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What are the side effects of treatments for hepatitis C infection?

Side effects of interferon or pegylated interferon

  • The most common side effects of interferon or pegylated interferon include fever, flu-like symptoms, and depression. Patients must be monitored closely for depression. Risk of suicide is a reason to avoid interferons.
  • Interferons also reduce white blood cell and/or red blood cell counts (leucopenia and anemia, respectively). This may cause increased susceptibility to infection. Interferons also increase the risk of certain cancers. Death rarely occurs as a result of therapy, but may occur from progression of liver failure in patients with advanced cirrhosis.

Side effects of ribavirin

  • Ribavirin most commonly causes anemia due to destruction of red blood cells (hemolysis). This can be severe enough that people with heart disease may suffer a heart attack from insufficient blood flow, so people with heart disease should not receive this drug. Anemia improves with a reduction in the dose of ribavirin. Injected growth factor (erythropoietin) that stimulates the production of red blood cells often is used to improve the anemia associated with ribavirin. Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.

Side effects of DAAs

Compared to these drugs, the side effects of DAAs are far fewer and more tolerable. These side effects usually do not require discontinuation of therapy and are self-limiting after completion of therapy.

  • The most common and significant side effects of boceprevir (Victrelis), sofosbuvir (Sovaldi), and ledipasvir/sofosbuvir (Harvoni) include
    • fatigue (feeling tired),
    • headache, and
    • trouble sleeping (insomnia).
  • The most common side effects of simeprevir (Olysio) include
    • itching,
    • skin rash, and
    • photosensitivity (tendency to get sunburns).
  • Simeprevir has significant drug interactions with other medications. Certain medications can affect levels of simeprevir in the body and make simeprevir less effective or more toxic.
  • The combination of ombitasvir, paritaprevir, and ritonavir tablets with dasabuvir tablets (Viekira Pak) is very well tolerated, and the most commonly reported side effects are
    • fatigue,
    • trouble sleeping, and
    • itching.
  • The combination of elbasvir and grazoprevir (Zepatier) is well-tolerated. Most common side effects include
    • fatigue,
    • headache, and
    • nausea.
    • It may be used with ribavirin, which adds the side effect of anemia.
    •  About 1% of people in studies may develop elevated liver enzyme blood tests last into treatment or afterward, so these tests are closely monitored.
  • Use of milk thistle should be discussed with the treating doctor, because it interacts with several DAAs.
Return to Hepatitis C (HCV, Hep C)

See what others are saying

Comment from: Margaret, 65-74 Female (Patient) Published: April 05

I was diagnosed with hepatitis C when I was 72. After months of testing, the doctor and I decided the treatment would be worth it. The drugs used were ribavirin, Incivek and interferon. After the 6 month treatment my viral load was negligible. I go back for an update on lab, etc. in June. I am now almost 76. Should we find that the hepatitis C is active, I would never submit to treatment again. I was so sick, hated the food that goes along with one of the drugs, was nauseated constantly, was anemic, and had absolutely no energy. Sometimes ignorance is bliss. The doctor explained what to expect. I assured him I was a fighter and could deal with it. After I started the treatment, I was determined to finish it, and I did. Now that I know how awful it is, I definitely would not do it again. I hope the new drugs will be a blessing to folks who are diagnosed now. I understand that the new drugs can't be used after being treated the old way. I don't know if this is correct information or not. Good luck to all of you who are dealing with this.

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Comment from: krystalblue, 55-64 Female (Patient) Published: December 12

It has been 11 years of recovery for me. I did the yearlong treatment which also most killed me. I lost over 50 lb., plus loss of hair which is so normal. I was stage 4 liver failure. Today I test as if I never suffered hepatitis C. Thanks modern science. My main concern is the memory loss and long term lack of concentration. My doctor told us of the memory loss but you always figure it would return, but still is deeply affected.

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Comment from: a friend, 45-54 Female (Patient) Published: October 31

I found out I had hepatitis C 20 years ago but in the last couple of years my levels were elevated and I ended up on interferon and developed cirrhosis of the liver, stage 4. It was the hardest year of my life being on that treatment and it did a lot of damage to my teeth, you lose your hair (which of course grows back) and I got a lot of scarring from itching. The treatment has a lot of side effects and I will say causes major depression and suicidal thoughts. You need to have a lot of support which I didn't. I ended early (some people do the 6 month treatment and others have to do the yearlong treatment). I would say one needs to take good care of oneself while on the treatment. It did work for me but I'm just now, 13 months later, getting over the trauma of being on the treatment. Well, you have to do it or die from liver problems. I get checked every 3 months to see how I'm doing.

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