Here are some tips for managing the side effects of hepatitis C treatment:
- Prior to starting hepatitis C treatment, tell your health care provider and pharmacist about all prescription and nonprescription drugs and supplements that you take. Continue this practice throughout treatment. Avoid potential drug interactions by checking in with your provider and pharmacist prior to adding a new drug or supplement while on hep C treatment.
- Ask your health care provider about how to take your medication, and then create a routine. Some people find it helpful to use weekly pill organizers or other reminders.
- Report side effects to your health care provider. It is better to mention a side effect in its early stages rather than waiting until it becomes a bigger problem.
- Make use of additional resources that may help you during treatment. Most drug manufacturers offer support services, available 24/7 via a toll-free number. Some insurance companies and specialty pharmacies also offer free advice services. These are handy to use, especially if you are wondering whether you should call your health care provider after regular business hours.
- Join a hep C support group, such as the Hep Forum. Talking to others who have experience with HCV treatment can be enormously useful.
- Stay current on recommended vaccines. It is OK to have a flu shot and other immunizations while taking HCV medications.
- Aim for a healthy lifestyle. Try to eat a diet that is rich in vegetables, fruit and low-fat proteins (such as chicken, fish, beans and yogurt). Drink six to eight glasses of water a day. Be physically active every day. Sleep seven to nine hours a night. Engage in activities that bring you pleasure, and find ways to reduce stress.
- Remember to keep regular lab appointments and medical visits. A calendar, smartphone or other device can help to remind you.
Here are some tips for dealing with specific side effects:
- Cough, runny nose, sore throat
- Dizziness and lightheadedness
- Gastrointestinal Disorders (abdominal discomfort, decreased appetite, diarrhea, nausea)
- Impaired concentration
- Mood issues (depression, anxiety, irritability, moodiness)
- Pain (back, joint, muscle)
- Shortness of breath
- Skin problems (rash, itching, dry skin, photosensitivity reaction)
Anemia—Anemia rarely occurs now that direct-acting antivirals (DAAs) are used. However, in some cases, ribavirin is still prescribed. This drug can cause the red blood cells to burst, resulting in hemolytic anemia. The bone marrow can’t make new cells fast enough, so you may feel like you are running on three cylinders. Some symptoms of anemia are fatigue, weakness, shortness of breath, dizziness, and a rapid heart rate during periods of exertion. You may be pale, and your hands and feet may be cold.
There are many other types of anemia, and various blood tests will help your health care provider determine whether and what kind of anemia you have. You can’t fix anemia yourself. You may have heard of iron-deficiency anemia, and wonder whether you can take iron, but don’t unless your doctor prescribes it. Extra iron may harm your liver.
The body can function with a certain amount of anemia, but if your hemoglobin is too low, your doctor may lower your medication dose or order a blood transfusion. Take it easy and don’t overexert yourself. See tips for managing fatigue and dizziness.
Cough, runny nose, sore throat—These side effects rarely occur when being treated with direct-acting antivirals (DAAs). If mild, manage these as you would if you had a cold. Drink plenty of liquids. Throat and cough lozenges may be soothing. Use a humidifier or keep a bowl of water in the room to increase humidity. Avoid irritants such as smoke and cold air.
Dizziness and lightheadedness—These side effects rarely occur when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Dizziness and lightheadedness are sometimes used interchangeably, but they are different. Dizziness is when the world is spinning around you and it may be hard to maintain balance. Lightheadedness is when you feel like you are about to black out or faint and is more common than dizziness. Feeling lightheaded may indicate anemia, so be sure to discuss this with your health care provider.
A common reason people feel lightheaded is a sudden drop in blood pressure, particularly after standing up too quickly. Low blood sugar and dehydration may also cause you to feel lightheaded. Here are some tips to help with lightheadedness:
- Stay hydrated. If your urine is clear or pale yellow, you are probably drinking enough fluids.
- Eat at regular intervals, and avoid going for more than four or five hours without eating something nutritional.
- When moving from sitting or reclining to standing, do so slowly and gradually. Wiggle your toes, flex your feet and move your legs before you get up. Squeeze and relax your leg muscles before and as you rise. This helps to pump the blood to your upper torso.
- Replenish your electrolytes if you are overheated or sweating too much.
- Stay active. Exercise helps circulation.
- If the problem is severe or your legs are swollen, ask your health care provider whether you should wear compression socks or stockings.
- If you feel lightheaded, sit or lie down to avoid fainting and possibly injuring yourself.
Fatigue—In addition to being a side effect of HCV medications, fatigue is a symptom of hepatitis C infection. Since there are many causes of fatigue, such as anemia, depression, insomnia, pain and thyroid problems, report this to your health care provider. Here are some tips to help with fatigue:
- Get enough sleep. The National Sleep Foundation recommends seven to nine hours of sleep per night for adults. If sleep is a problem, discuss this with your health care provider.
- Light exercise is a good remedy for fatigue. Find an activity you like or can tolerate, and do it for 10-to-15 minute intervals, two to three times daily. If you are not accustomed to physical activity, start with five minutes. Activities to try are walking, biking, swimming, dancing, gardening, yoga and tai chi.
- Vary your activities—do not sit too long or stand too long.
- Drink plenty of water.
- According to the Institute of Medicine, men need about 13 cups (3 liters) of total beverages a day; women need about 9 cups (2.2 liters) daily. If you are drinking enough liquids, your urine will be pale yellow or colorless.
- Stress can be wearing. Reduce stress and find ways to relax.
- Take short naps of 20 minutes or less. Don’t nap close to bedtime.
- Use caffeine. Coffee and tea may give you a lift. Coffee may protect the liver and help with HCV treatment side effects. Do not drink caffeinated drinks late in the day, as this may interfere with sleep.
- Prioritize your tasks. This is a good time to do what is necessary, and focus on completing treatment.
- Ask for help. Some of us feel good when we can help someone else, so we are helping others to feel good when we let them help us.
- Abdominal discomfort—You may experience occasional mild upset stomach. Call your health care provider if you have severe or chronic stomach pain. Some stomach medications may interfere with HCV drugs, so ask your health care provider or pharmacist to recommend safe over-the-counter medications. Try not to get too hungry, as stomach pain may be caused or worsened by hunger. Eat small, frequent meals.
- Decreased appetite—Try to eat small, frequent meals of nutritional, high-calorie foods such as peanut butter, nuts, avocados, protein shakes and smoothies. If weight loss is a problem, supplement with nutritional powders and drinks. If food doesn’t taste good, try to vary what you eat.
- Diarrhea—Frequent, loose, watery stools are a side effect of most of the HCV drugs. Be sure to drink plenty of clear liquids, such as water, tea, juice and broth. Gradually add solid food to your diet, starting with crackers, toast, rice, eggs or plain chicken. Avoid high-fiber, fatty, greasy and spicy food. Avoid alcohol, coffee and dairy. Ask your doctor whether you should take over-the-counter anti-diarrheal medications, such as Imodium A-D (loperamide) or Pepto-Bismol (bismuth subsalicylate).
- Nausea—If you are taking ribavirin, try taking it with food. Hunger can intensify nausea, so eat a cracker or other small piece of food every hour. Ginger helps with mild to moderate nausea. Peppermint, chamomile or raspberry leaf tea may also alleviate nausea. Try an acupressure technique by applying pressure to the inside of your wrist, approximately two fingers above the crease where your hand meets your arm. You may also purchase wristbands developed for motion sickness sold in drugstores. If nausea is severe or you are vomiting, your health care provider may prescribe something for you.
Headache—Dull headaches are common during HCV treatment, and will usually respond to over-the-counter pain relievers. Limit the use of pain relievers, as overuse of these drugs may cause a rebound headache. This means that the headache will most likely return once the relief wears off. Dull headaches may respond to acupressure. Try pinching the deep tissue between your thumb and forefinger with your other hand. Hold it for at least seven seconds, repeating until the headache fades. For stubborn headaches, relax in a dark room for a while. Some people report that caffeine improves a headache, and some say it will cause or worsen a headache. You may have to experiment with this yourself.
Impaired concentration—This side effect rarely occurs when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Ribavirin may cause you to feel foggy and impair your ability to concentrate. Also, you may have difficulty concentrating if you aren’t getting sufficient sleep. This is normal, albeit frustrating. Things to try include: drinking enough fluids, getting extra sleep, taking short walks, increasing your oxygen intake by deep breathing, getting some fresh air, and finding ways to relax. Humor may also provide some relief.
Insomnia—Whether the issue is getting to sleep or staying asleep, insomnia is especially frustrating. It’s better to address sleep problems early, before a poor sleep pattern is established. Your health care provider may be able to prescribe something for sleep. Some patients find that when they take antihistamines for rashes, it also helps them sleep. Here are some tips to help you sleep:
- Turn off the computer, TV and other electronic devices an hour or two before bedtime.
- Create relaxing bedtime rituals. Read, meditate or listen to relaxing music before retiring.
- Exercise during the day may help you sleep better at night.
- Avoid coffee, soda, tea, chocolate and anything else with caffeine late in the day.
- Other things that may interfere with a good night’s sleep are alcohol, certain drugs, eating before bedtime and going to bed hungry.
- If noise disturbs your sleep, try earplugs.
- Your bed is for sleep and sex; it isn’t for worrying. If you are fretting, get up, do something boring for a little while and then go back to bed.
Mood issues (depression, anxiety, irritability, moodiness)—These side effects rarely occur when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Ribavirin and insomnia may cause a variety of neuropsychiatric side effects, such as depression, irritability and moodiness. If you have these side effects, then the question is how severe are they? Thoughts of hurting yourself or others, severe depression or anxiety and rage are serious issues that require immediate help. If you have these thoughts, call your health care provider or 911.
Antidepressant medications may help with depression. If you are experiencing anxiety, your provider may prescribe anti-anxiety medication. If addiction or abuse is a concern, discuss this with your provider. Do not take St. John’s wort if you are taking a direct-acting antiviral such as Harvoni, Olysio, or Sovaldi. Here are some tips to help with moods and other neuropsychiatric side effects:
- Join an HCV support group, such as the HEP Forum. Sometimes it can help to have a place to vent. It can also be uplifting to help others.
- Try to be active every day. Light exercise has been proved to lessen the intensity of depression.
- Go easy on alcohol and drugs that have depressing or stimulating effects. If you can, avoid these altogether.
- Stress makes it harder to cope with depression and anxiety, so find ways to reduce stress. Some ideas to try: Take a walk in a pleasing environment, listen to your favorite music or engage in activities that distracts you.
- Get enough sleep. If sleep is a problem, discuss this with your health care provider.
- Find ways to laugh. Humor reduces stress hormones and has a positive effect on the body.
- Keep life simple. Treatment is relatively short, and you can resume regular activities when you are done.
Pain (back, joint, muscle)—Pain rarely occurs when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Staying active usually helps. Try to avoid prolonged sitting or reclining. Hot baths may soothe aching muscles. Stretching and relaxing may provide relief. Massage, performed by a friend, a professional or yourself, may also help. Talk to your health care provider about taking over-the-counter pain relievers such as Tylenol (acetaminophen), aspirin, Advil/Motrin (ibuprofen) or Aleve (naproxen).
Shortness of breath—This side effect rarely occurs when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Because breathing problems can be life-threatening, shortness of breath without exertion needs immediate medical attention. If you can’t breathe, call 911. However, shortness of breath upon exertion while you are on HCV treatment is a common occurrence, especially if you are taking ribavirin. Your health care provider will monitor you for anemia. Take it easy and don’t overexert yourself.
Skin Problems (rash, itching, dry skin, photosensitivity reaction)—These side effects rarely occur when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used.The most important measure you can take if you get a rash is to tell your health care provider. It is much easier to treat a rash in the early stages, rather than in the later ones. Other tips for skin problems:
- Ask your health care provider about prescription or over-the-counter anti-itch medication, such as hydrocortisone cream.
- Try not to scratch. If you can’t resist, try rubbing itchy areas with an ice cube. You can also apply firm pressure to an itchy area.
- Stay well hydrated.
- Keep your skin moist; begin moisturizing before you develop a problem.
- Avoid extremely hot showers and baths.
- Instead of soap, use a moisturizing cleanser such as Cetaphil or its generic substitute.
- Apply a fragrance-free hypoallergenic cream immediately after bathing. Cream is generally more effective than lotion. For extra protection, mix in a couple of drops of unscented lightweight body oil.
- Avoid direct sunlight and always use sunscreen. Wear protective clothing, and if you must be outside, stay in the shade or use an umbrella.
Weakness—This side effect rarely occurs when being treated with direct-acting antivirals (DAAs), unless ribavirin is also used. Weakness may indicate anemia, so be sure to mention this side effect to your health care provider. Stay well hydrated. For more about weakness, see “anemia” and “dizziness and lightheadedness.”
Last Reviewed: January 4, 2019