HEPATITIS Medications 1 Interferons l This group of

HEPATITIS Medications 1. Interferons. l This group of medications are natural proteins that activate immune functions in the body and have anti-viral properties. l These drugs do not work for everyone who takes them, but for those who do respond, the possible benefits include: l Diminished viral levels of hepatitis B and C. l Reduced symptoms. l Improved survival rates. l Interferons play an important role in the first line of defense against viral infections l Interferons are part of the non-specific immune system l Interferons are made by cells in response to an appropriate stimulus

Types on Interferon Alpha (leukocyte interferon) l Produced by virus infected leukocytes Beta (fibroblast interferon) l Produced by virus infected fibroblasts or epithelial cells Gamma (immune interferon) l Produced by certain activated T cells & NK cells Mechanisms of Action IFN alpha and beta l Inducing the release of intracellular enzymes such as 2'5' oligoadenylate synthetase and double stranded RNA dependent protein kinase, the drug causes degradation of viral messenger RNA and inhibits protein synthesis IFN gamma l Ability of macrophages to resist viral infix and kill other cells if infected

Viral Defense Against Interferon • • Block / prevention of interferon binding to cells. inhibit action of interferon-induced protein kinase. interfere with cell surface expression. block complement activation. Interferon Side Effects l l Flu-like symptoms Headache, Nausea, vomiting, diarrhea, Depression, irritability, anxiety, partial alopecia, Hematologic abnormalities, Autoimmune disorders 2. Corticosteroids l enhance the effects of interferon. 3. Nucleoside Analogues l used to stop replication of the virus.

Nutrition and Dietary Supplements 1. Eating small snacks during the day, prevent weight loss, and reduce nausea. 2. Avoid drinking alcohol/ smooking cigarettes/ drus addiction as this may further damage the liver. Supplements: 1. Alpha-Lipoic Acid combination l antioxidant that your body makes and is also available as a supplement. l It relieves liver stress and Helps to get rid of toxins. 2. Cysteine (N-Acetyl-L-Cysteine [NAC]) l It helps in detoxification of the harmful substances in the body. 3. S-Adenosylmethionine (SAMe) l It may provide protection against liver damage and scarring 4. Selenium (in fish, garlic, …etc): l Lower than normal selenium levels may be associated with an increased risk for liver cancer in people with hepatitis B and/or C.

Spirulina l Spirulina is a type of blue-green algae found in most lakes and ponds. l It stimulates the immune system and have anti-viral effects. l There is some preliminary evidence suggesting that spirulina may protect against liver damage and cirrhosis (liver scarring and failure) in those with chronic hepatitis. Active constituents Ø Amino acids, B complex vit. , β-carotene, vit. E, Carotenoids, manganese, zinc, copper, iron, selenium and gamma linoleic acid (an essential fatty acid)

Herbs, like medications, have potential side effects and may interact with prescription or over the counter drugs. l They should be used with caution and only under the guidance of a professionally trained and qualified herbalist. Milk thistle (Silybum marianum) l Several scientific studies lend support to this traditional use because they suggest that active substances in milk thistle (Flavolignans collectively known as Silymarin) l N. B. : Silymarin is a mixture of the following compounds: Silybin, Dehydrosilybin, Silydianin and silycrystin (flavonolignans). Role of silymarin l Protect the liver from damage caused by viruses and a variety of toxins. l Improvements of liver function in those with viral hepatitis taking milk thistle. l Relief of liver stress, decrease liver enzymes. l Shielding of liver cells.

Mechanism of Silymarin: l It increases the regeneration of liver cells by stimulation of protein synthesis thus activating the liver’s ability to regenerate itself. l It inhibits alters the structure of the outer cell membrane of hepatic cells to the passage of toxins, i. e. it provides hepato-cellular protection by stabilizing hepatic cell membrane. l It increases glutathione levels in liver cells and so acts as a free radical scavenging agent ‘antioxidant’. l They have an anti-inflammatory action. l improve the synthesis of proteins and glycoproteins. l Improve peroxidation of lipids in the liver = enhancement in liver breaking down. l Lowered values of the transaminases, g globulines and blood bilirubin.

2. Liquorice root (Glycyrrhiza glabra) l Glycyrrhiza significantly improves liver function in hepatitis C after only one month. A. C. : l Triterpenoidal saponins Flavonoids/bitter principles/ V. O. Action: l l l (Glycyrrhizin)/ Hepatic-protective due to triterpenes. Cytotoxic. due to triterpenes Antiviral / anti-inflammatory = cortisone like action. Antioxidant. Enhancement of absorption of vit. C Digestive

3. Green tea (Camellia sinensis) l Catechin, epi catechin l Leucoanthocyanidins: Flavan-3 - ol, Flavan-4 -ol and Flavan-3, 4 - diol. l Alkaloids (caffeine). Benefits of Green Tea l Reduces blood pressure: drinking green tea represses angiotensin II which leads to high blood pressure. l Lowers blood sugar: green tea polyphenols and polysaccharides are effective in lowering blood sugar. l Fights cancer: catechins are effective at preventing cancer. l Boosts the immune system due to high concentrations of polyphenols and flavonoids. l Green tea antioxidants have been shown to lower cholesterol.

Green Tea Components and Healthy Effects l Catechins: reduces risk of cancer, restrains tumors, reduces risk of mutations, lowers blood cholesterol, prevents high blood pressure, prevents high blood sugar, kills bacteria, fights with flu virus, prevents cavities, prevents bad breath, and anti-aging. l Caffeine: keeps you awake and works as diuretic l Vitamin C: reduces stress and prevents cold and flu l Vitamin B Complex: promotes metabolism l Gamma-Amino Butyric Acid(GABA): lowers high blood pressure l Flavanoids: strengthens blood vessel wall and prevents bad breath l Polysaccharides: prevents high blood sugar and anti-radiation injuries l Vitamin E: works as in antioxidant, and helps to maintain youthfulness l Theanine (amino acid): emphasizes flavor

4. Turmeric (Curcuma) ﺍﻟﻜﺮﻛﻢ Hepatoprotective effect on the liver due to turmeric’s ability to clear toxins. l Antioxidant/anti-inflammatory/Anti-emetic. l Reduction of blood cholesterol/sugar level. l 5. Ginger ﺍﻟﺰﻧﺠﺒﻴﻞ / ﺍﻟﺠﻨﺰﺑﻴﻞ Contiaining: Ø Pungent V. O. : gingerol, zingeberine, zingeberol. Ø Terpenes/ flavonoids. Action: q Liver stimulant and hepatoprotective due to terpenes. q Antiviral/ anti-inflammatory due to terpenes q Antioxidant due to flavonoids. q Antiviral due to V. O.

6. Dandelion (Taraxacum l l officinalis). While the leaves tend to act as potent diuretics. It is the roots that are used specifically to promote bile and restore liver function. Constituents: l Vitamins- esp. beta carotine (vit. A) and ascorbic acid. l minerals including potassium and calcium. l inulin and pectin; sterols. Actions and use: l Dandelion is classes as a choleretic, cholagogue, diuretic and mild laxative. l It increases appetite and improves digestion. l Its alkalising effect is beneficial in all detoxification treatments. Dosage form l They can be taken in decoction form. Fresh juice of leaves and roots can be taken in 5 ml doses.

6. Artichoke (Cynara scolymus) Globe artichoke is a popular food originating in Europe which can be easily cultivated in Australia. l It has a long history of use as a bitter digestive herb and is a major remedy for liver and gall bladder disorders. l It is the leaf that contains these properties. Constituents: q Cynarin and other phenolic acids; q Sesquiterpene lactones; q Flavonoids; inulin. q Minerals, vitamins and enzymes. Actions and use: q Choleretic; digestive tonic; diuretic; ttt of hypocholesterolemia; hepatoprotective. q A safe and reliable herb for all liver disturbances including hepatitis. q Helps lower cholesterol (made in the liver) and assists weight reduction. It can be made into a leaf decoction l