Managing side effects

As with all medications, peg-interferon and ribavirin can cause side effects. Most side effects are mild and become easier to tolerate as treatment progresses but, occasionally, side effects can be severe enough to make it necessary to stop treatment. Once the decision has been made to start treatment, having a doctor monitor and manage the patient's side effects becomes a primary concern because it can help maximize the patient's chance of completing treatment. All side effects should be reported to healthcare providers, as some may indicate the presence of serious medical conditions. 

Note: Side effects from the medications can be similar to Hep C symptoms. Check the information on Symptom management for more tips on how to help people manage specific symptoms. 

Minor Side Effects

These side effects are the most common and after a few weeks they often become easier to tolerate or they subside. 

Flu-like symptoms include fever, sweating, chills, muscle aches and pains. 

Tips to offer:

• A doctor can provide advice about taking painkillers like Tylenol or Advil, because these over-the-counter medications can harm the liver if people take more than the recommended dose.
• Getting plenty of rest and drinking plenty of fluids can help these side effects.
• Flu-like symptoms can be linked closely to the timing of peg- interferon injections; taking the injection before bed can let people sleep through the bulk of the discomfort.
• Stretching can help with minor aches and pains.

Hair loss or thinning hair is a temporary side-effect. It can be severe but only in about 5% of patients on treatment. Hair will usually grow back when treatment ends. 

Tips to offer:

• Using mild shampoos and conditioners and avoiding damage caused by heat, dyeing, perming or straightening can reduce breakage.
• Changing hairstyle to a shorter one or wearing a wig or hairpiece will make the hair loss less noticeable.
• Consider being inventive by shaving the whole head completely or wearing hats and scarves.

Loss of appetite or nausea can make a person skip meals because they feel queasy, have an upset stomach or are just not hungry. This will impair their nutrition intake, which is an important part of living with Hep C. 

Tips to offer:

• Avoid acidic, spicy and greasy foods as well as foods that are too hot or too cold.
• Drink plenty of water—try for 2 L per day.
• Eat smaller meals throughout the day instead of a few large meals.
• Avoid alcoholic, sugary, or carbonated beverages.
• Cut back on dairy products.
• Ask a doctor about anti-nausea medications.

Dry or itchy skin can be caused by the medications and by changes in a person's environment. Skin irritation may also be a result of injecting the peg-interferon. 

Tips to offer:

• Use unscented body lotions or creams and apply sunscreen if in the sun.
• Avoid long hot showers or baths, and use tepid or lukewarm water more often.
• Some soaps may dry out the skin—look for ones that are moisturizing or high in oil.
• Drink plenty of water.
• Look for laundry detergents that are designed for sensitive skin.

Headaches can be a side effect of Hep C treatment. Changes in eating, sleeping, or drinking habits can affect the presence or severity of headaches. 

Tips to offer:

• Drink enough water to prevent dehydration, which can cause headaches.
• Avoid bright lights and loud noises.
• Avoid alcohol and other dehydrating beverages.
• A doctor can discuss what painkillers are appropriate to use.

Major Side Effects

These side effects can lead to very severe medical complications and are potentially life-threatening. They should be reported to a doctor as soon as possible. Major side effects occur in less than 10% of people and generally stop shortly after treatment ends. Attending regular appointments to monitor chemical changes in the body will detect these conditions in time to counteract any negative effects. 

Depression and emotional changes can manifest themselves as despair, anxiety, irritability or suicidal thoughts, especially in people who have experienced depression or who have a history of depression or mental illness in their family. Some signs that the medications are causing emotional changes include fatigue, irritability, changes in eating or sleeping patterns, mood swings and problems concentrating. 

Tips to offer:

• Depression is manageable and is likely caused by the treatment and often goes away over time or after treatment ends.
• Counselling or support groups can help a person deal with emotional changes, and so can accessing telephone support through distress centres (find a local phone crisis line in Ontario at www.dcontario.org).
• A doctor can prescribe medication to counteract changes in mental health, such as antidepressant or anti-anxiety meds; for people with a history of depression or mental illness, these can be started before Hep C treatment begins.
• Exercise can help alleviate stress and give a boost of energy and well-being.
• Find sources of humour and enjoyable recreation activities.
• Avoid circumstances that can trigger feelings of anxiety or sadness.
• Hospitals and emergency rooms can help people who are thinking of hurting themselves or feeling suicidal.

Anemia (a drop in red blood cells) and other blood changes like leukopenia or neutropenia (a drop in other blood cells) and thrombocytopenia (a drop in platelets) are a result of the way Hep C meds affect bone marrow. Anemia may make a person feel tired, dizzy, cold or out of breath. 

Heart problems, such as arrhythmias (irregular heartbeats), can be caused by peg-interferon; some side effects of ribavirin, like anemia, can make existing heart conditions worse. 

Hep C meds can also cause auto-immune disorders, like rheumatoid arthritis, in which the immune system turns on or attacks the body's own tissues. 

These changes represent very serious side effects. If a patient suspects that he or she is experiencing any of these side effects, report them right away. 

Tips to offer:

• Doctors will monitor these side effects at regular intervals during treatment with blood tests, complete blood counts and electrocardiograms (ECGs), so it is recommended that patients attend all appointments during treatment.
• Some side effects can be treated with medications. Alternatively, the dose of Hep C medications can be changed to try to reduce the severity of side effects. In rare cases, treatment might need to be halted. Doctors can make this decision based on the test results and the patient's response to treatment.