Most drugs are metabolised by the liver. Even something as routine as Paracetamol/Acetaminophen can be liver toxic – while 2 x 500 mg four times a day is safe, if you take all 20 at once there is a good chance you get liver failure.

So as a rule of thumb many medications are liver toxic at high doses – in effect the liver can not process them fast enough and toxic products build up. A number of promising drugs across many areas have failed in Phase 2/3 trials when patient have got liver failure from them.

Daclatasvir is a good medication but please be aware of interactions with other medications. You can check for them here: http://www.hep-druginteractions.org/checker

You are welcome. As a doctor I would have no difficulty in supporting a decision to treat.

If it was my son I would treat them if they wanted to.

If, in the worst case, it went badly I would find solace in knowing we tried.

While we know these drugs have risks they are far safer than Interferon/Ribavirin and they have been used. In “UpToDate”

http://www.uptodate.com/contents/hepatitis-c-virus-infection-in-children

We can read that PEG Interferon/Ribavirin is approved for use in children.

To me that’s like saying amputation is approved for the treatment of gangrene in children but I can’t give you antibiotics because they are too new and only approved in adults.

Personally I would take a punt on the antibiotics and leave the amputation to the annals of history….

You won’t find an official answer, and the trials in children are phase 2 and not scheduled for completion until August 2017.

https://clinicaltrials.gov/ct2/show/NCT02249182

So let’s resort to the logic of first principles.

Children are different in three primary ways (physiologically)

1. They are growing both physically and mentally
2. They may not have all the metabolic pathways for drug breakdown seen in adults
3. They are a different weight

He’s old enough that most of his bits are fully formed but some – cartilage in bones allowing them to grow, and his brain are not – it’s possible these medications could do stuff here – ?

You can observe that for many common medications there are < 12 yo doses and then Adult doses - tick If your son is full sized then we need not have concerns that the tablet size is too big for his body - tick So if you weigh up the risks of treatment they are real, and to a degree unknown. Then you look at the impact of Hep C and the risks of having it - they are real, substantial and well known. To my logic the risk of treatment are small, the risks of not treatment are large, so the risk:benefit stacks up on the treatment side. He's around the age of Gillick competence which is where the child is deemed capable of consent (usual situation an underage girl seeking either contraception or a termination). On that basis if he wants to do it, and you are assessing a significant impact treatment is not unreasonable. There is nothing magical that suddenly happens on a child's 18th birthday that says yesterday treatment was dangerous, but today it's safe. It is an arbitrary line in the sand and an adult sized 15 year old should tolerate an adult dose of medication fine and have a risk profile similar to an adult. I would certainly be thinking along your lines if faced with the same dilemma.

Here’s a video about it:

[video width=425 height=344 type=youtube]vCcpES8O6P0[/video]