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A dear friend with genotype 1 hepatitis C contacted me. He was excited because his doctor prescribed hepatitis C treatment for him for the first time. My friend has multiple medical problems, including pain, fatigue, insomnia, depression, and anxiety (emphasis on the anxiety). Because of his complex health problems, his doctor advised against peginterferon, and counseled my friend to wait. The doctor gave my friend the green light, prescribing 24 weeks of ribavirin and sofosbuvir (Sovaldi). My friend got the impression he would not have any side effects.

He practically had an anxiety attack as I listed the side effects of these two medications. However, information is power. Knowing what might happen can help us prepare. Unlike my friend, I was not prepared for side effects. As a two-time veteran of interferon-based hepatitis C treatments, I thought that interferon-free would be a cakewalk. Call it whatever you want--denial, stupidity, or sheer egotism, I honestly thought that after 48-weeks of peginterferon and ribavirin I could handle anything. Although it was an improvement, I was caught unprepared. It was quite humbling for a nurse who has written two books to help patients prepare for hepatitis C treatment.

At the end of this blog I will list the side effects for ribavirin and sofosbuvir (Sovaldi). Keep in mind that despite this frightening list, 99% of patients in clinical trials made it through treatment without quitting. Nearly 90%  succeed in clearing hepatitis C, so although it isn’t an easy treatment, the outcome is worth working for.

And although I was not prepared for the side effects I experienced, every single side effect was manageable. This is where I followed the advice in my books, and now I am happily free from hepatitis C. Don’t let these possible side effects scare you--just be smarter than I was before starting hepatitis C treatment.  

Here are some known side effects of ribavirin from Drugs.com:

More common:

  • acid or sour stomach
  • anxiety
  • being forgetful
  • belching
  • black, tarry stools
  • blurred vision
  • body aches or pain
  • bone pain
  • change in taste or bad, unusual, or unpleasant (after) taste
  • chest pain
  • congestion
  • cough or hoarseness
  • cracked, scaly skin
  • crusting, irritation, itching, or reddening of the skin
  • crying
  • depersonalization
  • diarrhea
  • difficult or labored breathing
  • difficulty with moving
  • discouragement
  • dizziness or lightheadedness
  • dry mouth
  • dryness of the throat
  • dysphoria
  • euphoria
  • feeling of constant movement of self or surroundings
  • feeling sad or empty
  • feeling unusually cold
  • fever or chills
  • general feeling of discomfort or illness
  • hair loss or thinning of the hair
  • headache
  • heartburn
  • hyperventilation
  • indigestion
  • irregular heartbeats
  • irritability
  • joint pain
  • lack of appetite
  • lack or loss of strength
  • loss of interest or pleasure
  • lower back or side pain
  • menstrual changes
  • mental depression
  • muscle aches and pains
  • nausea
  • nervousness
  • pain or tenderness around the eyes and cheekbones
  • painful or difficult urination
  • pale skin
  • paranoia
  • poor concentration
  • quick to react or overreact emotionally
  • rapidly changing moods
  • rash
  • restlessness
  • right upper abdominal or stomach pain
  • runny nose
  • sensation of spinning
  • shaking
  • shivering
  • shortness of breath
  • sleeplessness
  • sneezing
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • stomach discomfort, upset, or pain
  • stuffy nose
  • sweating
  • swelling
  • swollen joints
  • tender, swollen glands in the neck
  • tightness in the chest
  • trouble with concentrating
  • trouble with sleeping
  • trouble with swallowing
  • troubled breathing with exertion
  • unable to sleep
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • voice changes
  • vomiting
  • weight loss
  • wheezing

Less common

  • back pain
  • bleeding gums
  • blood in the urine or stools
  • burning, dry, or itching eyes
  • constipation
  • depressed mood
  • discharge, excessive tearing
  • dry skin and hair
  • feeling cold
  • feeling of warmth
  • hair loss
  • husky voice
  • muscle cramps and stiffness
  • pinpoint red spots on the skin
  • redness of the face, neck, arms, and occasionally, upper chest
  • redness, pain, swelling of the eye, eyelid, or inner lining of the eyelid
  • right upper abdominal or stomach fullness
  • skin rash, encrusted, scaly, and oozing
  • slowed heartbeat
  • weight gain

Incidence not known

  • blistering, flaking, or peeling of the skin
  • change in or loss of hearing

Here are some known side effects of ribavirin and Sovaldi from the package insert listed in descending order of frequency:

  • Fatigue
  • Headache
  • Nausea
  • Insomnia
  • Pruritus (itching)
  • Anemia  
  • Asthenia (weakness)
  • Rash  
  • Decreased Appetite
  • Chills
  • Influenza-like Illness
  • Pyrexia  (fever)
  • Diarrhea
  • Neutropenia (low white cells)
  • Myalgia (muscle aches)
  • Irritability

Less Common Adverse Reactions Reported in Clinical Trials (<1%):

  • Hematologic Effects: pancytopenia (drop in platelets, red and white blood cells) - particularly in subjects receiving pegylated interferon.
  • Psychiatric Disorders: severe depression (particularly in subjects with pre-existing history of psychiatric illness), including suicidal ideation and suicide.