A 55-year-old woman was started on
boceprevir (800 mg orally thrice daily) during week 5 of triple
therapy for
chronic hepatitis C. Her serum
sodium concentration the morning before starting
boceprevir use was 140 mmol/L. After the fourth dose of
boceprevir, the patient developed progressive
dizziness leading to eventual
loss of consciousness. She was taken to the emergency department (ED), where her serum
sodium concentration was measured as 126 mmol/L;
boceprevir use was temporarily discontinued. The patient's symptoms improved with infusion of 0.9%
sodium chloride injection, and she was discharged home the same day. After resuming
boceprevir use that evening, the woman developed extreme
dizziness and
headache upon awakening the next morning. On her return to the ED later that day, she had a serum
sodium value of 134 mmol/L and was admitted to the hospital for monitoring and evaluation. Over the next three days, her symptoms improved with additional infusion
therapy and discontinuation of
boceprevir. The patient continued to receive dual
therapy (peginterferon alfa-2a and
ribavirin) without further documented serum
sodium instability. Using the
adverse drug reaction probability scale of Naranjo et al., the case was assigned a score of 5, indicating a probable reaction to
boceprevir.
CONCLUSION: