Coping with side effects of hepatitis C drugs
For those with chronic hepatitis C, the outlook has never been better. Still, many treatment regimens contain drugs with side effects that erode your quality of life. Here are some tips for coping.
Many people who start treatment for chronic hepatitis C don't make it through the entire course of therapy because of side effects. For some, new antiviral drugs may soon replace the hard-to-tolerate medications — peginterferon alfa and ribavirin — that were, until recently, the backbone of hepatitis C treatment. Even so, peginterferon alfa and ribavirin are likely to remain in use for some time, particularly in parts of the world with limited medical resources.
The new anti-hepatitis C drugs also have unpleasant side effects, including flu-like symptoms similar to those affecting most people on peginterferon alfa and ribavirin. These side effects typically aren't severe enough to lead to stopping treatment, but they may erode quality of life.
Fortunately, you can take steps to reduce the impact of hepatitis C treatment side effects. Here are some tips for managing the most common ones.
Feeling tired and run-down is the most common side effect of both interferon-based and interferon-free treatments. To avoid fatigue or limit its impact, try:
- Scheduling interferon injections for days when you can take it easy — at the start of a weekend, for example
- Cutting back on work hours, if possible
- Napping during the day
- Taking a walk on most days to increase your alertness and promote better sleep
- Drinking a caffeinated beverage in the morning
- Considering antidepressant therapy if depression may be contributing to your fatigue
Headache, muscle aches and fever — typically accompanied by fatigue — are common side effects of peginterferon alfa. They appear several hours after the first few weekly injections of peginterferon alfa. You can cope with these signs and symptoms by:
- Taking an over-the-counter medication such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) before each injection and as needed while the symptoms last — if your doctor says it's safe for you
- Giving yourself peginterferon alfa injections, which a member of your care team can usually show you how to do, shortly before bedtime
- Drinking plenty of fluids
- Getting enough rest
- Avoiding strong sunlight and bright indoor lights to prevent headache
- Using warm, moist heat on achy muscles
Cough is the most common respiratory side effect of peginterferon alfa and ribavirin treatment. Shortness of breath also may develop, as may airway and lung infections. See your doctor if you often feel out of breath or if you have fever and a deep cough that produces thick sputum. To manage a cough:
- Drink plenty of fluids throughout the day
- Use a humidifier
- Use sugar-free hard candy or cough drops to soothe a scratchy throat
Hepatitis C treatment, particularly with peginterferon alfa, can cause depression, mood swings and confusion. These side effects aren't trivial, particularly for people who have a history of mental health problems. Strategies for coping with depression include:
- Anticipating possible mental health side effects before starting treatment and discussing them with your doctor so that you'll know what to do if they occur
- Taking an antidepressant throughout treatment and for a few months after treatment
- Avoiding caffeine if you're feeling anxious or irritable
- Taking regular walks or going to a gym regularly for mild exercise
- Reducing your dose of peginterferon alfa under your doctor's supervision
- Talking to your doctor or a mental health professional immediately if you feel like you might hurt yourself or someone else
The older hepatitis C drugs sometimes cause dry skin, itching and a rash triggered by sunlight. Hair loss also may occur, but the hair usually grows back after treatment. Protect your skin and hair by:
- Bathing and showering in warm (not hot) water
- Applying plenty of moisturizing lotion or cream to your skin after you shower or bathe
- Putting on sunscreen before going outside
- Using mild, unscented laundry detergent and avoiding fabric softener
- Rubbing or pressing on itchy skin instead of scratching
- Using mild shampoo and gentle styling techniques
- Avoiding hair dye and chemical processing until after treatment
- Switching to a satin pillow case to reduce friction on your scalp
Difficulty falling or staying asleep (insomnia) may be a result of mood problems caused by peginterferon alfa, potentially worsening depression and anxiety. Insomnia is also a side effect of ribavirin, as well as of the new combination treatment of ledipasvir-sofosbuvir (Harvoni). To get enough sleep:
- If you're also being treated for depression, take an antidepressant that improves sleep rather than one that makes you alert
- Stick to a regular schedule of going to bed at night and getting up in the morning
- Avoid reading and watching TV in bed
- Take ribavirin in the late afternoon
- Avoid caffeine
- Try not to nap during the day
- Eat a light meal well before bedtime
- Limit the fluid you drink in the two hours before bedtime, so you won't have to go to the bathroom during the night
- Wind down with a recorded relaxation exercise, warm bath or massage before going to bed
- Take diphenhydramine (Benadryl, others) or another sleep-promoting medication under your doctor's supervision
New antivirals as well as peginterferon alfa and ribavirin can cause nausea, vomiting, diarrhea, appetite loss or a combination of these side effects in some people. Many also complain of a bad taste in the mouth. Sometimes, these side effects can lead to weight loss. Coping strategies include:
- Taking ribavirin with food
- Eating small meals
- Eating food cold or at room temperature so its odor is less intense
- Choosing high-protein snacks, such as cheese or peanut butter, if you can tolerate them
- Trying protein drinks if solid food is unappealing
- Avoiding spicy or greasy foods
- Eating foods that contain soluble fiber, such as bananas, rice, applesauce and white toast, to relieve diarrhea
- Avoiding dairy products during and for several days after a bout of diarrhea
- Taking a walk before eating
- Using plastic utensils if you have a metallic taste in your mouth
Serious side effects
Some peginterferon alfa and ribavirin side effects are serious enough to require close monitoring by your doctor. If necessary, you may have to reduce your medication dosage or stop treatment completely. These serious side effects include:
- A sharp reduction in red blood cells (anemia), which is particularly dangerous for people with heart disease or at high risk of heart disease
- Suicidal thoughts and impulses, particularly in people with a history of depression, addiction or both
- A low level of clotting cells in your blood (thrombocytopenia), potentially leading to serious bleeding problems, particularly in those with liver disease
- Eye problems — specifically, abnormalities in the light-sensitive lining at the back of the eye (retina), particularly in people with diabetes or high blood pressure
- Inflammation of tissue in the air sacs and lining of the lungs (interstitial pneumonitis), which can severely restrict breathing in a short time
- Increased or new signs and symptoms of thyroid disease (hypothyroidism), a condition that can be hard to distinguish from the most common treatment side effects, such as fatigue
- Flares of existing autoimmune conditions, such as rheumatoid arthritis, lupus and psoriasis
Exposure to ribavirin during pregnancy can cause abnormalities in the developing fetus. Women should have pregnancy tests before and periodically during ribavirin treatment. Similarly, men considering ribavirin treatment should take precautions to avoid exposing their female partners' unborn children to the drug by:
Sept. 27, 2018
- Abstaining from sex with any woman who may be pregnant
- Postponing treatment until a pregnant partner has given birth
- Using two forms of birth control every time they have sex during treatment
See more In-depth
- Chopra A, et al. How to optimize HCV therapy in genotype 1 patients: Management of side-effects. Liver International. 2013;33(suppl):30.
- Foster GR, et al. Hepatitis C genotype 1. Current Opinion in Infectious Diseases. 2014;27:535.
- Afdahl M, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. New England Journal of Medicine. 2014;370:1889.
- Sulkowski MS, et al. Management of adverse effects of pegIFN α and ribavirin therapy for hepatitis C. Gastroenterology and Hepatology. 2011;8:212.
- Slim J, et al. Managing adverse effects of interferon- and ribavirin in combination therapy for HCV. Infectious Disease Clinics of North America. 2012;96:917.
- Hepatitis C treatment side effect management tips. U.S. Department of Veterans Affairs. http://www.hepatitis.va.gov/products/patient/side-effects-chart.asp. Accessed Dec. 17, 2014.