Therapy/ Hepatitis C Side Effects

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Therapy/ Hepatitis C Side Effects

The side-effect profile of the pegylated interferons is similar to that of regular interferon. Adverse effects were seen in 42% of patients who received peginterferon and ribavirin, compared with 34% of those who received standard interferon and ribavirinHowever, neutropenia is more common with pegylated interferon than with regular interferonMost experience myalgia, fatigue, headache, and malaise. Some also have fever and rigors. Because interferon raises the body temperature, hydration is extremely important in ameliorating flu-like symptoms.,Fortunately, these symptoms tend to lessen after the first few weeks of therapy.

Flu-like symptoms, weight loss and fatigue

Flu-like symptoms (fever, aches and pains, headache, chills, nausea) are common side effects of interferon-based therapy.

They usually appear 2 to 24 hours after an injection, and tend to lessen over time.

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Taking the PEG interferon injection in the evening helps, as does a low dose of paracetamol (or ibuprophen or aspirin—not recommended for people with cirrhosis) and anti-nausea medication.Drinking plenty of water and juice helps to lessen flu-like symptoms and keep you hydrated..

Weight loss often occurs during HCV treatment, because people may lose their appetite, have diarrhoea, and/or feel nauseated.

..If possible, eat many small, light meals to keep energy up.

..If you have diarrhoea your doctor should check for other causes.Diet advice (including bananas, apples, rice, cereals and toast) can help.Anti-diarrhoea medication such as loperamide may help.Fatigue (feeling tired) is also common.Napping and regular but light exercise, when possible, can help.

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Depression, anxiety, and other psychiatric side effects

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Persons with severe depression, a history of suicidal ideation or attempts, manic-depressive disorder, or other severe psychiatric illness are not candidates for therapy. In select cases, if a patient with a psychiatric disorder is under close monitoring by a psychiatrist, antiviral therapy may be considered.

..Depression and anxiety are commonly reported side effects of interferon..If you have a history of depression you may be at greater risk for developing these side effects during HCV treatment, although depression and anxiety are also common in people who have not experienced them before. Interferon can also cause irritability, difficulty sleeping, mood swings and psychosis.

..It’s important to have access to mental health care before and during (and sometimes after) HCV treatment, so that psychiatric side effects can be treated promptly and appropriately.Some experts think that starting an anti-depressant before going on HCV treatment can help to prevent depression from the interferon. However, as antidepressants and other psychiatric drugs have their own side effects, other experts think it is better to provide these drugs only if and when people need them.

..Being prepared to consider using an antidepressant if you get these side effects is important, as depression is one of the main reasons that people abandon treatment before finishing the full course. Your own history and how you feel about this are important. If you have never suffered depression or mental illness you may not identify the symptoms.It is important to correctly diagnose and properly treat psychiatric symptoms of HCV treatment.

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ThrombocytopeniaThrombocytopenia is a low platelet count, and can be caused by serious liver damage (because the hormone that stimulates platelet production is made in the liver).Thrombocytes or platelets stop bleeding by clotting blood. Serious thrombocytopenia can have life-threatening consequences, such bleeding inside of the brain. If severe thrombocytopenia develops, HCV treatment is usually stopped

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Manufacturer guidelines recommend reducing interferon dosage (to 135 µg peginterferon alfa-2a or to 50% of peginterferon alfa-2b) when the platelet count falls below 80,000/µL, and suspending interferon for platelet counts below 50,000/µL.

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Ribavirin Adverse Effects

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Ribavirin-associated dermatologic side effects include diffuse or localized rash and pruritus, which may be a cause of drug discontinuation. GI side effects, such as nausea and dyspepsia, often occur as a result of ribavirin therapy. Other side effects are irritability, anemia, and fatigue

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Anemia can cause weakness, pallor, shortness of breath, rapid heartbeat and headache.

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Histamine-Like EffectsHistamine is a substance released in response to an allergen. Side effects include itching, stuffy nose, cough, sinusitis, bronchitis and asthma-like symptoms. The NDDIC states that histamine-like symptoms affect 10 to 20 percent of patients.

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The teratogenic effects associated with ribavirin necessitate the use of effective contraception during treatment and for 6 months afterward. Patients should be counseled to practice contraception even if only the male partner is receiving therapy. Unwillingness to use reliable contraception is an absolute contraindication to treatment with ribavirin.

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Hematologic Adverse Effects

;Bone marrow suppression caused by interferon and ribavirin-induced hemolytic anemia are common occurrences. A decrease in hemoglobin levels of at least 2 to 3 g/dL is common and is caused by both hemolysis from ribavirin and bone marrow suppression from interferon, which blunts the reticulocyte response.

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The decrease in hemoglobin is most pronounced during the first 4 to 8 weeks of therapy and gradually stabilizes thereafter.

;Neutropenia

Manufacturer guidelines recommend reducing interferon dosage (to 135 mcg peginterferon alfa-2a or to 50% of peginterferon alfa-2b) when the absolute neutrophil count falls below 750/µL, and suspending interferon for neutrophil counts below 500/µL

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Neutropenia is an abnormally low amount of neutrophils, a white blood cell that fights bacterial infections. Interferon can cause neutropenia. The risk of developing bacterial infections is increased in people with neutropenia.

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Absolute neutropenia may also occur during treatment. This adverse effect is more common in patients treated with pegylated interferon (up to 20% of such patients). Cytopenias are especially common in patients with cirrhosis. However, it was demonstrated in a study that ribavirin and interferon can be used safely in patients with well-compensated cirrhosis, provided they are closely monitored.

Careful monitoring of hematologic parameters is required, especially at the beginning of treatment. A complete blood cell count with differential should be obtained weekly or biweekly for the first 4 to 8 weeks of therapy and monthly thereafter. Because ribavirin-associated anemia may be severe, caution must be used in patients with preexisting anemia or heart disease.

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Some authorities consider these preexisting conditions to be contraindications to therapy

Management of neutropenia is also critical to successful therapy.The use of growth factors (epoetin alfa and granulocyte colony-stimulating factor) has been recommended to prevent interferon and ribavirin dose reductions or discontinuations because of bone marrow suppression and hemolysis. A recent study demonstrated that patients who were treated with epoetin alfa were able to maintain higher doses of ribavirin than those who were treated with standard of care. The effect of using growth factors to achieve SVR has not been extensively studied.

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Also See : Neutropenia During HCV Therapy

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Breathlessness and coughingBreathlessness can be a symptom of anaemia.If your feel breathless or develop a cough, again, tell your doctor. Common treatments for cough are appropriate -- drink more water, avoid smokey places and try over-the-counter cough syrups.

Dyspnea= (shortness of breath) should be evaluated by a clinician to ensure that it does not have a serious cardiac, pulmonary, or other origin which needs to be managed specifically.

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Hair LossInterferon can cause hair thinning, hair loss, hair breakage, and can change the texture of hair. However, some women are under the impression that interferon therapy will cause them to lose all their hair. This is a total misconception. In fact, hair loss while on interferon therapy is infrequent. If it occurs at all, the amount of hair lost is often minimal and usually unnoticeable to others. Women on interferon do not experience hair loss in the way that a cancer patient on chemotherapy does. Hair loss from interferon appears to be most frequent in Caucasians with black hair, and in Orientals. It typically occurs around the third or fourth month of therapy. Hair loss may continue for up to three months after treatment is discontinued. Hair loss is more common among women then it is among men (as well as less socially acceptable)..

If hair loss does occur, there are many steps that women can take to minimize this side effect. Women should refrain from dying or bleaching their hair while on interferon therapy, since this may exacerbate hair loss. A mild hair rinse may be used as an alternative to coloring. Avoid permanents and hair straightening procedures while on therapy. Many women have found the vitamin biotin (a B vitamin) to be helpful. It is advisable to take this vitamin daily a few weeks prior to beginning therapy and to continue while on therapy. A mild shampoo and a detangling conditioner are advisable. Nioxin shampoo, Nioxin conditioner and Nioxin hair growth promoter can help keep hair loss to a minimum while on therapy. Nioxin hair loss treatment should be started about a month prior to starting antiviral therapy. Other recommended shampoos include Tricomin, Revivogen and Nizoral. Minoxidil (Rogaine) liquid topical medication may be of some benefit.

It should be applied only to the scalp and not ingested. It may stop hair loss and thicken the remaining hair, but continued use twice daily for at least 4 months is typically required before obvious results are noted.

..Other tips for diminishing hair loss include: the use of a wide tooth comb, avoidance of curling irons and rollers, and avoidance of daily shampooing. Avoid cornrowing, tight braids and pulling hair back in a ponytail with tight rubberbands. A short haircut may be in order. If hair loss becomes a major problem, medical insurances will typically cover the cost of a wig or a hairpiece. Often a doctor’s note or prescription along with a receipt of purchase is all that is required for insurance reimbursement.

..Fortunately, any hair loss induced by interferon therapy is temporary, and regrowth typically occurs within three to six months from the drug’s discontinuation. The color and texture of hair may differ from the person’s original hair type. In fact, many women have noted that their hair grows back thicker, straighter, and shinier than before!

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http://www.liverdisease.com/womenhcv.html

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Dental ProblemsInterferon therapy may increase the likelihood of tooth decay and dental cavities due to decreased saliva production. Saliva contains antibacterial agents which kill the bacteria that cause tooth decay. It is therefore important to take steps to increase the flow of saliva in the mouth. This can be achieved by chewing sugarless gum and by drinking fluids consistently throughout the day

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Thyroid and Treatment

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Thyroid DysfunctionInterferon therapy can be associated with changes in thyroid function, with both hypothyroidism and hyperthyroidism occurring. Such changes are more common in patients with a history of thyroid dysfunction.l

ManagementSerum thyroid stimulating hormone (TSH) levels should be checked before, during, and after therapy. Free thyroid levels (“free T4â€) also should be assessed if changes in TSH values are noted. Patients should be evaluated by a clinician if biochemical thyroid abnormalities are noted, and should be aware that prolonged thyroid dysfunction is a rare side effect of therapy.Therapy can be stopped and thyroid hormone replacement can be initiated if indicated. .

;Visual Changes

kVisual changes are fairly common, but the exact incidence is unknown.(10) The most commonly documented eye complications are “cotton wool spots†and retinal hemorrhages, but most interferon-related retinopathy is asymptomatic and reversible.

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ManagementIt is reasonable to perform a baseline eye exam in any patient with diseases associated with the retina (eg, diabetes, hypertension) to establish a pretreatment baseline. Any patient who develops visual changes while on interferon should be evaluated by an ophthalmologist. Treatment changes can then be made in consultation with the ophthalmologist based on the findings observed. Patients should know that there have been instances of serious eye injury (eg, optic neuritis, visual loss, retinal detachment) in patients taking interferon, although these are rare and may improve with discontinuation of the medication

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Also see : Hepatitis C Treatment Eye/Retinal & SJS Syndrome Side Effects

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On September 1, 2009 the U.S. Food and Drug Administration (FDA) announced that label warnings for interferon alpha products were updated to reflect some newly recognized safety issues, namely stroke, retinal detachment, peripheral neuropathy, and pulmonary hypertension. Pegylated interferon alpha (Pegasys or PegIntron) is standard treatment for hepatitis C, and pegylated or conventional interferon are used for hepatitis B

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Pegylated interferon can cause serious eye problems in HIV/HCV coinfected patients, says study

,Treatment with pegylated interferon alpha-2b (PegIntron) and ribavirin can cause serious eye problems in individuals coinfected with HIV and hepatitis C virus according to an article published in the September 3rd edition of AIDS.The US investigators recommend that patients coinfected with HIV and hepatitis C and treated with pegylated interferon and ribarvirin receive regular ophthalmic monitoring. Optic neuropathy, including retinal haemorrhage, cotton wool spots and decreased colour vision have been reported in individuals receiving interferon therapy who are monoinfected with hepatitis B or hepatitis C. However, these are the first cases to be reported of serious eye problems developing in HIV and hepatitis C coinfected patients receiving therapy with pegylatedContinue

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Also See : From HCV Advocate

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/SEM_Dental_08.pdfPoor dental hygiene can lead to tooth decay, gum problems,mouth blisters and other infections in the mouth. It is generallyrecommended that a complete dental exam be completedbefore therapy. People are also encouraged to have any potentialproblems, such as dental fillings, gum surgery or rootcanals completed well before starting HCV therapy

A Guide to Hepatitis CTreatment Side Effect Management.

HeadachesAbout 60% of patients experience headaches whileon HCV therapy. Although in some cases the headachesassociated with HCV treatment can be debilitating, mostpeople find that they have mild headaches that come andgo. If you experience a persistent or ongoing headachefor more than 24 hours, contact your healthcare providerimmediately.There are many strategies to help relieve the headachepain. First, it is important to rule out any causesother than treatment side effects that may be causing orcontributing to a headache. Stress, insomnia, and dietcan all induce headaches. After ruling out other possiblecauses, there are some simple steps that may help preventthe occurrence or reduce the severity of a headache.

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http://www.hepatitis.va.gov/vahep?page=prtop04-cs-01

http://Hepatitis Cnewdrugs.blogspot.com/2010/06/therapy-hepatitis-c-side-effects.html