient neuropsychiatric events such as self-harm or mental confusion , And may have sudden breathing difficulties aggravated.

 (1) Precautions Adverse reactions include nausea, vomiting, insomnia, headache, diarrhea, abdominal pain, dizziness, fatigue, nasal congestion, sore throat, cough, hematuria, eosinophilia, decreased white blood cell count, dermatitis, rash, angioedema Wait.

 (2) Interactions with other drugs.
Oseltamivir should not be taken within 2 weeks of using live attenuated influenza vaccine, and live attenuated influenza vaccine should not be used within 48 hours after taking oseltamivir.

 2.
Zanamivir (inhalation) is suitable for the treatment of children ≥7 years old and adults with influenza A and B and preventive medication for children ≥5 years old.
It is mainly used for those who cannot take oral medications, which can significantly shorten the duration of flu symptoms and hospitalization.
Treatment time, but cannot reduce influenza complications, especially pneumonia, or reduce hospitalization and mortality.
It is not recommended for patients with severe or complications, and those with underlying diseases such as bronchial asthma.

 (1) Precautions Adverse reactions include nasal symptoms, gastrointestinal dysfunction, headache, dizziness, cough, infection, rash, bronchitis, allergic reaction, arrhythmia, bronchospasm, dyspnea, facial edema, convulsions and fainting, etc.
.

Avoid using it in people with severe asthma.

 (2) Interaction with other drugs Do not inoculate live attenuated influenza vaccine within 2 weeks before inhalation of zanamivir and within 48 hours after inhalation.

 3.
Peramivir (intravenous) Peramivir-sodium chloride injection is suitable for severe patients, who cannot accept inhalation or oral NAI, and those who have poor efficacy or resistance to other NAIs, and have serious complications such as children and consciousness disorders.
The patient has good curative effect.

 (1) Matters needing attention Adverse reactions include diarrhea, vomiting, leukopenia, neutropenia, shock and so on.

 (2) Interaction with other drugs Peramivir may interact with live attenuated influenza vaccine.
It is recommended that peramivir should not be used within 2 weeks of using live attenuated influenza vaccine, and 48 hours after peramivir use.
Live attenuated influenza vaccine should not be used inside, because peramivir may inhibit the replication of live vaccine virus.

 4.
M2 ion channel blockers Amantadine, rimantadine play a role by inhibiting the activity of the ion channel of the virus M2 protein and preventing the virus from uncoating.

The M2 protein is unique to influenza A virus, so it only has an inhibitory effect on influenza A virus.
It is mainly clinically suitable for the treatment and prevention of influenza A virus.
However, it should be noted that the current drug resistance rate is high and it is not recommended to use it alone.  (1) Matters needing attention Adverse reactions include gastrointestinal reactions such as nausea and vomiting, and nervous system reactions such as nervousness, anxiety, inattention, and mild headaches.

 (2) Interaction with other drugs ① The combination of amantadine and central nervous system stimulants can strengthen the central nervous system.
In severe cases, it can cause adverse reactions such as convulsions or arrhythmia.

 ②Combination of amantadine with anti-tremor paralysis drugs, anticholinergic drugs, antihistamines, phenothiazines or tricyclic antidepressants can enhance atropine-like side effects, especially in those with mental disorders, hallucinations and nightmares.

Anti-herpes virus drugs Anti-herpes virus drugs can be used for the treatment of herpes virus diseases, such as herpes zoster, cytomegalovirus infection and so on.

 1.
Aciclovir (ACV) has an inhibitory effect on herpes simplex virus, varicella-zoster virus, cytomegalovirus, etc.

It can be used to treat herpes simplex virus infection, herpes zoster, varicella in immunodeficiency patients, and acute retinal necrosis.

 (1) Precautions During the administration period, adequate water should be consumed to prevent acyclovir from precipitating in the renal tubules and causing damage to renal function.

 (2) Interaction with other drugs ①Acyclovir is alkaline, and it is easy to cause pH changes when mixed with other drugs.
Try to avoid compatibility.

②Combined use with interferon or methotrexate (intrathecal) during intravenous administration may cause mental disorders, so use with caution.

③Combination with zidovudine can cause nephrotoxicity, manifesting as deep lethargy and fatigue.

④Combined administration with nephrotoxic drugs during intravenous administration can aggravate nephrotoxicity, especially those with renal insufficiency.

 2.
Ganciclovir can be used for the treatment of cytomegalovirus (CMV) infection.

 (1) Precautions Adverse reactions include bone marrow suppression, abnormal liver and kidney function, etc.
During medication, blood routine and liver and kidney function should be monitored.
If liver function deteriorates significantly, platelets and granulocytes decline ≤ 25×109/L and 0.
5×109/L L or 50% of the level before medication should be discontinued.

HIV patients with cytomegalovirus infectious retinitis may have retinal detachment.

 (2) Interaction with other drugs ① Combined with imipenem-cilastatin, it can cause systemic convulsions.

②Combined use with zidovudine can enhance the toxicity to the hematopoietic system, so use it with caution.

③Combined use with nephrotoxic drugs (such as cyclosporine and amphotericin B) may enhance renal damage and reduce the renal excretion of ganciclovir, which may cause toxic reactions.

④ It can be used equivalently with drugs that affect the hematopoietic system and bone marrow inhibitors, which can increase the suppression of bone marrow.

Anti-hepatitis virus drugs Anti-hepatitis virus drugs can be used for the treatment of hepatitis C, hepatitis B and other diseases, such as NS5A protease inhibitor, NS3/4A protease inhibitor, nucleoside drugs.

 1.
NS5A protease inhibitor dalatavir, combined with other drugs, used for adult chronic hepatitis C.

 (1) Matters needing attention Adverse reactions include headache, diarrhea, nausea, rash, fatigue, insomnia, anemia, thrombocytopenia, single cell number reduction, and eosinophilia.

 (2) Interaction with other drugs ① Metabolized by CYP3A4, and transported via transporters P-gp and OCT1.

②When combined with moderate CYP3A4 inducers such as dexamethasone, rifapentine, etc.
, the dose should be adjusted to 90mg/d; with strong CYP3A4 inhibitors such as clarithromycin, ketoconazole, etc.
, or anti-HIV drugs such as A When zanavir, indinavir and other protease inhibitors are used in combination, the dose should be reduced to 30mg/d; it is forbidden to use it in combination with potent CYP3A4 inducers such as carbamazepine.

OCT inhibitors and moderate/low-efficiency P-gp inhibitors have little effect on dalatavir.

 2.
NS3/4A protease inhibition Asurevir, combined with other drugs, used for adult chronic hepatitis C.

 (1) Matters needing attention Adverse reactions include headache, fever, diarrhea, nausea, rash, fatigue, thrombocytopenia, single cell count reduction, eosinophilia, and ALT/AST increase.

(2) Interaction with other drugs ① It is transported into the liver through OATP and undergoes oxidative metabolism of CYP3A4.
It is a moderately effective CYP2D6 inhibitor. ②Avoid combination with CYP3A4 inhibitors such as clarithromycin, CYP3A4 inducers such as carbamazepine, rifampicin and dexamethasone, and powerful OATP1B1 inhibitors such as cyclosporine and gemfibrozil.

It is forbidden to use it in combination with drugs that rely on CYP2D6 metabolism, such as thioridazine, which can increase plasma concentration and cause severe ventricular arrhythmia and sudden death.

 3.
Entecavir can inhibit HBV-DNA replication, has strong selectivity for HBV-DNA, and weak selectivity for human DNA polymerase, with relatively little influence.

Can be used for the treatment of hepatitis B.

 (1) Matters needing attention Adverse reactions include headache, fatigue, dizziness, nausea, vomiting, abdominal pain, diarrhea, drowsiness, insomnia, rubella, and elevated AST.

 (2) Interaction with other drugs Combining with other drugs that are cleared by the kidney or that have an effect on renal function may affect the blood drug concentration of the latter two.

 4.
Adefovir dipivoxil has a strong anti-HBV, HIV, herpes virus effect and can be used for the treatment of hepatitis B.

 (1) Matters needing attention Adverse reactions include fatigue, headache, nausea, abdominal distension, diarrhea, indigestion, elevated liver enzymes, nephrotoxicity, rash, pharyngitis, sinusitis, aggravated cough, etc.

 (2) Interaction with other drugs Combined with other drugs that may affect renal function, such as cyclosporine, tacrolimus, aminoglycosides, vancomycin, NSAIDs, etc.
, may cause renal damage.

Antiretroviral drugs Antiretroviral drugs can be used in the treatment of HIV and can inhibit virus replication.

 1.
Lopinavir/Ritonavir (LPV/RTV) Lopinavir is an HIV protease inhibitor, which can block the division of Gag-Pol polyprotein, resulting in the production of immature, non-infectious virus particles; Ritonavir is an active peptidomimetic inhibitor against HIV-1 and HIV-2 aspartyl proteases.
By inhibiting HIV protease, it is unable to process the precursor of Gag-Pol polyprotein, leading to the production of immature forms of HIV Particles without starting a new infection cycle.

Ritonavir can inhibit the metabolism of lopinavir mediated by CYP3A4, and produce a higher concentration of lopinavir.

It can be combined with other antiretroviral drugs for the treatment of HIV-1 infection.

 (1) Matters needing attention Adverse reactions include diarrhea, nausea, vomiting, hypertriglyceridemia, hypercholesterolemia, liver damage, etc.
, and mild asymptomatic prolongation of the PR interval.

 (2) Interactions with other drugs cannot be used with drugs that mainly rely on CYP3A4 for clearance and whose blood concentration increases will cause serious and/or fatal adverse events, such as astemizole, cisapride, and midazolam , Triazolam, ergotamine, pimozide, ergonovine, dihydroergotamine, metergonovine.

 2.
Darunavir Darunavir is an HIV-1 protease inhibitor, which can selectively inhibit the cleavage of HIV-encoded Gag-Pol polyprotein in virus-infected cells and prevent the formation of mature infectious virus particles.

It is combined with ritonavir and other antiretroviral drugs for the treatment of HIV-infected persons who have used antiretroviral drugs.

 (1) Matters needing attention Adverse reactions include diarrhea, headache, abdominal pain, nausea, vomiting, elevated liver enzymes, elevated pancreatic enzymes, hypertriglyceridemia, and hypercholesterolemia.

Contains sulfa, sulfa allergic to use with caution.

People with hemophilia may have increased bleeding.

Combined antiretroviral drug therapy can cause redistribution of body fat (lipid metabolism disorder).

 (2) The interaction with other drugs should not be used with drugs that are highly dependent on CYP3A4 clearance, such as astemizole, midazolam, triazolam, cisapride, pimozide, ergot alkaloids (ergotamine, Dihydroergotamine, ergonovine, metergonovine, etc.
).  References: 1.
Chen Xinqian et al.
Chen Xinqian's new compilation of pharmacology[M].
Beijing: People's Medical Publishing House, 2018: 139-1602.
Qian Zhiyu.
Pharmacology[M].
Beijing: China Medical Science and Technology Press, 2009: 139-1413.
Yang Baofeng.
Pharmacology[M].
Beijing: People's Medical Publishing House, 2013:405-4124.
Zhu Yizheng et al.
Pharmacology[M].
Beijing: People's Medical Publishing House, 2016:475-4835.
Children Expert consensus on the diagnosis and treatment of viral pneumonia with integrated traditional Chinese and western medicine (formulated in 2019)[J].
Chinese Journal of Practical Pediatrics,2019,34(10):801-8056.
Expert consensus on the rational application of anti-influenza virus drugs in the treatment of influenza (2016) Years)[J].
Chinese Journal of Internal Medicine,2016,55(3):244-2477.
Expert consensus on diagnosis and treatment of influenza in adults in China[J].
Chinese Emergency Medicine,2019,39(10):915-9288.
Consensus of Chinese experts on the treatment and prevention of influenza antiviral drugs[J].
Chinese Medical Journal,2016,96(2):85-889.
Children's influenza treatment plan recommended by domestic and foreign guidelines[J].
Chinese Journal of Practical Pediatrics and Clinical Medicine ,2017,32(18):1361-136310.
Expert consensus on diagnosis and treatment of influenza in children (2015 edition)[J].
Chinese Journal of Practical Pediatrics,2015,30(17):1296-130011.
US FDA announces Zanami Wei Safety Information[J].
Journal of Clinical Rational Use,2010,3(4):5412.
Expert consensus on prevention and treatment of influenza in pregnant women[J].
Chinese Journal of Perinatal Medicine,2019,22(2):73-7713.
Tong Rongsheng Etc.
.
Drug comparison and clinical reasonable choice-Respiratory Diseases Section [M].
Beijing: People's Medical Publishing House, 2014: 209-21714.
New Coronavirus Pneumonia Diagnosis and Treatment Plan (Trial Fifth Edition Revised Edition) 15.
Influenza Diagnosis and Treatment Program (2019 edition) 16.
Expert consensus on the safe and reasonable use of aminophylline in children[J].
Chinese Journal of Practical Pediatrics,2019,34(4):249-25417.
Recommendations for the diagnosis and prevention of cytomegalovirus disease in children[J].
J].
Chinese Journal of Pediatrics,50(4):290-29218.
Guidelines for diagnosis and treatment of cytomegalovirus infection in Chinese solid organ transplant recipients (2016 edition)[J].
Chinese Journal of Organ Transplantation,2016,37(9):561-56319.
Clinical diagnosis and treatment of cytomegalovirus infection in organ transplant recipients (2019 edition)[J].
Organ Transplantation,2019,10(2):142-14620.
Chinese expert consensus on herpes zoster[J].
China Dermatology Journal,2018,51(6):403-40621.
Expert consensus on drug interaction management in the application of direct antiviral drugs for hepatitis C[J].
Journal of Clinical Hepatobiliary Diseases.
2018.
34(9):1855-186022.
Multiple in the elderly Expert consensus on medication safety management[J].
Chinese Journal of Diabetes,2018,26(9):705-706