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									Managing Side Effects –
Peginterferon and Ribavirin Therapy -- Dual or Triple Therapy
You may experience undesirable side effects of hepatitis C treatment. Below is a list of the most common
possible side effects and recommended measures to control them.

Flu-like Symptoms: Fever, Chills, Muscle and Joint Aches
 This will most likely be at its worst after your first injection, but may continue somewhat throughout
 You may use acetaminophen (Tylenol), ibuprofen (Motrin, Advil) or naproxen sodium (Aleve). Use of
   aspirin depends on platelet count. Take before the injection and repeat the next day.
 Good hydration is important. Drink non-caffeinated fluids. Divide your weight in half and drink at
   least that amount in ounces every day.

 Tends to occur on trunk and arms but can be anywhere. May be reddened, raised and very itchy. Try
   Claritin or Benadryl. Contact us if it persists. (See additional rash sheets)

 Most common and long lasting of the side effects. Can be caused be anemia, depression, lack of sleep,
   inactivity, poor nutrition or no identifiable reason.
 Plenty of fluids, regular exercise, sleep and good nutrition may increase energy.

 May be described as feeling sad, “the blues,” anxious, crabby, “short-tempered,” loss of interest in usual
  activities and relationships.
 Contact your provider if you are experiencing any of these symptoms. Medications or consultation with
  a psychiatrist/counselor may be necessary.

Loss of Appetite/Taste Changes/Bad Taste in Mouth
 Weight loss is common. You may not feel like eating the usual three meals a day.
 Eat frequent small meals. Low-fat, easily digestible foods may be more tolerable. Fruits and vegetables
   retain their usual flavor. Try plastic utensils if metallic taste is a problem.
 Try lozenges, hard candies, peppermint for the bad taste in mouth

Nausea, Vomiting, Diarrhea
 Eat small meals of bland foods. Drink flat ginger ale. Medications may be needed.
 Try methycellulose or psyllium products to control bowel changes.

Anorectal symptoms – burning, discomfort
 May use topical over the counter steroid creams, hemorrhoid cream or Boudreaux’s butt paste
 Gentle cleansing of anorectal area. Avoid scratching or harsh rubbing of perianal area.
 May use over the counter antihistamines or prescription antihistamines at bedtime.
Thinning Hair
 Hair breaks easily and releases out of the scalp.
   Gentle hair care. Wash less frequently with mild shampoo. Use soft brushes, wide-tooth combs, and
    satin pillowcases. Avoid bleaching and coloring – use rinses if necessary.

Dry Skin
 Avoid hot showers, use mild soaps, and apply moisturizers immediately after showering. Use good
   creams and lotions often.

Injection site reaction
 A day or two after doing the injection, the skin may get reddened and stay that way for 1-2 weeks. It
    should not be hard, painful or hot to touch. It may be itchy and dry.

Thyroid Dysfunction
 We monitor your thyroid function throughout therapy. A change in function could be permanent and
   necessitate replacement by a medication.

Shortness of Breath, Chest Discomfort, Cough
 These are all side effects of the ribavirin. Shortness of breath can also occur from a low or sudden drop
   in the hemoglobin.
 The cough can be dry, hacking or accompanied with clear phlegm. It can be difficult to distinguish
   from asthma or other respiratory problems.
 Do not assume all chest pains are a medication side effect. If there is any question seek medical

 Can be quite troublesome or debilitating. Usually are relieved with over-the-counter medications.

Lowered Blood Counts
 The hemoglobin is affected mostly by ribavirin and interferon lowers the white blood cells and platelets.
  It is very important that lab appointments are not missed. Other medications are occasionally needed to
  boost production of red and/or white cells.

Dry Mouth
 Drink plenty of fluids. Eat softer moister foods. Try sugarless candy. Perform good oral hygiene.
   Avoid mouthwash with alcohol.

Overall Treatment Recommendations
 Drink plenty of water, with most of the fluid early in the day to avoid nighttime urination.
 Good nutrition, frequent small meals generally better tolerated.
 Regular exercise.
 Fatigue is common but avoid sleeping during the day. If tired, rest during the day or take a short nap,
   otherwise you may not sleep at night.
 Take the injection before going to bed and use over-the-counter products to decrease symptoms.
 Do not forget your lab appointments. Your medications may not be refilled if no current labs are
                         Minnesota Gastroenterology: 612-871-1145

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