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Learn how the side effects of hep C therapy have changed as the drugs have improved, and how to handle them

By Marijke Vroomen Durning, RN

Not long ago, side effects from treatment for hepatitis C (or hep C, also known as HCV, for hepatitis C virus) caused many people to reduce their doses of medicine, stop treatment early — or not start it at all. But with the newer drugs known as direct-acting antivirals (DAAs), people experience fewer side effects, and the ones that can happen are often less serious and easier to tolerate. Mark Mailliard, MD, chief of the gastroenterology and hepatology division at University of Nebraska Medical Center in Omaha, says the newer drugs have reduced side effects by about 90% over drugs that were used before 2005.  

Yet although these older medications, such as interferon (a long-acting antiviral drug that’s injected similar to drugs given for chemotherapy), have the potential for serious side effects, many people still need them to treat their hep C. And whenever you take any drug, you should know which side effects are common and likely not harmful, and which you need to tell your healthcare provider about right away. Here's a guide to side effects for both types of medications, and advice to help you manage them.

Common Side Effects of DAAs and Tips for Helping to Manage Them

There are several commonly reported side effects of DAAs that may improve if you try some of the following tips:

Headaches:

• Drink plenty of water
• Limit or eliminate caffeine (in beverages as well as foods, such as chocolate)
• Stay away from loud noises, bright lights and strong odors and avoid any personal headache triggers
• Get a good night's sleep as often as possible, but don't oversleep

Tiredness or fatigue:

• Practice “good sleep hygiene”: keep your room dark and quiet, avoid using electronics right before bed and follow a regular bedtime routine, etc.
• Take short naps as needed, but not too late in the day
• Complete tasks earlier in the day, when you have the most energy
• Eat a balanced diet

Nausea:

• Ask your pharmacist if you can take the medication with food
• Ask your pharmacist or specialist if you should take an antacid or an antiemetic, a type of medication for treatment of nausea
• Eat small, frequent meals
• Drink water and other fluids that don’t upset your stomach

Insomnia:

• Exercise, but not too late in the day
• Practice good sleep hygiene (see above)
• Avoid caffeine and other stimulating food and beverages, such as ones that are spicy or acidic
• Try relaxation or meditation techniques like yoga or meditation

Common Side Effects of Older Medications and Tips for Feeling Better

The more common side effects of older drugs include those listed above, as well as:

Fever:

• Take a fever-reducing medication, such as acetaminophen or ibuprofen, with your specialist’s approval, a half-hour to an hour before injecting the medication
• Try cooling methods like ice packs or cool compresses

Muscle and body aches:

• Take acetaminophen or ibuprofen, with your specialist’s approval, a half-hour to an hour before injecting the medication
• Drink plenty of water
• Do gentle or low-impact exercise 
• Apply warm, moist heat and gently massage the sore areas

Depression or anxiety:

• Exercise at least 3 times a week
• Ask for help from those around you and/or join a support group (like MedHelp’s Hepatitis C Community)
• Try relaxation or meditation techniques like yoga or meditation 
• Consider meeting with a therapist
• Discuss your symptoms with your specialist to see what may be done 

Dry mouth or ulcers in your mouth:

• Drink plenty of water and other beverages that don’t irritate your mouth
• Suck on ice chips or sugar-free candies
• Brush your teeth often
• If you use mouthwash, make sure it’s alcohol-free
• Talk to your specialist, as there are medications that may help relieve the discomfort

Poor appetite, bad taste or nausea and vomiting:

• Eat smaller, more frequent meals
• Use smaller plates, so portions aren’t overwhelming
• Avoid fatty, spicy foods
• If smells turn you off, eat cold foods that don’t need to be cooked or warmed 
• Eat dry crackers when your stomach is empty, to keep away the hunger that can trigger nausea
• Ask your pharmacist or specialist about taking an antacid or anti-nausea medication

Diarrhea:

• Drink plenty of water and other fluids that don’t upset your stomach
• Avoid spicy foods and dairy products

Hair loss or thinning:

• Choose mild hair products
• Groom gently: use a soft brush, and don’t pull at tangles

Skin rash:

• Avoid skin products that contain perfume
• Wear cotton or other natural fibers as much as possible
• Don’t rub or scratch your skin

Contact your specialist if:

• Your fever is above 101° for more than 24 to 48 hours
• You can’t eat regular meals because of nausea or you can’t stop vomiting
• You can’t control your diarrhea by following the advice here, it’s causing skin irritation, or it doesn’t go away
• You have a skin rash, especially if it causes your skin to crack or break, you develop any swelling or soreness in the area of the rash, or it gets worse instead of better
• You experience shortness of breath or changes in your eyesight

Go to the nearest emergency room if: 

• You have any thoughts of harming yourself or others
• You’re experiencing chest pain or having difficulty breathing

Remember that many patients don’t experience any side effects with their hep C treatment, especially if they’re using one of the newer drugs. But if you do experience side effects, working with your specialist and pharmacist may help you eliminate them or, at least, lessen their severity. Learn about lifestyle changes to boost your chances of successful treatment. 

Published on March 1, 2016. Updated on April 5, 2017.

Marijke Vroomen Durning, RN, has written articles for numerous healthcare sites and is the author of Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.