What is interferon

Interferons are a family of glycoproteins naturally made by your immune cells which have antiviral, anti-cancer, and immunomodulatory functions ¹. Interferons are used widely for the treatment of many conditions like hepatitis C, cancers, and immune-mediated disorders like multiple sclerosis. Interferon was discovered by Issacs and Lindenmann in 1957 while studying the phenomenon of virus interference. There are several classes of interferon including interferon alpha, beta, and gamma. interferon alpha has been used for management of hairy cell leukemia, malignant melanoma, follicular lymphoma, condylomata acuminata, AIDS-related Kaposi sarcoma, and chronic hepatitis B and C. interferon beta has been used for multiple sclerosis, and interferon gamma has been used for chronic granulomatous disease and malignant osteopetrosis. In ophthalmology, interferon has been used to manage subretinal neovascularisation of age-related macular degeneration, glaucoma filtering surgery, and ocular cicatricial pemphigoid.

The types of interferon are named after the first 3 letters of the Greek alphabet:

• Interferon-alfa (interferon alpha)
• Interferon-beta
• Interferon-gamma

Only interferon-alfa is used to treat cancer. Interferon-alfa boosts the ability of certain immune cells to attack cancer cells. Interferon-alfa may also slow the growth of cancer cells directly, as well as the blood vessels that tumors need to grow.

Interferon-alfa can be used to treat these cancers:

• Hairy cell leukemia
• Chronic myelogenous leukemia (CML)
• Follicular non-Hodgkin lymphoma
• Cutaneous (skin) T-cell lymphoma
• Kidney cancer
• Melanoma
• Kaposi sarcoma

Side effects of interferons can include:

• Flu-like symptoms (chills, fever, headache, fatigue, loss of appetite, nausea, vomiting)
• Low white blood cell counts (which increase the risk of infection)
• Skin rashes
• Thinning hair

These side effects can be severe and can make treatment with interferon hard for many people to tolerate. Most side effects don’t last long after the treatment stops, but fatigue can last longer. Other rare long-term effects include damage to nerves, including those in the brain and spinal cord.

The U.S. Food and Drug Administration (FDA) approved the use of Interferon alpha-2a and alpha-2b for the treatment of hairy cell leukemia in 1986. As time progressed, the use of interferons has expanded to include a broad spectrum of conditions. However, interferons use is associated with numerous adverse effects like fatigue, influenza-like syndrome, toxicities related to the central nervous system, the gastrointestinal tract, endocrine system, and cardiovascular, renal, and musculoskeletal systems ².

Interferon alpha

Interferon alfa or alpha interferon is a cytokine produced by the innate immune system in response to environmental exposures including viral infections. Alpha interferon in various formulations has been developed as therapy of several forms of cancer and viral infections, but its major use has been as therapy of chronic hepatitis C.

Alpha and beta interferon are considered type I interferons which share antiviral, immunomodulatory as well as antiproliferative effects. The pathways of induction and actions of alpha interferon are quite complex and the antiviral effects are due to induction of multiple intracellular genes. Overall, type I interferons produce an antiviral state inside of cells that decreases viral replication and protects against infection. There are at least 20 copies of the alpha interferon gene in the human genome and multiple formulations of standard recombinant interferon have been produced (alfa-2a, alfa-2b and alfa-con1 or “consensus” interferon). Furthermore, the interferon molecule can be pegylated which causes a prolongation of its half-life, allowing for once weekly as opposed to daily or every other day administration. Because interferon is a protein, it must be given parenterally (usually subcutaneously). Recombinant human interferons were approved for use in cancer in the 1980s, for hepatitis B in 1991 and for hepatitis C in 1992. Peginterferon became available in 2000 and has largely replaced the standard preparations.

The typical dose of peginterferon alfa-2a is 180 µg once weekly for 24 or 48 weeks, and for peginterferon alfa-2b 1.5 µg/kg once weekly for 24 to 48 weeks. In chronic hepatitis C, peginterferon is usually given with ribavirin and, more recently, as triple therapy with a protease inhibitor, such as boceprevir, telaprevir, simiprevir or sofosbuvir. Ultimately, oral antiviral regimens are likely to replace peginterferon therapy in chronic hepatitis C. Standard interferon alfa is also approved for use in hairy cell leukemia, malignant melanoma, follicular lymphoma and AIDS-related Kaposi’s sarcoma. Local injections of interferon are used to treat condylomata acuminata. Interferon has many side effects which often limit the dose and duration of therapy.

The most common side effects include fatigue, muscle aches, headaches, depression, anxiety, bone marrow suppression and rash.

Pegylated interferon alfa-2a

Peginterferon alfa-2a is used alone or in combination with other medications to treat chronic (long-term) hepatitis C infection (swelling of the liver caused by a virus) in people who show signs of liver damage. Peginterferon alfa-2a is also used to treat chronic hepatitis B infection (swelling of the liver caused by a virus) in people who show signs of liver damage. Peginterferon alfa-2a is in a class of medications called interferons. Peginterferon is a combination of interferon and polyethylene glycol, which helps the interferon stay active in your body for a longer period of time. Peginterferon works by decreasing the amount of hepatitis C virus (HCV) or hepatitis B virus (HBV) in the body. Peginterferon alfa-2a may not cure hepatitis C or hepatitis B or prevent you from developing complications of hepatitis C or hepatitis B such as cirrhosis (scarring) of the liver, liver failure, or liver cancer. Peginterferon alfa-2a may not prevent the spread of hepatitis C or hepatitis B to other people.

Peginterferon alfa-2a comes as a solution (liquid) in a vial, a prefilled syringe, and a disposable autoinjector to inject subcutaneously (into the fatty layer just under the skin). It is usually injected once a week, on the same day of the week, and at around the same time of day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use peginterferon alfa-2a exactly as directed. Do not use more or less of this medication or use it more often than prescribed by your doctor.

Your doctor will probably start you on an average dose of peginterferon alfa-2a. Your doctor may decrease your dose if you experience serious side effects of the medication. Be sure to tell your doctor how you are feeling during your treatment and ask your doctor or pharmacist if you have questions about the amount of medication you should take.

Continue to use peginterferon alfa-2a even if you feel well. Do not stop using peginterferon alfa-2a without talking to your doctor.

Only use the brand and type of interferon that your doctor prescribed. Do not use another brand of interferon or switch between peginterferon alfa-2a in vials, prefilled syringes, and disposable autoinjectors without talking to your doctor. If you switch to a different brand or type of interferon, your dose may need to be changed.

You can inject peginterferon alfa-2a yourself or have a friend or relative give you the injections. Before you use peginterferon alfa-2a for the first time, you and the person who will be giving the injections should read the manufacturer’s information for the patient that comes with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. If another person will be injecting the medication for you, be sure that he or she knows how to avoid accidental needlesticks to prevent the spread of hepatitis.

You can inject peginterferon alfa-2a anywhere on your stomach or thighs, except your navel (belly button) and waistline. Use a different spot for each injection. Do not use the same injection spot two times in a row. Do not inject peginterferon alfa-2a into an area where the skin is sore, red, bruised, scarred, infected, or abnormal in any way.

If you do not receive the full prescribed dose because of a problem (such as leakage around the injection site), call your doctor.

Never reuse syringes, needles, or vials of peginterferon alfa-2a. Dispose of used needles and syringes in a puncture-resistant container. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

Before you use peginterferon alfa-2a, look at the solution in the vial, prefilled syringe, or autoinjector closely. Do not shake vials, syringes, or autoinjectors containing peginterferon alfa-2a. The medication should be clear and free of floating particles. Check the vial or syringe to make sure there are no leaks and check the expiration date. Do not use the solution if it is expired, discolored, cloudy, contains particles, or is in a leaky vial or syringe. Use a new solution, and show the damaged or expired one to your doctor or pharmacist.

Pegylated interferon alfa-2a special precautions

Before using peginterferon alfa-2a:

• tell your doctor and pharmacist if you are allergic to peginterferon alfa-2a, other alpha interferons, any other medications, benzyl alcohol, or polyethylene glycol (PEG). Ask your doctor if you are not sure if a medication you are allergic to is an alpha interferon.
• tell your doctor if you have ever received interferon alfa injection for treating hepatitis C infection.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain medications for HIV or AIDS such as abacavir (Ziagen, in Epzicom, in Trizivir), didanosine (ddI or Videx), emtricitabine (Emtriva, in Truvada), lamivudine (Epivir, in Combivir, in Epzicom, in Trizivir), stavudine (Zerit), tenofovir (Viread, in Truvada), zalcitabine (HIVID), and zidovudine (Retrovir, in Combivir, in Trizivir); methadone (Dolophine, Methadose); mexiletine (Mexitil); naproxen (Aleve, Anaprox, Naprosyn, others); riluzole (Rilutek); tacrine (Cognex); telbivudine (Tyzeka); and theophylline (TheoDur, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with peginterferon alfa-2a, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor or pharmacist if you have ever had an organ transplant (surgery to replace an organ in the body). Also tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or any of the following: anemia (red blood cells do not bring enough oxygen to other parts of the body), or problems with your eyes or pancreas.
• tell your doctor if you are pregnant, plan to become pregnant or are breastfeeding. Peginterferon alfa-2a may harm the fetus or cause you to miscarry (lose your baby). Talk to your doctor about using birth control while you are taking this medication. You should not breastfeed while you are taking this medication.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking peginterferon alfa-2a.
• you should know that peginterferon alfa-2a may make you dizzy, confused, or drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• do not drink alcohol while you are taking peginterferon alfa-2a. Alcohol can make your liver disease worse.
• you should know that you may experience flu-like symptoms such as headache, fever, chills, tiredness, muscle aches, and joint pain during your treatment with peginterferon alfa-2a. If these symptoms are bothersome, ask your doctor if you should take an over-the-counter pain and fever reducer before you inject each dose of peginterferon alfa-2a. You may want to inject peginterferon alfa-2a at bedtime so that you can sleep through the symptoms.

Special dietary instructions

Drink plenty of fluids while you are taking peginterferon alfa-2a.

What should I do if I forget a dose?

If you remember the missed dose no longer than 2 days after you were scheduled to inject it, inject the missed dose as soon as you remember it. Then inject your next dose on your regularly scheduled day the following week. If more than 2 days have passed since the day you were scheduled to inject the medication, ask your doctor or pharmacist what you should do. Do not use a double dose or use more than one dose in 1 week to make up for a missed dose.

Pegylated interferon alfa-2a side effects

Peginterferon alfa-2a may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• bruising, pain, redness, swelling, or irritation in the place you injected peginterferon alfa-2a
• upset stomach
• vomiting
• heartburn
• dry mouth
• loss of appetite
• weight loss
• diarrhea
• dry or itchy skin
• hair loss
• difficulty falling asleep or staying asleep
• tiredness
• weakness
• difficulty concentrating or remembering
• sweating
• dizziness

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, or those listed in the IMPORTANT WARNING section or the SPECIAL PRECAUTIONS section, call your doctor immediately:

• blurred vision ,vision changes, or loss of vision
• lower back pain
• rash
• hives
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• difficulty swallowing
• hoarseness

Peginterferon alfa-2a may cause other side effects. Call your doctor if you have any unusual problems while taking peginterferon alfa-2a.

Symptoms of peginterferon alfa-2a overdose may include the following:

• tiredness
• unusual bleeding or bruising
• fever, sore throat, chills, cough, or other signs of infection

Interferon alfa-2b

Interferon alfa-2b injection is used to treat a number of conditions.

Interferon alfa-2b is in a class of medications called immunomodulators. Interferon alfa-2b works to treat hepatitis C virus (HCV) and hepatitis B virus (HBV) by decreasing the amount virus in the body. Interferon alfa-2b may not cure hepatitis B or hepatitis C or prevent you from developing complications from these infections such as cirrhosis (scarring) of the liver, liver failure, or liver cancer. It also may not prevent the spread of hepatitis B or C to other people. It is not known exactly how interferon alfa-2b works to treat cancer or genital warts.

Interferon alfa-2b is also sometimes used to treat hepatitis D virus (HDV; swelling of the liver caused by a virus), basal cell carcinoma (a type of skin cancer), cutaneous T-cell lymphomas (CTCL, a type of skin cancer), and kidney cancer. Talk to your doctor about the risks of using this medication for your condition.

Interferon alfa-2b injection is used:

• alone or in combination with ribavirin (Copegus, Rebetol, Ribasphere) to treat chronic (long-term) hepatitis C infection (swelling of the liver caused by a virus) in people who show signs of liver damage,
• to treat chronic hepatitis B infection (swelling of the liver caused by a virus) in people who show signs of liver damage,
• to treat hairy cell leukemia (a white blood cell cancer),
• to treat genital warts,
• to treat Kaposi’s sarcoma (a type of cancer that causes abnormal tissue to grow on different parts of the body) related to acquired immunodeficiency syndrome (AIDS),
• to treat malignant melanoma (a cancer that begins in certain skin cells) in certain people who have had surgery to remove the cancer,
• along with another medication to treat follicular non-Hodgkin’s lymphoma (NHL; a slow-growing blood cancer).

Interferon alfa-2b comes as a powder in a vial to mix with liquid and as a solution to inject either subcutaneously (just under the skin), intramuscularly (into a muscle), intravenous (into the vein), or intralesionally (into a lesion). It is best to inject the medication at around the same time of day on your injection days, usually in the late afternoon or evening.

If you have:

• Hepatitis C infection, inject the medication either subcutaneously or intramuscularly three times a week.
• Hepatitis B infection, inject the medication either subcutaneously or intramuscularly three times a week usually for 16 weeks.
• Hairy cell leukemia, inject the medication either intramuscularly or subcutaneously 3 times a week for up to 6 months.
• Malignant melanoma, inject the medication intravenously for 5 consecutive days for 4 weeks, then subcutaneously three times per week for 48 weeks.
• Follicular melanoma, inject the medication subcutaneously three times per week for up to 18 months.
• Genital warts, inject the medication intralesionally three times weekly on alternate days for 3 weeks, then treatment may be continued for up to 16 weeks.
• Kaposi’s sarcoma, inject the medication either subcutaneously or intramuscularly three times a week for 16 weeks.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon alfa-2b injection exactly as directed. Do not use more or less of this medication or use it more often or for a longer period of time than prescribed by your doctor.

Your doctor may decrease your dose if you experience serious side effects of the medication. Be sure to tell your doctor how you are feeling during your treatment and ask your doctor or pharmacist if you have questions about the amount of medication you should use.

You will receive your first dose of interferon alfa-2b in your doctor’s office. After that, you can inject interferon alfa-2b yourself or have a friend or relative give you the injections. Before you use interferon alfa-2b for the first time, you or the person who will be giving the injections should read the manufacturer’s information for the patient that comes with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. If another person will be injecting the medication for you, be sure that he or she knows how to avoid accidental needlesticks.

If you are injecting this medication subcutaneously, inject interferon alfa-2b anywhere on your stomach area, upper arms, or your thighs, except near your waistline or around your navel (belly button). Do not inject your medication into skin that is irritated, bruised, reddened, infected, or scarred.

If you are injecting this medication intramuscularly, inject interferon alfa-2b in your upper arms, thighs, or outer area of the buttocks. Do not use the same spot two times in a row. Do not inject your medication into skin that is irritated, bruised, reddened, infected, or scarred.

If you are injecting this medication intralesionally, inject in directly into the center of the base of the wart.

Never reuse syringes, needles, or vials of interferon alfa-2b. Throw away used needles and syringes in a puncture-resistant container, and throw away used vials of medication in the trash. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

Before you use interferon alfa-2b, look at the solution in the vial. The medication should be clear and free of floating particles. Check the vial to make sure there are no leaks and check the expiration date. Do not use the solution if it is expired, cloudy, contains particles, or is in a leaky vial.

You should only mix one vial of interferon alfa-2b at a time. It is best to mix the medication right before you plan to inject it. However, you may mix the medication in advance, store it in the refrigerator, and use within 24 hours. Be sure to take the medications out of the refrigerator and allow it to come to room temperature before you inject it.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with interferon alfa-2b and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions.
Other uses for this medicine

Interferon alfa-2b special precautions

Before receiving interferon alfa-2b injection:

• tell your doctor and pharmacist if you are allergic to interferon alfa-2b injection, other interferon alfa medications including PEG-interferon alfa-2b (PEG-Intron) and PEG-interferon alfa-2a (Pegasys), any other medications, albumin, or any of the other ingredients in interferon alfa-2b injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: telbivudine (Tyzeka), theophylline (Elixophyllin, Theo-24, Theochron), or zidovudine (Retrovir, in Combivir, in Trizivir). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  tell your doctor if you have severe liver disease or autoimmune hepatitis (condition in which the cells of the immune system attack the liver). Your doctor will probably tell you not to use interferon alfa-2b injection.
• tell your doctor or pharmacist if you have ever had an organ transplant (surgery to replace an organ in the body) and are taking medications to suppress your immune system. Also tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or any of the following: anemia (low red blood cells) or low white blood cells, bleeding problems or blood clots including a pulmonary embolism (PE; a blood clot in the lung), a lung disease such as pneumonia, pulmonary arterial hypertension (PAH; high blood pressure in the vessels carrying blood to the lungs, causing shortness of breath, dizziness, and tiredness), chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), or eye problems.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while receiving interferon alfa-2b injection, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving interferon alfa-2b.
• you should know that you may have flu-like symptoms such as headache, sweating, muscle aches, and tiredness after you receive your injection. Your doctor may tell you to take acetaminophen (Tylenol), an over-the-counter pain and fever medication to help with these symptoms. Talk to your doctor if these symptoms are difficult to manage or become severe.

Special dietary instructions

Be careful to drink enough fluid during your first interferon alfa-2b treatments.

Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

If you miss a dose of interferon alfa-2b injection, inject your next dose as soon as you remember or are able to give it. Do not use interferon alfa-2b injection two days in a row. Do not inject a double dose to make up for a missed dose. Call your doctor if you miss a dose and have questions about what to do.

Interferon alfa-2b side effects

Interferon alfa-2b injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• bruising, bleeding, pain, redness, swelling, or irritation in the place you injected interferon alfa-2b
• muscle pain
• change in ability to taste
• hair loss
• dizziness
• dry mouth
• concentration problems
• feeling cold or hot
• weight changes
• skin changes

Some side effects can be serious. If you experience any of these symptoms or any or those listed in the IMPORTANT WARNING or the SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment:

• rash
• hives
• skin peeling
• itching
• difficulty breathing or swallowing
• swelling of the eyes, face, mouth, tongue, or throat
• changes in vision
• stomach pain, tenderness or swelling
• yellowing of the skin or eyes
• extreme tiredness
• confusion
• diarrhea
• loss of appetite
• nausea
• vomiting
• back pain
• loss of consciousness
• numbness, burning or tingling in the hands or feet

Interferon alfa-2b injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.

Interferon beta

Interferon beta (beta-1a and beta-1b) is a cytokine and belongs to a group of naturally occurring proteins which interact with cell surface receptors to produce intracellular antiviral, anti-proliferative, and immuno-modulatory effects. Interferon beta is used commonly to prevent relapses in multiple sclerosis.

Interferon beta is a type I interferon produced by fibroblasts and macrophages in response to viral infection and antigenic stimuli. Interferon beta is structurally and antigenically distinct from interferon alfa, but they share the same cell surface receptors. Despite having a common receptor, the two interferons have different intracellular effects, acting through related but different pathways to trigger changes in gene expression that modulate inate and adaptive immune responses and antiviral pathways. Interferon beta was developed largely as an immunomodulatory agent and showed evidence of benefit in relapsing multiple sclerosis for which it was first approved for use in the United States in 1993. Its major indication is to reduce the frequency of clinical exacerbations.

Currently, five forms of interferon beta are available:

1. Betaseron – interferon beta-1b, subcutaneous injection (250 mcg) every other day. Approved 1993.
2. Extavia – interferon beta-1b, subcutaneous injection (250 mcg) every other day. Approved 1993
3. Avonex – interferon beta-1a, intramuscular injection (30 mcg) once weekly. Approved 1996.
4. Rebif – interferon beta-1a, subcutaneous injection (8.8 mcg, 22 mcg, 44 mcg) thrice weekly. Approved 2003.
5. Plegridy – peginterferon beta-1a, subcutaneous injection (63, 94, 125 mcg) every 14 days. Approved 2014.

The various forms of beta interferon are provided as a lyophilized powder for reconstition or as a solution in single dose vials or in prefilled syringes, pens or autoinjectors. All five forms of beta interferon are produced by recombinant DNA techniques. They differ in specific activity and pharmacokinetics and thus are used in different doses and regimens. Peginterferon beta-1a consists of recombinant beta interferon covalently linked to polyethylene glycol which makes it a larger protein molecule with a longer half-life and duration of action. Therapy is routinely given long term.

Interferon beta typical side effects include fatigue, muscle aches, headache, depression, fever and mild bone marrow suppression. Severe adverse events reported with use of beta interferon include hypersensitivity reactions, thrombotic microangiopathy, severe depression, suicidal thoughts and behaviors and autoimmune disorders.

Interferon beta 1a

Interferon beta-1a subcutaneous or intramuscular injection is used to reduce episodes of symptoms and slow the development of disability in patients with relapsing-remitting forms (course of disease where symptoms flare up from time to time) of multiple sclerosis (MS, a disease in which the nerves do not function properly and patients may experience weakness, numbness, loss of muscle coordination and problems with vision, speech, and bladder control). Interferon beta-1a is in a class of medications called immunomodulators. It is not known how interferon beta-1a works to treat multiple sclerosis.

Interferon beta-1a subcutaneous injection

Interferon beta-1a subcutaneous injection comes as a solution (liquid) in a prefilled syringe or a prefilled automatic injection device to inject subcutaneously (under the skin). It is usually injected three times a week. You should inject this medication on the same 3 days every week, for example, every Monday, Wednesday, and Friday. The injections should be spaced at least 48 hours apart, so it is best to inject your medication around the same time of day on each of your injection days. The best time to inject this medication is in the late afternoon or evening. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon beta-1a exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor may start you on a low dose of interferon beta-1a and gradually increase your dose, not more than once every 2 weeks.

Interferon beta-1a controls symptoms of MS but does not cure it. Continue to use interferon beta-1a even if you feel well. Do not stop using interferon beta-1a without talking to your doctor.

You will receive your first dose of interferon beta-1a subcutaneous in your doctor’s office. After that, you can inject interferon beta-1a subcutaneous yourself or have a friend or relative perform the injections. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. Before you use interferon beta-1a subcutaneous for the first time, your or the person who will be giving the injections should also read the manufacturer’s information for the patient that comes with it. Follow the directions carefully.

Use a new prefilled syringe or prefilled automatic injection device each time you inject your medication. Do not reuse or share syringes or automatic injection devices. Even if there is still some solution left in the syringe or device after you inject, do not inject again. Discard used syringes or automatic injection devices in a puncture resistant container that is out of the reach of children. Talk to your doctor or pharmacist about how to discard the puncture-resistant container.

Always look at the medication in your prefilled syringe or automatic injection device before you use it. It should be a clear to slightly yellow solution. If the solution is cloudy, discolored, or contains particles or if the expiration date marked on the syringe or automatic injection device has passed, do not use that syringe or device.

Talk to your doctor or pharmacist about where on your body you should inject interferon beta-1a subcutaneous. You can inject interferon beta-1a in areas of your body with a layer of fat between the skin and muscle, such as your thigh, the outer surface of your upper arms, your stomach, or your buttocks. If you are very thin, only inject in your thigh or the outer surface of your arm for injection. Choose a different spot each time you inject your medication. Keep a record of the date and spot of each injection. Do not use the same spot two times in a row. Do not inject near your navel (belly button) or waistline or into an area where the skin is sore, red, bruised, scarred, infected, or abnormal in any way.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with interferon beta-1a subcutaneous injection and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer’s website to obtain the Medication Guide.

What should I do if I forget a dose?

Inject the missed dose as soon as you remember it. If you are scheduled for a dose the following day, skip that dose. Do not inject interferon beta-1a subcutaneous 2 days in a row. Do not inject a double dose to make up for a missed dose. You should return to your regular dosing schedule the following week. Call your doctor if you miss a dose and have questions about what to do.

Interferon beta-1a intramuscular injection

Interferon beta-1a intramuscular injection comes as a powder in vials to be mixed into a solution for injection. Interferon beta-1a intramuscular injection also comes as a solution (liquid) in prefilled injection syringes and in a prefilled automatic injection pen. This medication is injected into a muscle, usually once a week, on the same day each week. Inject interferon beta-1a intramuscular at around the same time of day on your injection days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon beta-1a exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Your doctor may start you on a low dose of interferon beta-1a and gradually increase your dose, not more than once every 2 weeks.

Interferon beta-1a controls symptoms of MS but does not cure it. Continue to use interferon beta-1a even if you feel well. Do not stop using interferon beta-1a without talking to your doctor.

You will receive your first dose of interferon beta-1a intramuscular in your doctor’s office. After that, you can inject interferon beta-1a intramuscular yourself or have a friend or relative perform the injections. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. Before you use interferon beta-1a intramuscular for the first time, you or the person who will be giving the injections should also read the manufacturer’s information for the patient that comes with it. Follow the directions carefully.

Be sure you know what type of container your interferon beta 1b comes in and what other supplies, such as needles or syringes, you will need to inject your medication. If your interferon beta 1b intramuscular comes in vials, you will need to use a syringe and needle to inject your dose.

Always use a new, unopened vial, prefilled syringe and needle, or prefilled automatic injection pen for each injection. Never reuse vials, syringes, needles, or automatic injection pens. Discard used syringes, needles, and injection pens in a puncture-resistant container, kept out of reach of children. Talk to your doctor or pharmacist about how to discard the puncture-resistant container.

Always look at the medication in your vial, prefilled syringe, or automatic injection pen before you use it. If you are using a vial, the solution in the vial should be clear to slightly yellow after mixing. If you are using a prefilled syringe or automatic injection pen, the solution should be clear and colorless. If the solution is cloudy, discolored, or contains particles or if the expiration date marked on the vial, prefilled syringe, or automatic injection pen has passed, do not use that vial, prefilled syringe, or automatic injection pen.

Talk to your doctor or pharmacist about where on your body you should inject interferon beta-1a intramuscular. If you are using a syringe or prefilled syringe, you can inject interferon beta-1a intramuscular in your upper arms or thighs. If you are using a prefilled autoinjection pen, you can inject interferon beta-1a intramuscular in the outer surface of your upper thighs. Use a different spot for each injection. Do not use the same spot two times in a row. Do not inject into an area where the skin is sore, red, bruised, scarred, infected, irritated, or abnormal in any way.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (medication guide) when you begin treatment with interferon beta-1a and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the interferon beta-1a Medication Guide.

What should I do if I forget a dose?

Inject the missed dose as soon as you remember it. Do not inject interferon beta-1a two days in a row. Do not inject a double dose to make up for a missed dose. Return to your regular dosing schedule the following week. Call your doctor if you miss a dose and have questions about what to do.

Interferon beta 1a special precautions

Before using interferon beta-1a:

• tell your doctor and pharmacist if you are allergic to interferon beta-1a, any other interferon medications (Avonex, Betaseron, Extavia, Plegridy), any other medications, or human albumin. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you drink or have ever drunk large amounts of alcohol; if you have or have ever had an autoimmune disease (a disease in which the body attacks its own cells; ask your doctor if you are not sure if you have this type of disease); anemia (low red blood cells) or low white blood cells; blood problems such as easy bruising or bleeding; mental illness such as depression, especially if you have ever thought about killing yourself or tried to do so; seizures; heart failure; or heart, kidney, liver, or thyroid disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using interferon beta-1a subcutaneous, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist you are using interferon beta-1a subcutaneous.
• ask your doctor about the safe use of alcoholic beverages while you are using interferon beta-1a subcutaneous. Alcohol can make the side effects of interferon beta-1a worse.
• you should know that you may have flu-like symptoms such as headache, fever, chills, sweating, muscle aches, back pain, and tiredness after your injection. Your doctor may tell you to take an over-the-counter pain and fever medication to help with these symptoms. These symptoms usually improve or go away over time. Talk to your doctor if these symptoms are difficult to manage or become severe.

Interferon beta 1a side effects

Interferon beta-1a subcutaneous may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• fever
• chills
• dry eyes
• vision problems
• dry mouth
• bruising, pain, redness, swelling, or tenderness at the injection site

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately or get emergency medical treatment:

• new or worsening depression
• thinking about harming or killing yourself or planning or trying to do so
• anxiety
• hives
• rash
• itching
• difficulty breathing or swallowing
• swelling of the eyes, face, mouth, tongue, throat, hands, arms, feet, ankles, or lower legs
• lightheadedness
• fainting
• seizures
• loss of coordination
• extreme tiredness
• lack of energy
• nausea
• vomiting
• loss of appetite
• pale stools
• pain in the upper right part of the stomach
• yellowing of the skin or eyes
• dark urine
• pale skin
• chest pain
• fast heartbeat
• unusual bruising or bleeding
• sore throat, cough, fever, chills, or other signs of infection
• unexplained weight gain or loss
• feeling cold or hot all the time
• blackening of skin or drainage at the injection site
• red or bloody stools or diarrhea
• stomach pain
• slow or difficult speech
• purple patches or pinpoint dots (rash) on the skin
• decreased urination or blood in the urine

Interferon beta-1a may cause other side effects. Call your doctor if you have any unusual problems while using interferon beta-1a.

Interferon beta 1b

Interferon beta-1b injection is used to reduce episodes of symptoms in patients with relapsing-remitting (course of disease where symptoms flare up from time to time) of multiple sclerosis (MS, a disease in which the nerves do not function properly and patients may experience weakness, numbness, loss of muscle coordination and problems with vision, speech, and bladder control). Interferon beta-1b is in a class of medications called immunomodulators. It is not known exactly how interferon beta-1b works to treat MS.

Interferon beta-1b subcutaneous injection

Interferon beta-1b injection comes as a powder to be mixed with liquid and injected subcutaneously (just under the skin). It is usually injected every other day. Inject interferon beta-1b injection at around the same time of day each time you inject it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon beta-1b injection exactly as directed. Do not inject more or less of it or inject it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of interferon beta-1b injection and gradually increase your dose.

You will receive your first dose of interferon beta-1b in your doctor’s office. After that, you can inject interferon beta-1b yourself or have a friend or relative perform the injections. Before you use interferon beta-1b yourself the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.

Never reuse or share syringes, needles, or vials of medication. Throw away used needles and syringes in a puncture-resistant container and throw away used vials of medication in the trash. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

You should only mix one vial of interferon beta-1b at a time. It is best to mix the medication right before you plan to inject it. However, you may mix the medication in advance, store it in the refrigerator, and use it within 3 hours.

You can inject interferon beta-1b anywhere on your abdomen, buttocks, the back of your upper arms, or your thighs, except the area near your navel (belly button) and waistline. If you are very thin, only inject in your thigh or the outer surface of your arm. Refer to the diagram in the manufacturer’s patient information for the exact places you can inject. Choose a different spot each time you inject your medication. Do not inject your medication into skin that is irritated, bruised, reddened, infected, or scarred.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin treatment with interferon beta-1b and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions.

What should I do if I forget a dose?

If you miss a dose of interferon beta-1b injection, inject your next dose as soon as you remember or are able to give it. Your next injection should then be given about 48 hours (2 days) after that dose. Do not use interferon beta-1b injection two days in a row. Do not inject a double dose to make up for a missed dose. Call your doctor if you miss a dose and have questions about what to do.

Interferon beta-1b intramuscular injection

Interferon beta-1a intramuscular injection comes as a powder in vials to be mixed into a solution for injection. Interferon beta-1a intramuscular injection also comes as a solution (liquid) in prefilled injection syringes and in a prefilled automatic injection pen. This medication is injected into a muscle, usually once a week, on the same day each week. Inject interferon beta-1a intramuscular at around the same time of day on your injection days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon beta-1a exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Interferon beta-1a controls the symptoms of MS but does not cure it. Continue to use interferon beta-1a even if you feel well. Do not stop using interferon beta-1a without talking to your doctor.

You will receive your first dose of interferon beta-1a intramuscular in your doctor’s office. After that, you can inject interferon beta-1a intramuscular yourself or have a friend or relative perform the injections. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it. Before you use interferon beta-1a intramuscular for the first time, you or the person who will be giving the injections should also read the manufacturer’s information for the patient that comes with it. Follow the directions carefully.

Be sure you know what type of container your interferon beta 1b comes in and what other supplies, such as needles or syringes, you will need to inject your medication. If your interferon beta 1b intramuscular comes in vials, you will need to use a syringe and needle to inject your dose.

Always use a new, unopened vial, prefilled syringe and needle, or prefilled automatic injection pen for each injection. Never reuse vials, syringes, needles, or automatic injection pens. Discard used syringes, needles, and injection pens in a puncture-resistant container, kept out of reach of children. Talk to your doctor or pharmacist about how to discard the puncture-resistant container.

Always look at the medication in your vial, prefilled syringe, or automatic injection pen before you use it. If you are using a vial, the solution in the vial should be clear to slightly yellow after mixing. If you are using a prefilled syringe or automatic injection pen, the solution should be clear and colorless. If the solution is cloudy, discolored, or contains particles or if the expiration date marked on the vial, prefilled syringe, or automatic injection pen has passed, do not use that vial, prefilled syringe, or automatic injection pen.

Talk to your doctor or pharmacist about where on your body you should inject interferon beta-1a intramuscular. If you are using a syringe or prefilled syringe, you can inject interferon beta-1a intramuscular in your upper arms or thighs. If you are using a prefilled autoinjection pen, you can inject interferon beta-1a intramuscular in the outer surface of your upper thighs. Use a different spot for each injection. Do not use the same spot two times in a row. Do not inject into an area where the skin is sore, red, bruised, scarred, infected, irritated, or abnormal in any way.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet (medication guide) when you begin treatment with interferon beta-1a and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the interferon beta-1a Medication Guide.

What should I do if I forget a dose?

Inject the missed dose as soon as you remember it. Do not inject interferon beta-1a two days in a row. Do not inject a double dose to make up for a missed dose. Return to your regular dosing schedule the following week. Call your doctor if you miss a dose and have questions about what to do.

Interferon beta 1b special precautions

Before receiving interferon beta-1b injection:

• tell your doctor and pharmacist if you are allergic to interferon beta-1b injection, other interferon beta medications (Avonex, Plegridy, Rebif), any other medications, human albumin, mannitol, or any of the other ingredients in interferon beta-1b injection. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you drink or have ever drunk large amounts of alcohol, if you have or have ever had anemia (low red blood cells) or low white blood cells, blood problems such as bruising easily or bleeding, seizures, mental illness such as depression, especially if you have ever thought about killing yourself or tried to do so, heart failure, or heart or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving interferon beta-1b injection, call your doctor.
• ask your doctor about the safe use of alcoholic beverages while receiving interferon beta-1b injection. Alcohol can make the side effects from interferon beta-1b worse.
• you should know that you may have flu-like symptoms such as headache, fever, chills, sweating, muscle aches, and tiredness after your injection. Your doctor may tell you to take an over-the-counter pain and fever medication to help with these symptoms. Talk to your doctor if these symptoms are difficult to manage or become severe.

Interferon beta 1b side effects

Interferon beta-1b injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• vaginal bleeding or spotting between menstrual periods
• tight muscles
• weakness
• changes in sex drive or ability (in men)
• change in coordination

Some side effects can be serious. If you experience any of these symptoms or any of the symptoms listed in the SPECIAL PRECAUTIONS section, call your doctor immediately or get emergency medical treatment:

• bruising, pain, redness, swelling, or tenderness at the injection site
• blackening of skin or drainage at the injection site
• yellowing of the skin or eyes
• dark urine
• extreme tiredness
• pale stool
• nausea
• vomiting
• loss of appetite
• unusual bruising or bleeding
• confusion
• irritability
• nervousness
• difficulty falling asleep or staying asleep
• thinking about harming or killing yourself or planning or trying to do so
• anxiety
• new or worsening depression
• aggressive or violent behavior
• seeing things or hearing voices that do not exist
• acting without thinking
• seizures
• shortness of breath
• fast or abnormal heartbeat
• chest pain or tightness
• pale skin
• increased urinary frequency, especially at night
• rash
• hives
• itching
• swelling of the eyes, face, mouth, tongue, throat, hands, arms, feet, ankles, or lower legs
• difficulty breathing or swallowing
• red or bloody stools or diarrhea
• stomach pain
• slow or difficult speech
• purple patches or pinpoint dots (rash) on the skin
• decreased urination or blood in the urine

Interferon beta-1b injection may cause other side effects. Call your doctor if you have any unusual problems while receiving interferon beta-1b.

Interferon gamma

Interferon gamma is a recombinant cytokine with a multitude of actions including stimulation of T cell immunity, increase in innate immune responses, induction of Class II major histocompatibility complex molecules, and inhibition of fibrosis. Interferon gamma is used for its immune enhancing properties as therapy of chronic granulomatous disease of childhood and is used experimentally for its anti-fibrotic actions.

Interferon gamma is human cytokine produced by macrophages and lymphocytes that plays a critical role in both innate and adaptive immune responses. While also known as type II interferon, interferon gamma has only modest direct antiviral activity and is unrelated in structure, genetic linkage and function to the type I interferons, such as interferon alpha, beta and lambda. It more closely resembles an interleukin and activates macrophages and increases Class II major histocompatibility complex (MHC) expression on cells. Absence of interferon gamma or its receptor is associated with autoinflammatory conditions and autoimmune diseases.

Interferon gamma has been evaluated as a therapy of multiple conditions, as an antiviral agent for hepatitis B and C, as an antifibrotic agent in chronic liver disease and pulmonary fibrosis, and as an immunomodulatory agent in several immune deficiency syndromes including AIDS and chronic granulomatous disease of childhood. Interferon gamma-1b was approved for use in the United States for chronic granulomatous disease in 1990 and remains an experimental agent for other uses.

Interferon gamma-1b is available as a solution in single use vials of 100 µg (2 million IU) in 0.5 mL under the brand name Actimmune. The typical adult dose is 50 µg/m2 (body surface area >0.5 m2) and 1.5 µg/kg/dose in small children (body surface area ≤0.5 m2) subcutaneously three times weekly.

Interferon gamma-1b side effects are common with the initial dose and include fever, malaise, body aches and nausea. With chronic therapy, injection site reactions, fatigue, headache and muscle aches are common. Rare, but potentially severe adverse reactions include hypersensitivity reactions.

Interferon gamma 1b

Interferon gamma-1b injection is used to reduce the frequency and severity of serious infections in people with chronic granulomatous disease (an inherited immune system disease). It is also used to slow down worsening of their condition in people with severe, malignant osteopetrosis (an inherited bone disease). Interferon gamma-1b is in a class of medications called immunomodulators. It is not known exactly how interferon gamma-1b works to treat chronic granulomatous disease and osteopetrosis.

Interferon gamma-1b injection comes as a solution to inject subcutaneously (just under the skin) three times a week, for example, every Monday, Wednesday, and Friday. Inject interferon gamma-1b injection at around the same time of day each time you inject it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use interferon gamma-1b injection exactly as directed. Do not inject more or less of it or inject it more often than prescribed by your doctor.

You will receive your first dose of interferon gamma-1b in your doctor’s office. Then you can inject interferon gamma-1b yourself or have a friend or relative give the injections. Before you use interferon gamma-1b yourself the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you or the person who will be injecting the medication how to inject it.

Never reuse or share syringes, needles, or vials of medication. Throw away used needles and syringes in a puncture-resistant container and throw away used vials of medication in the trash. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.

You can inject interferon gamma-1b in your upper arms, stomach area, or your thighs. Choose a different spot each time you inject your medication. Do not inject your medication into skin that is irritated, bruised, reddened, infected, or scarred.

Your doctor or pharmacist will give you the manufacturer’s patient information sheet when you begin treatment with interferon gamma-1b and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions.

Interferon gamma 1b special precautions

Before receiving interferon gamma-1b injection:

• tell your doctor and pharmacist if you are allergic to interferon gamma-1b injection, products made from the E. colibacteria, any other medications, or any of the other ingredients in interferon gamma-1b injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had seizures, a low number of red or low white blood cells, heart failure, an irregular heartbeat, or heart or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving interferon gamma-1b injection, call your doctor.
• you should know that you may have flu-like symptoms such as headache, fever, chills, muscle aches, and tiredness after your injection. Your doctor may tell
• you to take acetaminophen (Tylenol), an over-the-counter pain and fever medication, to help with these symptoms. Talk to your doctor if these symptoms are difficult to manage or become severe.

What should I do if I forget a dose?

If you miss a dose of interferon gamma-1b injection, do not increase your dose or give two injections to make up for the missed dose.Call your doctor if you miss a dose and have questions about what to do.

Interferon gamma 1b side effects

Interferon gamma-1b injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• extreme tiredness
• diarrhea
• nausea
• vomiting
• muscle or joint pain
• dizziness
• problems with walking
• confusion
• bruising, redness, swelling, bleeding, or irritation at the injection spot

Some side effects can be serious. If you experience any of these symptoms or those listed in the SPECIAL PRECAUTIONS section, stop the medication and call your doctor immediately or get emergency medical treatment:

• rash
• itching
• difficulty breathing or swallowing
• hives
• swelling of the eyes, face, mouth, tongue, and throat

Interferon gamma-1b injection may cause other side effects. Call your doctor if you have any unusual problems while receiving interferon gamma-1b.

Interferon side effects

Interferon can cause significant side effects. These include “flu-like” symptoms like muscle aches, bone pain, fever, headaches, fatigue, nausea, and vomiting. Patients taking this drug may have problems thinking and concentrating. Interferon can also lower blood cell counts.

Side effects continue as long as the interferon drug is used, but can become easier to tolerate over time. They get better after the drug is stopped. Still, some patients find it hard to deal with these side effects every day and may need to stop treatment because of them.

1. Feroze KB, Wang J. Interferon Induced Retinopathy. [Updated 2019 Mar 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441862 [↩]
2. Medhat E, Esmat G, Hamza E, Abdel Aziz A, Fouad Fathalah W, Darweesh SK, Zakaria Z, Mostafa S. Ophthalmological side effects of interferon therapy of chronic hepatitis C. Hepatobiliary Surg Nutr. 2016 Jun;5(3):209-16[↩]