How Hepatitis Is Treated

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Treatment of hepatitis depends on whether it is a viral or non-viral form of the disease. Acute hepatitis (typically caused by hepatitis A, E, or sometimes C) often is asymptomatic or merely brings on mild flu-like symptoms that can be improved with rest and fluids. Chronic viral hepatitis, on the other hand, must be treated with prescription medications to prevent serious consequences, such as cirrhosis of the liver. In cases of severe liver damage, a liver transplant usually is necessary.

Treatment for non-viral hepatitis depends on the cause as well as the extent of liver damage that has occurred at the time it's diagnosed.

Lifestyle

Avoidance of alcohol and careful use of medications is important for all forms of hepatitis. It's especially so when it comes to medication-induced and alcoholic types, as these can be reversed or prevented from causing further harm by making changes in the use of the substance that caused them in the first place.

If diagnosed early, before liver inflammation has progressed to permanent damage, both of these types of hepatitis can improve.

Medication-Induced Hepatitis

Many drugs, both prescription and over-the-counter, are metabolized in the liver, which can sustain damage if too much of particular medication is taken.

Some of the medications associated most often with non-viral hepatitis are Tylenol (acetaminophen), including multi-symptom remedies that contain acetaminophen; non-steroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen), Aleve (naproxen), and others; anabolic steroids; birth control pills; Augmentin (amoxicillin-clavulanate), and Achromycin V (tetracycline).

Treating medication-induced hepatitis is a simple matter of discontinuing the use of the medication. This will stop the symptoms, but depending on the specific drug and how long it was taken, it's possible permanent damage that will require further treatment may have been done.

Alcoholic Hepatitis

As with hepatitis brought about by the overuse of a particular medication, alcoholic hepatitis may develop due to drinking large amounts of alcohol for prolonged periods of time. If caught in the early stages, treating liver inflammation caused by excessive drinking can be reversed if alcohol use is stopped.

For people dealing with alcohol addiction who will find it difficult to simply quit drinking, cutting back to two drinks per day for men and one drink per day for women may be enough to reverse symptoms of alcoholic hepatitis until other measures such a psychiatric help can bring about a full withdrawal, according to a 2019 review of the disease published in Alcohol and Alcoholism.

Alcoholic hepatitis that has progressed to the point of causing permanent damage may require more aggressive treatment.

Prescriptions

When a viral hepatitis infection becomes chronic, it likely will require prescription medication that's chosen based on the type of virus that has caused the infection. Autoimmune hepatitis also requires treatment with prescription medication.

For Viral Hepatitis

Hepatitis A (HAV): The drug type of choice for HAV usually is a corticosteroid. Examples include prednisone and budesonide.

Hepatitis B (HBV): Treatment typically is indicated for patients with high viral activity and elevated liver enzymes, particularly when cirrhosis has developed. Antiviral therapy may be less effective in those with severe or end-stage liver disease.

At present, there are five prescription drugs for treating chronic HBV approved by the U.S. Food and Drug Administration (FDA): Interferon and four other antiviral medications. Another, Tyzeka (telbivudine), was discontinued in 2016.

Although none can clear the virus, they can effectively prevent it from replicating and causing damage to the liver:

  • Interferon (interferon alpha-2b or pegylated interferon): A synthetic form of a protein of the same name that's produced by the immune system. Manmade forms of interferon for treating hepatitis include Intron-A (interferon alfa-2b injection) and Infergen (interferon alfa-2b recombinant). Both are highly effective, although they're expensive and have significant side effects. Interferon usually is given by injection over 24 to 48 weeks.
  • Hepsera (adefovir): A medication in a class of drugs called nucleotide analogs. Hepsera is a tablet that is taken once a day.
  • Baraclude (entecavir): An antiviral in a class of drugs called reverse transcriptase inhibitors. It's available as either a tablet or an orange-flavored liquid and usually is taken once a day for a year.
  • Viread (tenofovir): Viread is in a class of medications called nucleoside reverse transcriptase inhibitors. It comes as either a tablet that should be taken without food or as a powder to be stirred into something soft like yogurt or applesauce.
  • Epivir-HBV (lamivudine): This antiviral originally was developed and sold as Epivir to treat infection caused by human immunodeficiency virus (HIV). Although not a first-line treatment for HBV, for certain people Epivir-HBV may work well to prevent the virus from replicating. It's relatively inexpensive and comes as either a pill or a liquid: both are taken once a day for one year, with or without food.

Hepatitis C (HCV): The drugs approved by the FDA to treat a hepatitis C infection are newer generation direct-acting antivirals (DAAs). Two of these can treat all six genotypes of the HCV virus. The others are used only to treat specific genotypes. A doctor will also factor in the stage of liver disease when developing a treatment protocol for a patient.

Prescription Medications for HCV
Brand Name of Drug Active Ingredient(s) Approved For
Harvoni sofusbuvir + ledipasvir Genotype 1
Olysio simeprevir Genotype 1
Viekira Pak ombitasvir + paritaprevir + ritonavir co-packaged with dasabuvir Genotype 1
Daklinza daclatasvir Genotype 3
Technivie ombitasvir + paritaprevir + ritonavir Genotype 4
Sovaldi sofusbuvir Genotypes 1, 2, 3 and 4
Zepatier grazoprevir + elbasvir Genotypes 1, 4 and 6
Epclusa sofosbuvir + velpatasvir Genotypes 1, 2, 3, 4, 5, and 6
Vosevi sofosbuvir + velpatasvir + vixukaorevir Genotypes 1, 2, 3, 4, 5, and 6

These DAAs are sometimes used in combination with interferon and/or Copegus (ribavirin).

Hepatitis D (HDV): HDV can only propagate in the presence of HBV. Chronic HDV infection tends to be more difficult to treat. While there are currently no FDA-approved therapeutic options for HDV, Intron A is sometimes prescribed.

Hepatitis E (HEV): Treatment options for HEV are limited, although there has been success with ribavirin.

For Autoimmune Hepatitis

Non-viral hepatitis caused by an autoimmune disease requires medication to suppress the immune system and stop it from attacking the liver.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the drugs used most often to treat autoimmune hepatitis are corticosteroids (either prednisone or prednisolone). In some cases, an immunosuppressant—Azasan or Imuran (azathioprine)— is prescribed as well.

When treated early, serious liver damage from autoimmune hepatitis can be prevented.

Taking Pain Relievers

While over-the-counter (OTC) analgesics cannot treat hepatitis, they can be taken to relieve pain if used cautiously and with a doctor's consent. OTC drugs like Tylenol (acetaminophen) can cause liver damage. The daily limit is 4,000 mg from all sources, including multi-symptom cold remedies, but your doctor may want you to stick to even less.

Surgery

When chronic hepatitis becomes so advanced that major liver damage occurs, the only treatment option is a liver transplant. This is a complex surgical procedure that involves replacing a failing liver with that of a deceased donor.

There are many risks involved, so this is considered a treatment of last resort—but it can be life-saving.

A Word From Verywell

Scientists continue to revolutionize treatment for hepatitis in multiple ways. One is improving on existing prescriptions. Another is developing new treatments, such as antiviral drugs that more efficiently prevent viral replication in liver cells. In addition, new therapies are taking advantage of the explosion of knowledge in genetic engineering. Given these inroads, the future of treating chronic hepatitis is bright.

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