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
- 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
- trouble sleeping, and
- The combination of elbasvir and grazoprevir (Zepatier) is well-tolerated. Most common side effects include
- headache, and
- 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.