www.hepatitis.va.gov 

Managing Side Effects oHepatitis C T

The VA Hepatitis C R

and the National Cli

Veterans Health Adm

U.S. Department of V

June 2007
2 63 

NOTES 
62 

NOTES 

3 

Managing Side Hepatitis C TreaJune 2007 

VA Hepatitis C ResoNational Clinical PubVeterans Health AdmU.S. Department of www.hepatitis.va
4 

ContentsIntroduction ............................................6 Fatigue ..................................................9 Aches & Pains .......................................13 Sleep.............................................................17 

Depression.....................................................25 

Irritability.........................................................31 Nausea...........................................................35 Loss of Appetite.............................................39 Dry Skin.........................................................43 

Thinning Hair..................................................46 Internet Links for More Information................50 Quick Reference Guide..................................52 

61 

NOTES 
NOTES 

The quotes used in this side guide are from veterans with significant others) who receivVA Medical Center. 

60 5 

The quotes unpositive experistrategies vetetreatment. “Down Side” reexperiences vetreatment. 

These quotes are intended to the range and severity of sidexperienced while on interferremember that each individuto treatment, so you may or msymptoms reported by others
6 

Introduction Alpha interferons, which are given as injections under the skin, have been used since the late 1980s in the treatment of chronic hepatitis C. Through the refinement of interferon and the addition of oral ribavirin, long-term viral clearance has gone from about 5% to now approximately 50% in patients who have never before received treatment. Side effects of treatment, however, are common. There are many ways your health care provider can help you manage these side effects. A gentle modification of your behavior, lifestyle, or routine medical therapy is often the first step. Dose reduction or adding additional medications typically is the second step. Dose reduction is typically only done when the side effects are severe. Since reducing your dose could also mean reducing your chance of clearing the virus, your provider will carefully weigh the risks and benefits of this approach. The most common side effects from interferon therapy include: fatigue, headache, fever, nausea, weight loss, depression, and skin rash. The aim of this guidebook is to provide a source of information for patients on interferon 

59 

VA Telehealth Line ___________________Provider’s Name ___________________

If you’re expeemergency cato the emergedepartment 

Cover 
treatment about potential si

to help manage them. 

58 

Nausea & 

Vomiting 

(continued)

• Try eating ginger in ginger tea, ginger 

ale or gingersnaps

• Eat some crackers or dry white toast if 

you feel sick in the morning 

• Over-the-counter antacids or other 

medications may be rec

ommended by 

your provider

7 

Poor 

appetite 

• Eat smaller, more frequent (4-6) meals 

throughout the day 

• Drink protein drinks (Carnation Insta

nt 

Breakfast*, Ensure* or Boost*) 

• Eat snacks with protein (cheese, 

peanut butter, eggs) 

• Eat whatever appeals to you even if 

not hungry. Eat a variety of foods 

• Walk before a meal 

Rashes & 

Dry skin 

• Avoid long, hot showers or baths • Use moisturizing soaps (

Dove*, Oil of 

Olay*, Cetaphil*) 

• Use moisturizing lotion after showers 

(Aquaphor*, Absorbase*, Lac-Hydrin*) 

• Use mild unscented laundry 

detergents and avoid fabric softeners 

• Use sunscreen • Try rubbing or pressing on the itchy 

areas rather than scratching 

• Use petroleum jelly on dry, itchy areas. 

Your provider may recommend other agents to help 

* Generic versions are usually less expensi

ve t

han bran

d-na

me

products. Brand names are provided as e

xamples onl

y, and 

their i

nclusion does not indicate an e

n

dorsement by the 

Veterans Health Administration or an

y other

Govern

ment

agency. Also, if a particular brand name is not mentioned, thisdoes not mean or i

mpl

y t

hat the product is u

nsatisfactory.

“There's light at the it's not the train. Yokee

p goin

g, be pos

best.”“Expect to feel sick#@%$!y for a year.“If you’re goin

g to d

yourself a chance tdid the interferon trwhat life handed m“Consider having a a year.” “Interferon...it does system. You need t

—Veterans who’ve underg
8 57 

Irritability & 

Anxiety 

(continued)

• Avoid stim

maintain a

• Join a hep

Muscle & 

Body aches 

• Try injectin

body acheinjection 

• Take aceta

30-60 mininterferon 

• Take aceta

tablets priorepeat 4-6 a maximum not exceed 4 tablets/dacetamino

• Use ibupro

naproxen provider 

• Try low-im

walking or directed by 

• Maintain a

six to eighglasses/da

• Apply warm 

areas 

Nausea & 

Vomiting 

• Take ribav• Eat small • Avoid food

nausea. Tavoiding c

• Eat health

acidic or s
56 

Insomnia 

• Go to sleep and wake up at the same 

time every day 

• Do not read or watch TV in bed • Limit daytime naps • If ribavirin makes you jitt

ery, take at 4-

5 pm instead of before bedtime 

• Limit fluid int

ake for 2 hours before 

bedtime to avoid having to get up to go to the bathroom 

• Avoid caffeinated products, especially 

in the afternoon and at night 

• Avoid heavy meals close to bedtime • Take warm baths, read or listen to 

music, get a massage 

• Try a glass of warm milk (contain

s

tryptophan, a natural sleep agent) 

• Diphenhydramine (Benadryl*) or other 

medications may be rec

ommended by 

your provider

9 

Fatigue: 

fatigued

The majority 

chronic hepat

fatigued (tired

during their tr

important for 

you do not sto

before it is ti

Bright Side: “Gettcleared my head. myself to walk, wnot.” 

Irritability & 

Anxiety 

• Talk to your provider about your 

symptoms and medications that might help 

• Always discuss thoughts of harming 

yourself or someone else with your provider

• Go to the nearest emergenc

y roo

m

if 

you are i

n danger of harming 

yourself or others 

• Do mild to moderate exercises at least 

3 times/week as directe

d by your 

provider 

• Try relaxatio

n techniques such a

s

deep breathing, taped exercises, yoga, Tai Chi or meditation 

Down Side: “Treaweight. Gravity wmore than what it injections.” 

CHAPTE

Question: What are the syAnswer:

Patients with chro

usually report feeling the fo

• Decreased ability to 
• Feeling tired or sleepy 

Fever & 

Chills 

(continued)

• Use extra 

you have t

• Notify

y

o

u

temperatumore than 

Hair thinnin

g

or Hair loss 

• Avoid hars

dyes, permmousses 

• Use a mild 

shampoo 

• Avoid brai

comb or so

• Wear a ca

Headaches

• Maintain a• Take aceta

ibuprofen by your pr

• Keep light

stay in dar

• Try to get 

Injection site 

reactions 

• Before inje

by gently rhands for 

• Rotate/alte

thigh, uppeare thin, u

• Do not inje

irritated, b

• Do not rub • Apply a co• Your provi

applying hother med

• Feeling bored • Feeling physically weak or drained • Spending more effort on routine tasks 

Question: What can I do if I feel fatigued?

Answer: There are a number of things you 

can do to help yourself feel better. Here are som

e suggestions that m

ay help:

Exercise and Rest Try to go for a walk, take a light run, swim, play a sport, bicycle, or be active in a hobby. Try to do something active everyday! If you need to do some “physical” work, try to do it during times of the day when you usually feel the best. Try alternating rest with activity. Talk to your doctor, however, before starting any exercise program. Nutrition 

10 

It is important to eat a balanced 

diet with fresh fruits and 

vegetables to ensure you 

are getting enough vit

amins 

and minerals. Just remember 

to drink plenty of water throughout 

the day, especially during and after exercising! 

55 
Timing Your Medication

Dry mouth or 

Mouth ulcers 

• Brush teeth frequently, especially after 

eating 

• Avoid mouth

wash containing alcohol 

• Drink plenty of water or use ice chips 

or sugar-free lemon drops

• Other medications may be needed f

or 

mouth sores/ulcers 

• Ask your provider about medications 

that may help 

Fatigue 

• Try low-impact exercise such as 

walking or low-impact aerobics as directed by your provider

• Maintain adequate fluid intake (may 

have a caffeinated beverage in the morning) 

• Take a short nap during the day • Lessen your work schedule if possible • Eat well-balanced meals every day 

Fever & 

Chills 

• Try injecting interferon at bedtime if 

fever/chills d

evelop 1-3 hours after 

injection 

• Take aceta

minophen (Tylenol*) about 

30-60 minutes before weekly interferon injection 

• Take aceta

minophen (Tylenol*) 1-2 

tablets prior to interferon injection and repeat 4-6 hours later if needed up t

o

a maximum of 2,000 mg/day. Thus, do not exceed 6 tablets/day of 325 mg or 4 tablets/day of 500 mg acetaminophen (Tylenol*). 

• Use ibuprofen [Advil*, Motrin*] or 

naproxen [Aleve*] if approved by yourprovider 

• Try a cool sponge bath, ice pack or 

cold pack when you have a fever 

54 11 

You may find it helpful to cointerferon at bedtime or on notice that your fatigue is usdays after i

njecting your inte

your health care provider about adjusting when receive your injections so thhave 1-2 days that are not aWhat you might not knowOther medical conditions, sdisease and anemia may wOther things that can worse

• other medications • excessive use of caf• alcohol • street drug use • lack of exercise • sleep disturbances 

Please tell your doctor aboualcohol use before starting *These conditions m

a

y dev

treatment. Be sure to discuwith your medical provider. 
Notes 

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

12 

Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

Bright Side: “Keeping a consistent schedule helped.” 

53 

Cough 

• Increase in

caffeinated 

• Use a hum• Try sugar-

drops 

Dehydration 

• Increase in

caffeinated 

• Water dow

Crystal Lig

• Avoid caffe

Depressio

n

• Talk to you

symptoms help 

• Always dis

yourself or provider

• Go to the 

if 

you are 

yourself o

• Do mild to 

3 times/weprovider 

• Join a hep

Diarrhea 

• Eat more s

white 

Rice

Toast (the 

• Avoid food• Avoid dair

days after 

• Maintain a

six to eigh

• Your provi

loperamide methylcell(Metamuc
52 

Side Effects Quick Reference Guide 

If the clinic is closed and you are having a serious side effect (such as chest pain or severe depression), please seek immediate medical attention or call 911. 

13 

Aches & Pains: Will I bpain?Many patients taking interfeexperience some general apains. These symptoms mathroughout the course of trebut they are usually most induring the first month. 

Side Effect Management Strategies 

Abnormal 

labs 

• Be patient! Sometimes your lab 

results will vary while you are on therapy. 

• Get your labs done as requested by 

your health care provide, since medication dose adjustments may be needed based on lab tests.

Bad taste in 

mouth 

• Use sugar-free lemon drops or real 

lemon wedges 

• Eat a small amount of yogurt, 1⁄2 hour 

before meals or eat dark chocolate (monitor your glucose levels if you have diabetes) 

• Drink lemonade or cranberry juice 

(monitor your glucose levels if you have diabetes) 

• Eat food cold or at room temperature • Brush teeth frequently, especially after 

eating, to eliminate metallic taste 

• Use plastic utensils if experiencing 

metallic taste 

Bright Side: “I dand tons of watthought about itDown Side: “It fsymptoms. All mache and I had Even your hair 

CHAPTE

Question: What are these 

like?Answer: They can mimic f

as:

• Muscle and joint ach• Headache • Low-grade fever 
Website: 

www.hcvadvocate.org/hepatitis

• Chills • Fatigue and weakness 

American Liver Foundation (information of advocacy and edwell as information regarding thliver-related diseases. This sitevents and chapters in your arthe American Liver foundation. information about the liver, clinon the news front. Website: www.liverfoundation.o

Question: How do I manage them while on 

treatment?Answer: Here are some pain management strategies: 

• Injecting interferon right before going to 

bed may be helpful unless it results in insomnia. 

14 

• Drinking plenty of fluids will help keep 

your body hydrated and potentially help some of these symptoms. 

• Stay busy! Go to 

movies, attend 

community events, 

go on trips, visit an old 

friend, ride a bike, take a 

walk, begin a new hobby. 

Take the time to do the things 

you’ve always wanted to do. 

These ideas may help divert 

your attention from your symptoms. 

• Consider alternative treatments. 

Acupuncture or therapeutic massage may relieve pain effectively for some people. Hot showers, compresses, and 

51 
50 

I

15 

Internet Links for More Informationsoaking in a hot tub 

muscles and soothe 

VA National Hepatitis C Program. This is a Department of Veterans Affairs hosted website that “provides information about viral hepatitis for health care providers inside and outside the VA system, veterans, and the general public.” Included in the website is a wealth of up-to-date information, links, and resources for individuals interested in learning more about HCV. 

Use of Medications A common way to manage acetaminophen (Tylenol®*) health care provider or the exceed recommended dosaAcetaminophen may be helabout half an hour before inalso help with headaches. 

Website: www.hepatitis.va.gov National Center for Infectious Diseases (NCID).

Hosted by the Center for Disease Control (CDC), this website offers a large resource for information, statistics, facts, and links for providers and public. Includes information about HCV publications and National Institutes of Health (NIH) sponsored research. 

AVOID aspirin, acetaminopibuprofen (like Motrin®* or A

severely damaged. Ask youprovider which over-the-couright for you. 

Website: www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm 

Caution! Patients that ssignificant livecirrhosis shoukind of aspirin 

(Advil®*). 

HCV Advocate. A great site with lots of helpful information for people diagnosed with hepatitis C. Home of the Hepatitis C Support Project (HCSP). The founder, who is HCV positive, created this website for ”individuals to address the lack of education, support, and services available at that time for the HCV population. HCSP’s mission is to provide unbiased information, support, and advocacy to all communities affected by HCV and HIV/HCV co-infection.” 

If all else fails and pain becand/or chronic, talk to your about other treatment poss
16 

Notes ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

49 

Notes __________________________________________________________________________________________________________________________________________________________Questions for my health car__________________________________________________________________________________________________________________________________________________________
48 

• Satin pillowcases may help reduce any Sleep: Is it really that 

friction and pulling of your hair while you sleep. 

• Get a haircut! Cutting the hair length 

can decrease hair weight and may help reduce the rate of loss. 

17 

While on treatment, it is impsleep; your body needs it wstressed by drug treatmentsenough or excessive sleep cause problems with mood, thinking, energy, and anxiety. Finding time to exeand relax is important inlessening side effects. In addition, enjoying regular periods of relaxation and exercise may help to improvmemory and concentration. 

• Be sure to eat a balanced meal. Some 

studies suggest that severe deficiencies in iron or overdoses of vitamins A and E can lead to hair loss. Before taking any supplements, please discuss them with your health care provider to see if they will be helpful to you. 

Bright Side: “I’m not going to worry about it. All I’m going to dois take it one day at a time.” Down Side: “I was real sensitive to light, more than usual. I would lie down on a bed a lot and listen to music and have the lights out.” 

Bright Side: “I walwhen I didn’t feel myself go out to wonly for 10 minuteinto 20 or 30.” Down Side: “My s

CHAPTE

Question: What are some 

get a good night’s sleep whtreatment? 
Answer: There are many things you can do to 

help you sleep better: 

Question: How can I preve

loss?Answer: There are many “

that you can try to slow the your risk of hair loss. Some include: 

• Avoid stimulants like caffeine and 

nicotine, especially in the evening hours. 

• Maintain a regular sleep schedule: go to 

and get out of bed at the same time every day. • Avoid using hair dye

bleaches while on tremay accelerate hair damage. 

• Limit your fluid intake at nighttime to 

avoid needing to get up to go to the bathroom. 

• Avoid/limit use of ge

and mousse, which wdifficult to comb thro

• Create an optimal sleep environment. 

Replace your pillow or mattress if necessary, darken windows or use a sleep mask if required, set the thermostat in the bedroom to 65°, and wear earplugs if outside noise is a problem. 

47 

• Use mild shampoos 

baby shampoo and sfrequently (1–3 timesconditioner or de-tan

• Use soft hairbrushes 

as a natural bristle bor a wide-toothed co

• Avoid strenuous exercise within 4-6 

hours before your usual bedtime. 

• Take a hot bath before sleep. 

• Use low heat when d

your hair. 

18 

• Talk to your health care provider about 

other suggestions that may help you sleep. • Avoid using vigorous 

and other things sucwearing tight headgeincrease the risk of bof your hair. 

Exercise tips 
46 

__________________________________________________________________________Thinning Hair: What will happen to my hair?

Hair loss or thinning of the hair 

(alopecia) is a common side 

effect of interferon and occurs 

in up to one third of people 

on interferon. 

Interferon affects the 

hair strands and changes the 

texture of the hair, which makes 

it easier to break. 

Normally, hair re-growth occurs within three months of stopping interferon. This hair loss is frequently just a subtle thinning of hair, not new areas of baldness! You should know! Hair loss can occur on all parts of the body (facial hair, arm and leg hair, underarm hair, and even pubic). Hair loss can happen in patches and occur unpredictably in some patients. 

Down Side: “My hair got real brittle and treatment made it fall out.” 

CHAPTER 9 

“What gives?” 

19 

• Exercise for 30 minu

per week. 

• Begin exercising eas

progress. Activities ligardening count too! 

• Consult your primary 

before starting any e

Relaxation tips 

• Try drinking a hot, no

the evening. Milk is tryptophan (an amino as a natural sedative

• Listen to relaxing mu

bath or shower. 

• Try aromatherapy: th

concentrated oils frosuch as their flowersand bark, for the purperson’s health and candles, incense, ansome products that a

• Learn meditation, Yo

aromatherapy. 

• Get a relaxing massa
20 

Bright Side: “I used a meditation/breathing control exercise for relaxation. . . . You can control your pain psychologically with your mind.” You Should Know! 

Show your health care provdeveloped a rash anywhere (injection site, hands, torso, that develop while on treatmannoyances, but some rashproblem, that requires speca referral to a dermatologist

Question: What are some exercises I can practice to get a better night’s sleep? Answer: Here are two GREAT ways to help you catch some Zs:Gentle Breathing: Who knew breathing could be so relaxing! 

45 

Bright Side: “I follprovider’s directio

Go to a place where you can sit or lie down peacefully. Begin by breathing in normally through your nose, but then exhale back out through your mouth slowly. Think of a word or sound that you find calming and say that word or sound very slowly for about four seconds. Some may recite the word “peace” or “calm,” while others may chant the sound “Om,” (similar to: o-o-h-h-h-m-m-m-m-m-m). Trytaking at least 10 breaths each time and try this exercise a few times a day. Once you feel comfortable with this in your home, you can try doing it whenever or wherever you feel stressed (on the bus, waiting at the doctors office, stuck in traffic, etc.) tensing (flexing) and then releasing (relaxing) each muscle group, one by one. 

Down Side: “I devrash . . .” 

Notes __________________________________________________________________________________________________________________________________________________________Questions for my health car________________________________________________________________________________________
44 

Aveeno®*, or Lubriderm®* after 

showering or washing with soap. 

• Do not use harsh soaps, and avoid 

taking long hot showers, which can dry the skin. 

• Wearing loose-fitting clothes made of 

soft material. 

• Keep the dry skin covered! This means 

wearing gloves, socks, pants, etc. when going outside in bad weather (either really hot or really cold). 

• Over-the-counter hydrocortisone cream 

(1%) may help some more persistent itching. 

• Increase polyunsaturated fats in your 

diet (vegetable oils) such as olive oil and nuts. If skin on hands or feet cracks, apply pure lanolin and wear cotton gloves or socks to bed. 

Use of Medications There currently are some oral medications that may help relieve the itchiness caused by dry skin. Talk to your health care provider to see if it is right for your symptoms. 

21 

Progressive Muscle Relaxyour sleep muscles The important part of muscbecoming aware when your feeling tense. You can then relaxation to loosen or lesseuse this technique, you prac(flexing) and then releasing muscle group, one by one. seconds tensing and then 5 each group. If you have chronic pain, prrelaxation (PMR) does not sworse but rather to enable ydifference between tension tightening a muscle group heither back off or stop. The relaxed, not to increase paia comfortable place to sit oStart by clenching both fists tension...hold for 5 secondsslowly... feel the tension leadifference now that the musNow, tighten the muscles in Contract your biceps, hold fseconds...relax them slowlytriceps...now relax. Notice Repeat one more time. Point your foot downward umuscles are tight, hold for 5 
22 

them.... move up your leg flexing.... hold...relaxing each muscle... up through your thighs... slowly flexing...slowly relaxing. Feel the tension ease. Repeat one more time. Your arms are relaxed, your legs are relaxed, and your even breathing gives you a feeling of calmness and releases stress. Pull your stomach in up until your diaphragm feels the pressure. Now... slowly relax... slowly. Feel the tension ease. Pull your shoulders up to your ears. Feel the tension in your back and chest. Let your shoulders relax. You are feeling good. Your heartbeat is easy and restful. Tilt your head backward as far as you can. Stretch the muscles. Feel the tension. Now... slowly... roll your head in a complete circle...stopping at the very bottom. Feel the tension on the back of your neck. Allow it to stretch gently. Now relax. Let the tension go. Feel the tension go. Repeat one more time. Wrinkle your forehead. Hold it. Feel the tension. Now, relax. Feel the tension go. Squint your eyes as tight as you can. Hold it. Now... relax. Pucker your lips...hold...relax...make a face using all of your face muscles. Hold it. Now relax... slowly... let it go. Your arms are 

43 

 Dry Skin: Who gets d

Dry, itchy 

“pruritus” 

in people tak

interferon. M

rashes may 

the site of injection o

your body

You should tell your healtsoon as possible if you exredness, or swelling at thThis could be a sign of ininfections from occurring, aarea well with alcohol befor

interferon. 

Question: What should I d

or irritated? 

Answer: Sometimes curing difficult. While scratching mrelieve the itching, it can caskin surface and should be ways to decrease dryness, include: 

• Keeping skin moistu

important. Try using (non-scented) lotion 

CHAPTE
42 

Be Aware! About 24% of people on hepatitis C treatment lose weight from not eating enough calories, so watch your weight carefully! If you begin to lose weight too fast, tell your health care provider as soon as possible! Notes ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

23 

relaxed... your breathing is good all over. In a perfect state of relaxatito move a single muscle in feel is peaceful, quiet, and rrelax. When you want to gebackward from four to one. relaxed and refreshed, wideYou Should Know Try using both of these exedouble-dose of relaxation. Tlavender scent to the air (arsoft, soothing sounds to youapproach, your senses will peaceful rest and you’ll be stime! Notes __________________________________________________________________________________________________________________________________________________________Questions for my health car________________________________________________________________________________________
• Take time to relax w

chew your food thorodown your meal can cause nausea. 

Bright Side: “I started swimming a lot. I started to swim and it felt good.” 

24 

• Buy a cookbook for n

Down Side: “He was having a lot of recipes to try. nightmares.” 

—A spouse Increasing Calories 

• Don’t be afraid to ind

extra slice of pie, scoadd a bagel with creadaily snack box. 

• When you cook, top 

olive oil, or stir milk iprotein and calcium. 

41 

• Keep foods that are 

carbohydrates and pthings like cottage cheese, yogurt, peanbutter, and oatmeal mwith milk. 

• Liquid protein drinks

milk shakes, or smoothies may also helpful as a source ocalories. 

• Always talk to your h

before starting a new 
40 

CHAPTE

Tips on Improving Your Appetite Depression: What are 

getting depressed? • Don’t hold back—eat the foods that 

appeal to you. 

25 

As many as 35% 

treated with inte

experience dep

below and on fo

some point dur

So far, studies 

most likely to fe

around the third 

treatment. Depre

generally improv

antidepressant th

• Eat smaller meals or healthy snacks 

several times throughout the day. Eating smaller meals more frequently is actually more healthful. Don’t skip meals! 

• Add variety to your diet. Try to spend a 

few extra minutes preparing your meals so that you are eating food that is appealing and not just “convenient.” 

• Try to prepare extra meals and freeze 

them in re-usable containers for a fast and healthy meal. 

Question: How do I know 

depression?Answer: Symptoms of depon hepatitis C treatm

ent m

a

• Try not to do any strenuous exercise within 2 hours after eating. While 

exercising, the body slows the process of digestion to focus on keeping the muscles going. 

• Feeling sad or mood• Irritability • Feeling worthless or • Loss of energy or fee

• Have fun with your eating environment! 

Eat by candlelight, have a picnic, or 

invite friends over 

for a meal. 

• Agitation (feeling res• Loss of interest in fav• Changes in appetite • Trouble falling or sta

excessive sleep 
26 

• Decreased interest in sex or ability to 

perform 

Loss of Appetite: I useeat the whole thing... 

• Memory impairment or loss of 

concentration 

• Feeling like life isn’t worth living 

39 

Loss o

comm

under

you f

mild 

times, t

begin to fee

important that y

specified time, a

sure you are ea

If you are having thoughts of hurting yourself, please talk to your health care provider immediatel

y or call 911! 

Be Aware! Without help, depression may lead you to choose to alter or completely stop your interferon therapy. Stopping y

our treatment 

early may lessen y

our chance of clearing the 

virus. It is important to discuss any side effects you may be feeling with your health c

are 

provider s

o that the most effective treatment 

decisions can be made. 

There are two primary apprwith loss of appetite: trying amount of food you eat by iappetite, or by eating foods calorie dense. The tips belo

Question: What should I do if I am with both of these approach

experiencing a symptom of depression? Answer: Tell your health care provider!

Bright Side: “without eatinto make a cohealthy.” 

Bright Side: “I was in a better mood after going on the anti-depressants.” Down Side: “On treatment, I got depressed. The depression creeps in so subtly. I didn't notice what was going on.... I couldn't see it myself, sometimes.” 

Down Side: “Everything ta

CHAPT
38 

Notes ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

27 

Depression caused by intertreatable, but many patients provider about problems wiSymptoms of depression usthemselves when interferon If you experience symptoms during your therapy, it is imdiscuss them with your provcan be treated and do not bYour provider may suggest following: Use of Medications Your doctor may recommenantidepressant medication tyour moods. Current reseaantidepressants can eliminadepression caused by interfPlease tell your doctor abouantidepressant medications been on in the past. Supportive Therapy/CounFor many who experience sdepression, talking to a meprofessional can bring some include a psychiatrist, psychpractitioner or clinical socialistened to and understood your mood. These professifigure out ways to help your
Talk to your health care provider about a 

referral. You should know! 

If you are vomiting or constcontact your health care pro

Other Social Supports and Activities When you are depressed, you may feel like staying at home in bed. Socializing with others may not seem as interesting as it used to. Maintaining contact with others, however, is especially important if you are feeling depressed. It may take a bit more effort but can actually help you to feel better. Try to stay in contact with friends, family, or spiritual organizations. Do your best to maintain somesort of activity every day, even if it is getting out of bed, taking a shower, and getting dressed. While it may seem difficult to do, you will ultimately feel better. 

Use of Medications Your doctor may give “anti-medications to you if you hasevere or persistent nauseaYou may want to try an antastomach aid available over Please follow the directions label and do not exceed the daily dose of these aids. 

28 

Bright Side: “Going to those support meetings and listening to other guys in the group . . . meeting guys getting ready to get off treatment and those coming, some people starting the same day as you do . . . it’s helpful. Everyone deals with it differently.” 

You are not alone! 

Some patients have reported 

feeling better from attending 

37 
community support groups. 

care provider to see if there meet your needs. 

• Keep track of particular foods or smells 

that cause your nausea. Avoid those foods or smells in the future. To avoid smells from cooking, prepare food ahead of time and store it to eat later. 

36 29 

• Keep bland foods such as milk, yogurt, 

crackers, ginger ale or lemon-lime soda on hand for settling an upset stomach. 

• Eat smaller, but more 

frequent, meals. 

• Take your 

ribavirin with food. 

• Do not skip meals - snack frequently. 

You may feel more nauseous on an empty stomach. 

• Ginger may be helpful for nausea and 

can be found in ginger tea, ginger ale, and ginger snap cookies. 

• Avoid very hot or cold foods; those that 

are room temperature are more tolerable. 

• Avoid smoking cigarettes; if you live with 

smokers ask them to smoke outside the house. 

• Eat fresh fruit. It is often tolerable when 

you have nausea. 

Bright Side: harder to stawith the normhermit out. SDown Side: have goals twhen it affecBright Side: to do, I did ndepressed. 
30 

Notes ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

35 

Nausea: Will I experie

Treatment w

cause some 

experience 

sick to you

queasy

not on

may interf

routine a

to negle

medications as prescribed. that their nausea is worst dor so of treatment while youto the new drug. 

Bright Side: “Dietreatment. I tried whatever I ate hvalue.” Down Side: “I wmildly a lot of th

Question: What can I do if Answer: Here are a few suyou with nausea:

CHAPTE
34 

Notes ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 

31 

Irritability: I’m not irrit

Irritability 

approxim

patients 

Questions for my health care provider ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Bright Sideremove mwhen I got Down Sidehard. It affMy wife enpolice wheI didn't evewas gettinmellow pemy marria

CHAPTE

Question: How do I know i

Answer: Symptoms of irritatreatment for chronic hepatthe symptoms of depressioThese may include:
Other strategies 

• Outbursts of anger (short temper) 

Exercising may not only hefatigue, but it can also help and memory. Studies show makes “natural” antidepressduring periods of exercise. to “blow off steam.” 

• Feeling “cranky” or “on edge” • Mood swings • Getting not enough or too much sleep • Muscle tension • Change in sexual function • Problems remembering things • Difficulty in concentrating Support groups are not just 

people! Many patients have irritability after attendin

g reg

• Road Rage • Others tell you that you are irritable or 

impatient 

There may be a class or reateach you skills on how to mand anger. Talk to your heexplore which options are b

Question: What should I do if I am feeling 

very irritable?Answer: If you experience irritability during 

your therapy, it is important that you discuss it with your health care provider so the symptoms can be treated and do not become worse. Similar to depression, sympto

m

s of irritability 

usually end quickly when therapy is discontinued. 

Discuss this potential side efamily and employer. Be awa temper “fl

are” coming so t

them more effectively. Try a relaxation technique sbreathing. Use of Medications 

32 

Mental health care providers are experts at helping patients manage medications for all sorts of mood problems. Often, they will prescribe a single drug that will treat both depression and irritability. If you feel that your current medicines are not helping, ask your health care provider for a referral to the mental health clinic. 

33 

Downsidcalled my treatmen