1986-1990 HEPATITIS C CLAIMS CENTRE
HCV MEDICATION LIST FOR MEDICAL CONDITIONS ASSOCIATED
WITH DISEASE LEVEL 6*
Listed below are medications currently available and generally accepted by the medical community for the treatment of the
seven (7) medical conditions associated with disease level 6. This list was compiled in consultation with a number of HCV
medical specialists and reflects medications that may be recommended or prescribed for persons infected with HCV.
*This list shall be periodically updated in consultation with HCV medical specialists, at the Administrator’s discretion.
DECOMPENSATION OF
THE LIVER
BRAND NAME
Azathioprine
Cyclosporine
Mycophenolate Mofetil
Prednisone
Tacrolimus
Imuran
Neoral/Sandimmune
CellCept
Apo-Prednisone
Prograf
Antifungals
Caspofungin
Fluconazole
Itraconazole
Ketoconazole
Nystatin
Voraconazole
Cancidas
Diflucan
Sporanox
Nizoral
Mycostatin/Nilstat
Antivirals
Acyclovir
Famciclovir
Ganciclovir
Oseltamivir Phosphate
Pegylated Interferon alfa-2bRibavirin
Ribavirin, Interferon, alfa 2b
Valacyclovir Hydrochloride
Zanamivir
Zovirax
Famvir
Cytovene
Tamiflu
Pegetron
Sulfonamides and
Trimethoprim
Sulfamethoxazole
Bactrim DS
Gastroduodenal
Cytoprotective Agents
Aluminum Hydroxide
Cimetidine
Famotidine
Lansoprazole
Magnesium Hydroxide
Nizatidine
Omeprazole Magnesium
Pantoprazole Sodium
Ranitidine Hydrochloride
Sucralfate
Gaviscon
Tagamet
Pepcid AC
Prevacid
Mylanta
Axid
Losec
Pantoloc
Zantac
Sulcrate
Supplements
Calcium Carbonate
Calcium Gluconate
Iron Dextran
Ferrous Fumarate
Magnesium
Magnesium Chloride
Multi-Vitamins
Potassium Chloride
Caltrate
Calcium Gluconate
Dexiran/Infufer
Ferrous Sulphate/Palafer
Magnesium-Rougier/
Slow-Mag
Centrum
Slow-K
Pain Medications
Acetaminophen/Caffeine/
Codeine Phosphate
Acetaminophen
Hydromorphone Hydrochloride
Morphine Sulphate
Pentazocine Hydrochloride
Tylenol with Codeine
1.
Page 1 of 2
GENERIC NAME
2.
3.
ASCITES
HEPATIC
ENCEPHALOPATHY
VARICEAL
BLEEDING
AS A RESULT OF
PORTAL
HYPERTENSION
Rebetron
Valtrex
Relenza
Tylenol
Dilaudid
Morphine
Talwin
DIURETICS:
Furosemide
Hydrodiuril
Spironolactone
Lasix
Hydrochlorothiazide
Aldactone
Lactulose
Laxilose
Phytonadione
Somatostatin
Vitamin K Injections
Stilamin
ANTIHYPERTENSIVE:
Acebutolol Hydrochloride
Atenolol
Carvedilol
Esmolol Hydrochloride
Hydrodiuril
Metoprolol Tartrate
Nadolol
Pindolol
Propranolol Hydrochloride
Terazosin Hydrochloride
Timolol Maleate
Sectral
Tenormin
Coreg
Brevibloc
Hydrochlorothiazide
Lopresor
Corgard
Visken
Inderal
Hytrin
Timolide
09/01/2003
DISEASE LEVEL 6 ONLY
LIVER TRANSPLANTATION
THERAPEUTIC CLASS
Immunosuppressive
Therapy
1986-1990 HEPATITIS C CLAIMS CENTRE
HCV MEDICATION LIST FOR MEDICAL CONDITIONS ASSOCIATED
WITH DISEASE LEVEL 6
B-CELL LYMPHOMA
THERAPEUTIC CLASS
GENERIC NAME
Chemotherapy Treatment
EXAMPLES:
Cyclophosphamide
Dexamethasone
Doxorubicin Hydrochloride
Methotrexate
Prednisone
Vincristine Sulfate
Cytoxan
Maxitrol
Adriamycin
Methotrexate
Apo-Prednisone
Oncotice
Medications Related to
Treatment
Calcium Folinate
Chlorambucil
Dolasetron Mesylate
Epoetin alfa
Filgrastim
Granisetron Hydrochloride
Ondansetron Hydrochloride
Leucovorin
Leukeran
Anzemet
Eprex
Neupogen
Kytril
Zofran
MIXED CRYOGLOBULINEMIA
RENAL FAILURE
Immunosuppressive
Agents
CORTICOSTERIODS:
Betamethasone
Cortisone
Cyclophosphamide
Hydrocortisone
Interferon alfa 2B
Methylprednisolone
Triamcinolone
Imuran
Leukeran
Celestoderm/Betnovate
Cortisone
Cytoxan
Cortoderm
Intron A
Solu-Medrol
Kenacomb/Viaderm
Celecoxib
Diclofenac Sodium
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Naproxen
Piroxicam
Rofecoxib
Tolmetin Sodium
Celebrex
Voltaren
Motrin
Indocid
Orudis
Toradol
Naprosyn
Feldene
Vioxx
Tolectin
Dietary Supplements
Calcium Carbonate
Calcitriol
Iron Dextran
Caltrate
Rocaltrol
Dexiron
Erythropoiesis
Regulating Hormone
MEDICATIONS:
Epoetin Alfa
Eprex
Nonsteroidal AntiInflammatory Agents
09/01/2003
DISEASE LEVEL 6 ONLY
Azathioprine
Chlorambucil
Page 2 of 2
BRAND NAME