Side Effects of Hepatitis C Treatment: What to Expect

Hepatitis C can be treated and even cured. And treatment is important. Hepatitis C, caused by a virus, can permanently damage your liver if you don't get treatment for it.

Treatment for hepatitis C keeps changing quickly. The standard treatment was typically interferon along with other drugs -- usually ribavirin (Rebetal) and either boceprevir (Victrelis) or telaprevir (Incivek).

But many people have a hard time with interferon’s side effects, which include fatigue, fever, chills, and depression. Treatment now involves direct-acting antiviral drugs (DAAs). These medicines are highly effective for most people with hepatitis C and are interferon-free and often ribavirin-free. This means they typically have fewer side effects. The treatments are often simpler, using fewer pills for a shorter amount of time. DAAs are available as either single drugs or combined with other medicines in one pill.

Glecaprevir and pibrentasvir (Mavyret) is a fixed-dosage combination pill. The recommended dosage is 3 tablets daily. This medication offers a shorter treatment cycle of 8 weeks for adult patients with HCV who don’t have cirrhosis and who have not been previously treated. Treatment length is longer for individuals who are in a different disease stage. Vosevi is a combination of sofosbuvir, velpatasvir and voxilaprevir that has been approved to treat adults with chronic HCV either with no cirrhosis or with compensated cirrhosis who have already had certain treatments.

Elbasvir-grazoprevir (Zepatier), ledipasvir-sofosbuvir (Harvoni), and sofosbuvir-velpatasvir (Epclusa) and are once daily combination pills. Depending on the type of hepatitis C infection, these can often cure the disease in 8 to 12 weeks. Other treatment options include: daclatasvir (Daklinza); ombitasvir-paritaprevir-ritonavir plus dasabuvir, (Viekira Pak) ombitasvir-paritaprevir-ritonavir (Technivie); or some combinations of simeprevir (Olysio); sofosbuvir (Sovaldi); peginterferon or ribavirin.

Ask your doctor what's best for you, based on your medical needs.

What Are the Some of the Most Common Side Effects of Hepatitis C Medications?

It depends on which drugs you take to treat hepatitis C.

Daclatasvir (Daklinza)

You’ll take this pill once a day along with sofosbuvir for 12 weeks, around the same time every day.

It might cause:

  • Chest pain
  • Confusion
  • Diarrhea
  • Dizziness
  • Fainting
  • Headache
  • Memory problems
  • Shortness of breath
  • Weakness

Continued

This medication doesn’t interact well with certain medications and with St. John’s wort.

Sofosbuvir-velpatasvir (Epclusa)

This daily pill, which you take for 12 weeks, should cure your disease.

It could also cause:

  • Fatigue
  • Headache

If your doctor prescribes ribavirin along with it, you may also have diarrhea, an upset stomach, and trouble sleeping.

Ledipasvir-sofosbuvir (Harvoni)

You take this tablet once a day for 8 to 24 weeks. It should cure your hepatitis C.

The most common side effects include:

  • Fatigue
  • Headache
  • Nausea

When you use it with an older drug called ribavirin, it can also cause weakness or a cough.

Glecaprevir and pibrentasvir (Mavyret)

You'll take three tablets a day for 8 weeks if you don't have cirrhosis (liver scarring) and haven’t been treated before. You’ll get treatment longer if your disease is more advanced.

Side effects usually include:

  • Headache
  • Fatigue
  • Nausea
  • Diarrhea

Don’t take it if you've had hepatitis B in the past. It can cause severe liver damage

Peginterferon (Pegasys)

You take this medicine as a shot under your skin once a week. Try to take it the same day at the same time. You might take it alone or in combination with other medications. You’ll take it for 12 to 24 weeks.

Side effects can include:

  • Flu-like symptoms (headache, fatigue, fever, chills, muscle aches)
  • Arthritis-like pain in back, joints
  • Gastrointestinal problems (nausea, abdominal pain, diarrhea)
  • Insomnia
  • Depression
  • Low blood cell counts

Talk to your doctor if you’ve had an organ transplant, or if you’re pregnant, breastfeeding, or plan to get pregnant while taking it. It can cause miscarriages. Also tell your dentist or other doctor you’re on it before you have surgery or any other type of procedure.

Ribavirin (Copegus, Moderiba, Ribasphere, Virazole)

This comes as a tablet, capsule, or liquid. You take it with food twice a day, in the morning and evening, for 24 to 48 weeks or longer.

You can expect to have:

  • Flu-like side effects (fever, headache, chills, muscle aches)
  • Gastrointestinal problems (low appetite, nausea, vomiting, diarrhea)
  • Low blood cell counts
  • Depression
  • Insomnia
  • Hair loss

Continued

Sofosbuvir (Sovaldi) with interferon and ribavirin

Take this tablet at the same time every day with food. You have to take it along with ribavirin and/or interferon, and you’ll probably be on it for 12 to 24 weeks.

It will probably cause:

  • Flu-like symptoms (fatigue, headache)
  • Nausea
  • Insomnia
  • Low red blood cell count
  • Itching

Don’t take St. John’s wort while you’re on this medication. Also, you’ll need to use two methods of birth control to prevent pregnancy in you or your partner while taking ribavirin and for 6 months after you stop.

Ombitasvir-paritaprevir-ritonavir (Technivie):

You’ll take this tablet by mouth, possibly along with ribavirin. Take it every morning, with food

You might notice:

  • Trouble falling asleep
  • Rash
  • Reddened, itchy skin
  • Swollen throat, face, tongue, lips, hands, feet, ankles, or lower legs
  • Weakness
  • Confusion

This medication makes birth control less effective.

Ombitasvir, paritaprevir, dasabuvir, and ritonavir (Viekira Pak)

This treatment is a combo of pills: two that you'll take once a day, and one you'll take twice with meals. You’ll take it for 12 to 24 weeks.

During treatment, you may notice:

  • Fatigue
  • Nausea
  • Itching
  • Skin reactions
  • Insomnia
  • Weakness
  • Severe liver injury if given to someone who already has severe liver disease

If you use it with ribavirin, watch out for skin redness or rash. Feeling weak is also a common side effect.

Sofosbuvir-velpatasvir-voxilaprevir (Vosevi)

You’ll take it once a day for 12 weeks. It’s OK for people who have cirrhosis and have already had some treatment.

It could cause side effects like:

  • Headache
  • Fatigue

Side effects may last 2 to 12 weeks or even up to 6 months after you stop treatment.

Elbasvir-grazoprevir (Zepatier)

This once-a-day tablet could cure hepatitis in 12 to 16 weeks.

You can expect to have:

  • Fatigue
  • Headache
  • Skin reactions
  • Low red blood cell count
  • Gastrointestinal problems (nausea, diarrhea, abdominal pain)

If you're also taking ribavirin (Rebetol, Virazole), you could have joint pain, anemia, or feel depressed.

Let your doctor know if you've had hepatitis B before you start this drug. It could make the virus active again.

Continued

How to Know if Your Treatment Is Working

While you take any of these drugs, your doctor will keep close tabs on you. During office visits, they'll check your overall health and ask about any side effects that you have and how you're handling them.

During your treatment, you'll also get blood tests. They measure your "viral load" -- the amount of HCV that's in your body.

Your treatment is a success if tests show that HCV is no longer in your blood 3 months after you stop taking the antiviral medicine. When you hit this milestone, it's a good sign that you'll stay virus-free.

What to Avoid

While you take your hepatitis C medicine, it's super important that you don't put more strain on your liver. There are a bunch of things your doctor will ask you to stay away from:

  • Drugs and alcohol. Booze is a toxin, and your liver needs to work hard to process it. Too much can also lead to severe liver disease. If you inject street drugs, you might reinfect yourself with HCV. Ask your doctor how to get in touch with a substance abuse counselor if you need help to get or stay sober.
  • Foods high in salts, fats, or sugar. HCV puts you at risk for diabetes. So it's important to eat things that help you stick to a healthy weight. That will also help control your blood sugar. Try to have 5 servings of fruits and veggies each day.
  • Supplements. Check with your doctor before you take any. Some -- such as high doses of vitamins, like A and D, or minerals like iron -- can hurt your liver. Even some herbs can cause trouble.
  • Stress. When you worry too much, your blood pressure goes up and your immune system -- your body's defense against germs -- doesn't work as well. A good night's sleep is also tough to come by. Go easy on yourself, and find ways to relax. You may also want to join an HCV support group that helps you better manage your feelings.

Continued

5 Tips and Remedies to Help With Side Effects

There are things you can do to ease many of the side effects from hepatitis C treatment.

  1. If fever or aches start a few hours after your interferon shot, try getting the shot at bedtime. Take acetaminophen or ibuprofen about 30-60 minutes before your shot. Check with your doctor about which would be best for you.
  2. If you start to feel depressed, talk to your doctor. He might prescribe an antidepressant. Exercise can also boost your mood. For anxiety or crankiness, exercise regularly, get plenty of sleep, and try relaxation exercises like yoga or tai chi.
  3. If you have stomach problems, take your medications with food. Eat smaller, healthier meals and skip spicy, acidic foods. Ask your doctor about medications that might help ease nausea or diarrhea.
  4. Use moisturizing soaps and lotions to help with dry skin. Don't take long, hot showers or baths.
  5. For a dry mouth or sour mouth, brush your teeth often and suck on sugar-free candies. Drink lots of water.

Remember that these side effects will typically go away once you're cured, so stick with your treatment. Work with your doctor on your treatment plan so that you can manage any problems and try to get the virus out of your body as soon as possible

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on April 15, 2019

Sources

SOURCES

Paul Gaglio, MD, medical director of liver transplantation, division of hepatology at Montefiore Medical Center.

Alison Jazwinski, MD, assistant professor of medicine, division of gastroenterology, hepatology and nutrition, Center for Liver Diseases, University of Pittsburgh.

Medscape: "FDA Panel Backs Sofosbuvir for Hepatitis C," "FDA Panel Recommends Approval of Simeprevir for Hepatitis C."

U.S. Department of Veterans Affairs: "Hepatitis C Treatment Side Effects Management Chart."

UpToDate: "Patient Information: "Hepatitis C (Beyond the Basics)."

FDA: "FDA approves Mavyret for Hepatitis C," "Mavyret Prescribing Information."

Hepatitis C Online: "Elbasvir-Grazoprevir (Zepatier)," "Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi)."

Medline Plus: “Daclatasvir,” “Ombitasvir, Paritaprevir, and Ritonavir,” “Peginterferon Alfa-2a Injection,” “Ribavirin,” “Sofosbuvir

HHS AIDSinfo: “Peginterferon Alfa-2a (HBV, HCV).”

© 2019 WebMD, LLC. All rights reserved.

Pagination