November 30, 2015
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Hepatitis C (cont.)

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

Common side effects of interferon or pegylated interferon include:

Depression may be serious and is common enough that patients should be monitored for this side effect, and often lead to discontinuation of the drug. Depression (if pre-existing) also is one of the most common reason to not treat patients.

Interferons may cause transient bone marrow suppression resulting in reduced white blood cell and/or red blood cell counts (leucopenia and anemia, respectively). Reductions in white blood cell counts may cause increased susceptibility to infection. Growth factors (erythropoietin) can be used to improve the anemia associated with interferon. Death rarely occurs as a result of therapy, but may occur from progressive liver failure in patients with advanced cirrhosis.

Certain side effects are attributed to the addition of ribavirin to interferon, including:

Ribavirin also causes anemia due to the destruction of red blood cells (hemolysis). This anemia is usually mild but can become clinically significant. Ribavirin particularly may cause destruction of red blood cells (hemolysis) in people with kidney failure. Anemia improves with a reduction in the dose of ribavirin.

Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans as yet, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.

The side effects of direct acting antivirals have fewer and more tolerable. The most common and significant side effects of direct acting antivirals include:

  • fatigue (feeling tired, lacking of energy),
  • headache, and
  • trouble sleeping (insomnia)

Boceprevir (Victrelis) also may cause (in the addition to the above):

  • irritability,
  • gastrointestinal upset, and
  • anemia.

Sofosbuvir (Sovaldi) also may cause:

  • less fatigue,
  • headache

Sofosbuvir has a minimal effect on blood counts.

The most common side effects of Simeprevir (Olysio) are:

  • itching,
  • skin rash, and
  • photosensitivity.

Simeprevir also has significant interactions with other medications. Certain medications that affect the levels of drug-eliminating enzymes in the liver, known as cytochrome P450, can affect levels of simeprevir in the body and make simeprevir less effective or more toxic.

Ledipasvir/sofosbuvir (Harvoni) is very well tolerated with the most common side effects being fatigue and headache.

The combination of ombitasvir, paritaprevir and ritonavir tablets with dasabuvir tablets (Viekira Pak) is also very well tolerated, and the most commonly reported side effects are:

  • fatigue,
  • trouble sleeping, and
  • itching.

These side effects usually do not require discontinuation of therapy and are self-limiting after completion of therapy

Medically Reviewed by a Doctor on 5/26/2015


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