The following are some tools to help manage some of the more common side effects associated with current treatments for chronic hepatitis C virus (HCV) infection.  Use this as a guide, but please do not use this as a substitute for medical advice.  Talk to your doctor or nurse about any concerns you may have while you are undergoing treatment.

FLU-LIKE SYMPTOMS (The first dose is usually the worst):
Put layers of blankets and clothes at your bedside to manage chills.
Do not schedule the first injection the night before a major event.
Use acetaminophen (e.g., Tylenol, ES Tylenol) or ibuprofen (e.g., Motrin, Advil).
Get plenty of rest.
Increase your intake of fluids to one gallon per day, if possible (including water and clear juices, such as apple, grape, cranberry).
Try massage or heat to the back of neck for headache relief.
You may reduce your fever by sponging your body with lukewarm water (not hot or cold).
Try taking interferon in the evening with an analgesic (acetaminophen or ibuprofen) so you can sleep through some of these symptoms.

FATIGUE:
Rest as much and as often as possible.  If your home life is busy, try to have others take over some of your chores -- ask for help!
If possible, decrease your work schedule and/or take 1-2 weeks off work when you BEGIN treatment.
Avoid excess stress.  Use stress-reduction techniques, such as meditation, massage, watching the sun rise and set.
Get light exercise, such as walking or swimming.  Yoga is good for stretching muscles and reducing stress and reducing fatigue.
Don't plan too many activities in one day.  Alternate activities requiring a lot of energy with others that are less strenuous.
Try taking short naps or rest periods between outings or activities to prevent being overwhelmed by fatigue at the end of your day.

HEADACHE:
Discuss this complaint with your health care provider.  Ask your physician about the use of prescription and non-prescription medications.
Try relaxation techniques.
Heat applied to the back of the neck can be helpful.
Learn acupressure points for headache relief.

GASTROINTESTINAL PROBLEMS SUCH AS ANOREXIA (LOSS OF APPETITE), NAUSEA, DIARRHEA, ABDOMINAL PAIN, CONSTIPATION:
Eat regularly, even if you have no appetite.  Treat food as you would medication you must take to get healthy.
Choose low-fat, nutritional foods when at all possible.  Be sure to eat some meat or other high-protein food every day to help your body heal.
Avoid fats and rich foods, as they are harder to digest.
In addition to water, drink plenty of clear juices.
Brush your teeth often to help eliminate the metallic taste in your mouth.
Eat smaller, more frequent meals.  Avoid Αtrigger≅ foods and odors (those that cause you to have nausea or diarrhea).
Avoid citrus fruits or juices (orange, grapefruit, pineapple) as the acid may bother your stomach.
When nauseated, eat dry crackers, weak tea, gingerale, popsicles.   If your nausea continues or you have frequent vomiting that doesn"t respond to the above, please call the doctor.
Have healthy snacks on hand for nibbling whenever you are up to it.
Ginger (especially fresh ginger) stimulates the digestive process and can relieve nausea.  Take over-the-counter (OTC) medications, such as Pepto-Bismol, Imodium-AD, Tums, Pepcid, Maalox, as directed.
The acupressure points for nausea are on the inside of the wrists.  Acupressure bands can be purchased at most drug stores in the section that sells motion sickness remedies.  These bands apply pressure to the point that is used by Chinese medicine practitioners for nausea relief.  You can apply this pressure to yourself with your fingers.
If you lose too much weight, try products designed by promote weight gain, such as nutritional supplements.  Instant breakfast powders, high-calorie puddings, and “shakes” can be easy to digest.  For extra calories, add powdered milk to regular milk, soups, mashed potatoes, hot cereal, and puddings.  Peanut butter is an excellent source of nutrition and calories.

MUSCLE AND JOINT ACHES:
Get a proper diagnosis for the cause of pain before beginning a self-help regimen.
Ask your physician about the use of prescription and non-prescription medications to help with these symptoms.  It is a common myth that HCV patients cannot take acetaminophen (Tylenol).  In most cases, acetaminophen is considered to be safe if taken occasionally and within the recommended dose.  Never mix acetaminophen and alcohol.   If you take other prescription or OTC medications, ask your doctor about the safety of taking these along with acetaminophen.
Try gentle stretching exercises.
Avoid prolonged periods of inactivity.
Try warm or hot baths.  Spoil yourself with a bubble bath.
Massage may be helpful.

INJECTION SITE REDNESS, PAIN OR SKIN DISCOLORATION:
Rotate injection sites during your treatment.  Make sure you are not injecting into your muscle layer.
Drink water or clear juices right before and right after your injection.
Apply cold compress to site of your pain.
Use OTC hydrocortisone cream (e.g., Cortaid) for itching and irritation.   If the pain becomes severe or infection occurs, call your doctor.
HAIR THINNING:
This is a common symptom or side effect; your hair will grow back after treatment ends.  Try styling your hair in a fashion that makes it look fuller.  Use scarves; wear hats or caps.  Use hair extensions.  Use hair products that add body and texture, such as Prograine or Nioxin.


DRYNESS (INCLUDING DRY SKIN, MOUTH, NOSE AND EYES):
Drink sufficient water.
Hypoallergenic lotions applied immediately following bathing can reduce dry skin.  Add a couple of drops of lightweight oil to the lotion for extra protection.  (Neutrogena makes an excellent body oil.  Baby oil is another choice.)
Do not forget to use sun protection.
For occasional dry eyes, use OTC artificial tear drops.  If regular use is necessary, use a preservative-free type.  Eye lubricants that are in gel or ointment form can provide extra relief if applied before bedtime.  Talk to your doctor about any eye pain or vision problems that you feel may be caused by something other than dryness.
Saline nose sprays can help with dry nasal passages.
Mouth dryness can lead to an increased risk of dental cavities.  Add extra brushing and flossing to your dental care list.  Use a soft toothbrush.  Be sure to see your dentist regularly during treatment.
There are many OTC products that are formulated to help with a dry mouth.  Talk to your dentist about this or browse the dental section of your drug store for some products.
Try to avoid chapped lips by lubricating frequently, especially with a product that contains sunscreen.  For cracked or very chapped lips, Clinique makes a product called “All About Lips.”  It is expensive but is effective and will last a long time.  Another product is “Lansinoh” which was formulated for nursing mothers with cracked nipples.  This and similar products can be purchased at a drug store.
Dry, itchy skin is a common complaint during treatment.  From the outset, keep skin well hydrated by using the suggestions mentioned above.
Scratching leads to more itching.  Try to avoid scratching, especially with fingernails.  Cold packs or pressure can be applied to areas that are itchy.  If a rash develops, talk to your doctor about non-prescription and prescription hydrocortisone products.  In some cases, an anti-histamine may be recommended.

DEPRESSION, ANXIETY AND IRRITABILITY:
These are very common symptoms or side effects.   You may also experience feelings of anger, hostility or impatience toward others around you or even toward yourself.  You may find the following helpful in dealing with these feelings.
Get enough rest.  If you experience insomnia, try taking over-the-counter diphenhydramine (Benadryl).
Try relaxation techniques by listening to relaxation tapes or practicing yoga (slow stretching exercises that tone the body and relax the mind).
Avoid stressful situations as much as possible.
Have very little caffeine and NO alcohol.
Try journal writing as a way to express thoughts and feelings you have that may be difficult to discuss with your family and/or friends.  You can also use your journal to keep track of your progress and to set goals.
Professional counseling is also very helpful to many patients.
At each visit, you will be asked about any feelings of depression, anxiety, irritability, anger or hostility you may have experienced.  It is recommended that you start medication before you begin taking the study medication, if you have had a history of depression.  Please call your doctor's office or 911 if you have any thoughts of harming yourself or another person.
You may also be interested in joining a hepatitis C support group.  A support group can offer you emotional help, keep you updated on info about HCV and allow you to offer support to others.  Go back to the home page for more info.


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A general recommendation regarding side effects is to keep track of those symptoms you experience and what you do that helps relieve them, as well as how long your relief lasts so you can refer to this when the symptoms return.  Share your experiences with us and in your support group.  What worked for you may also work for others.  It is also possible for us to make dose adjustments when necessary, which may help relieve your symptoms.

***thanks to Dr. Marsano's office for this document