Quick Guide to Side Effect Management

 

Alpha interferons, which are given as injections under the skin, have been used since the late 1980s in the treatment of chronic hepatitis C. Through the refinement of interferon and the addition of oral ribavirin, long-term viral clearance has gone from about 5% to now approximately 50% in patients who have never before received treatment.Side effects of treatment, however, are common. There are many ways your health care provider can help you manage these side effects. A gentle modification of your behavior, lifestyle, or routine medical therapy is often the first step. Dose reduction or adding additional medications typically is the second step. Dose reduction is typically only done when the side effects are severe.

Since reducing your dose could also mean reducing your chance of clearing the virus, your provider will carefully weigh the risks and benefits of this approach. The most common side effects from interferon therapy include: fatigue, headache, fever, nausea, weight loss, depression, and skin rash.

Quick Guide for patients on interferon
 
 

Side Effect Management Strategies

Abnormal labs

 • Be patient!  Sometimes your lab results will vary while you are on therapy. 

• Get your labs done as requested by your health care provide, since medication dose adjustments may be needed based on lab tests.


 
Bad taste in mouth

 • Use sugar-free lemon drops or real lemon wedges

• Eat a small amount of yogurt, ½ hour before meals or eat dark chocolate (monitor your glucose levels if you have diabetes)

• Drink lemonade or cranberry juice (monitor your glucose levels if you have diabetes)

• Eat food cold or at room temperature

• Brush teeth frequently, especially after eating, to eliminate metallic taste 

• Use plastic utensils if experiencing metallic taste


 
Cough

 • Increase intake of water or non-caffeinated beverages

• Use a humidifier 

• Try sugar-free hard candy or cough drops


 
Dehydration

 • Increase intake of water or non-caffeinated beverages

• Water down juices, Gatorade* or Crystal Light*

• Avoid caffeinated beverages


 
Depression

 • Talk to your provider about your symptoms and medications that might help

• Always discuss thoughts of harming yourself or someone else with your provider

• Go to the nearest emergency room if you are in danger of harming ourself or others

• Do mild to moderate exercises at least 3 times/week as directed by your provider

• Join a hepatitis C support group


 
Diarrhea 

 • Eat more soluble fiber like Bananas, white Rice, Applesauce and white Toast (the “BRAT” diet)

• Avoid foods that are spicy or acidic 

• Avoid dairy products up to several days after diarrhea resolves

• Maintain adequate fluid intake (at least six to eight 8-oz glasses/day)

• Your provider may recommend loperamide (Imodium*) or methylcellulose (Citrucel*) or psyllium (Metamucil*)


 
Dry mouth or Mouth ulcers 

• Brush teeth frequently, especially after eating

• Avoid mouthwash containing alcohol

• Drink plenty of water or use ice chips or sugar-free lemon drops

• Other medications may be needed for mouth sores/ulcers

• Ask your provider about medications that may help


 
Fatigue

 • Try low-impact exercise such as walking or low-impact aerobics as directed by your provider

• Maintain adequate fluid intake (may have a caffeinated beverage in the morning)

• Take a short nap during the day

• Lessen your work schedule if possible

• Eat well-balanced meals every day


 
Fever & Chills

 • Try injecting interferon at bedtime if fever/chills develop 1-3 hours after injection

• Take acetaminophen (Tylenol*) about 30-60 minutes before weekly interferon injection

• Take acetaminophen (Tylenol*) 1-2 tablets prior to interferon injection and repeat 4-6 hours later if needed up to a maximum of 2,000 mg/day. Thus, do not exceed 6 tablets/day of 325 mg or 4 tablets/day of 500 mg acetaminophen (Tylenol*).  

• Use ibuprofen [Advil*, Motrin*] or naproxen [Aleve*] if approved by your provider

• Try a cool sponge bath, ice pack or cold pack when you have a fever

• Use extra blankets and clothes when you have the chills

• Notify your provider if your temperature is above 101ºF for more than 24-48 hours


 
Hair thinning or Hair loss

 • Avoid harsh hair products such as dyes, perms, gels, sprays and mousses

• Use a mild shampoo such as baby shampoo

• Avoid braiding hair; use a wide-tooth comb or soft brush

• Wear a cap, scarf, turban or wig 


 
Headaches

 • Maintain adequate fluid intake 

• Take acetaminophen (Tylenol*) or ibuprofen (Motrin*, Advil*) as directed by your provider

• Keep lights dim, wear sunglasses or stay in darkened rooms

• Try to get plenty of rest


 
Injection site reactions

 • Before injecting, warm your medicine by gently rolling the syringe in your hands for a minute

• Rotate/alternate your injection site - thigh, upper arm and abdomen. If you are thin, use the thigh area

• Do not inject into an area that is irritated, bruised or red

• Do not rub injection site 

• Apply a cold pack

• Your provider may recommend applying hydrocortisone cream or other medications to help

 


Insomnia

 • Go to sleep and wake up at the same time every day

• Do not read or watch TV in bed

• Limit daytime naps

• If ribavirin makes you jittery, take at 4-5 pm instead of before bedtime

• Limit fluid intake for 2 hours before bedtime to avoid having to get up to go to the bathroom

• Avoid caffeinated products, especially in the afternoon and at night 

• Avoid heavy meals close to bedtime

• Take warm baths, read or listen to music, get a massage

• Try a glass of warm milk (contains tryptophan, a natural sleep agent)

• Diphenhydramine (Benadryl*) or other medications may be recommended by your provider


 
Irritability & Anxiety

 • Talk to your provider about your symptoms and medications that might help

• Always discuss thoughts of harming yourself or someone else with your provider

• Go to the nearest emergency room if you are in danger of harming yourself or others

• Do mild to moderate exercises at least 3 times/week as directed by your provider

• Try relaxation techniques such as deep breathing, taped exercises, yoga, Tai Chi or meditation

• Avoid stimulants like caffeine and maintain adequate fluid intake

• Join a hepatitis C support group


 
Muscle & Body aches

 • Try injecting interferon at bedtime if body aches develop 1-3 hours after injection

• Take acetaminophen (Tylenol*) about 30-60 minutes before weekly interferon injection

• Take acetaminophen (Tylenol*) 1-2 tablets prior to interferon injection and repeat 4-6 hours later if needed up to a maximum of 2,000 mg/day. Thus, do not exceed 6 tablets/day of 325 mg or 4 tablets/day of 500 mg of acetaminophen (Tylenol*).

• Use ibuprofen (Advil*, Motrin*) or naproxen (Aleve*) if approved by your provider

• Try low-impact exercise such as walking or low-impact aerobics as directed by your provider

• Maintain adequate fluid intake (at least six to eight non-caffeinated 8-oz glasses/day)

• Apply warm moist heat or massage areas


 
Nausea & Vomiting

 • Take ribavirin with food 

• Eat small meals

• Avoid foods or smells that trigger nausea. Try eating cold foods and avoiding cooking smells

• Eat healthy foods. Avoid greasy, spicy, acidic or sweet foods

• Try eating ginger in ginger tea, ginger ale or gingersnaps

• Eat some crackers or dry white toast if you feel sick in the morning 

• Over-the-counter antacids or other medications may be recommended by your provider


 
Poor appetite

• Eat smaller, more frequent (4-6) meals throughout the day 

• Drink protein drinks (Carnation Instant Breakfast*, Ensure* or Boost*) 

• Eat snacks with protein (cheese, peanut butter, eggs)

• Eat whatever appeals to you even if not hungry. Eat a variety of foods

• Walk before a meal


 
Rashes & Dry skin

• Avoid long, hot showers or baths

• Use moisturizing soaps (Dove*, Oil of Olay*, Cetaphil*)

• Use moisturizing lotion after showers (Aquaphor*, Absorbase*, Lac-Hydrin*) 

• Use mild unscented laundry detergents and avoid fabric softeners

• Use sunscreen 

• Try rubbing or pressing on the itchy areas rather than scratching 

• Use petroleum jelly on dry, itchy areas.  Your provider may recommend other agents to help


 

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