For Patients Caregiver Tips and Advice For Medical Professionals

Treating Hepatitis C

Explore options, learn the questions to ask, and find out what to expect during treatment.

If you think you are at risk of having Hepatitis C, talk to your current healthcare provider about getting tested.  Once you’ve been diagnosed with Hepatitis C infection, you may want to see a specialist.  Specialists who work with people with Hepatitis C include the following healthcare providers:

  • Doctors who specialize in liver diseases (hepatologist)
  • Doctors who specialize in stomach and intestinal diseases (gastroenterologist)
  • Doctors who specialize in infectious disease
  • Nurse practitioners whose practice concentrates on people with liver diseases

Nurse practitioners are registered nurses who are prepared – through advanced education and clinical training – to assume some of the duties formerly assumed only by physicians.  They work in a medical care team, and can provide a wide range of health care services, including the diagnosis and management of common, as well as complex medial conditions.

Treatment for Hepatitis C depends on several factors, including:

  • How much virus is in your body (your viral load)
  • The genotype or strain of Hepatitis C you have
  • If you have liver damage, such as cirrhosis
  • What other health conditions you have
  • Your response to any previous treatments for Hepatitis C

Acute (short term) Hepatitis C

A majority of people with an acute Hepatitis C infection often do not know they have the virus and therefore do not get treated. However, if a person realizes that they may have been exposed to the virus – like a healthcare worker who gets a needle stick – an acute Hepatitis C infection can be identified early and medication may be recommended.

Doctors sometimes just recommend bed rest, drinking lots of fluids, eating a healthy diet, and avoiding alcohol. You must see your doctor regularly for follow-up blood tests to make sure your body has fully recovered from the virus.


Chronic (long term) Hepatitis C

Chronic Hepatitis C is defined by the presence of the hepatitis C virus (HCV) for 6 months or longer.  Many people already have chronic Hepatitis C when they’re first diagnosed because they were unknowingly infected with the virus many years ago.  Your healthcare provider will evaluate you to determine how much damage, or scarring, is present in your liver.

If you have severe scarring (cirrhosis), treatment with antiviral medications will generally be recommended.  If you have little to mild scarring (early stage fibrosis), you should still consider Hepatitis C treatment to avoid the long-term complications of the disease, even though you may not be at risk for many years.  In fact, with the advent of shorter, easier, and more effective treatment regimens, everyone should consider getting treated.  Discuss the risks and benefits of pursuing treatment with your healthcare provider.

In the past, when treatment for Hepatitis C basically consisted of interferon and ribavirin, side effects precluded many patients from being eligible.  However, with the current availability of interferon-free treatment regimens, many of these people can now receive treatment for their Hepatitis C infection.

Some things your Hepatitis C provider will want to know when discussing your eligibility for treatment, as well as deciding which treatment regimen is best for you, include the following:

  • What medications do you currently take?

Some medicines interact with Hepatitis C medications, which can affect the level of either one – meaning that the level of the Hepatitis C medicine or your other medicine may become too high or too low.  There can be risks of toxicity if too high, or the medication may be less effective if too low.  If available, your Hepatitis C provider will select a treatment option with no interactions.  If not available, he or she can talk to your other healthcare providers about the possibility of changing your current medicines before Hepatitis C treatment begins.

As an example, people taking amiodarone (brand names: Cordarone, Nexterone, Pacerone) should not take Sovaldi or Harvoni due to serious risks of a slow heart rate; deaths have been reported.  People taking amiodarone would need to take some other Hepatitis C treatment.

  • Do you have kidney disease?

If you have kidney disease you need to talk with your doctor about which treatment options might be right for you.  For example, Sovaldi and Harvoni are not recommended for people who have more advanced kidney disease.  Additionally, people with advanced kidney disease or those on dialysis who take ribavirin – which is cleared by the kidneys – must take low doses and be closely monitored.  Some providers do not recommend ribavirin for these patients.

  • Do you have any medical conditions that cause anemia (low red blood cell count)?

Treatment regimens that include ribavirin may not be recommended for some people who have a condition that causes anemia.  Ribavirin causes anemia and people with an existing disorder that leads to anemia may not be able to tolerate a further reduction in their red blood cells.

  • Are you pregnant?

Antiviral medications may not be recommended if you are pregnant, because these medications can cause birth defects in babies.


Liver Transplant

Over time, chronic Hepatitis C can lead to severe liver problems – including cirrhosis and liver cancer – resulting in decreased liver function and ultimately, liver failure.  When the liver can no longer perform its vital functions a transplant may be the only option.  People are typically considered for a liver transplant when their liver is working at approximately 10-20 percent of what is considered normal.  Chronic Hepatitis C is the most frequent cause of liver transplantation in the United States.

A liver transplant replaces a damages liver with a healthy one from someone else.  Most of the time, a liver is donated from someone who has died.  In rare cases, a living person donates a portion of their liver.  Livers must be matched for blood type and body size.

Advances in the surgical and medical management of liver transplantation have led to improved outcomes, however, people with Hepatitis C generally don’t do as well since the virus usually infects the donor liver.  Most people who receive a liver transplant for Hepatitis C survive at least five years after their transplant.

There are many things that are taken into consideration when getting evaluated for a liver transplant.  You need to be healthy enough to tolerate the surgery and recovery period – which is long – and have a support system in place that can help you through the process.  Your doctor will determine if your liver disease is severe enough that referral for a transplant is appropriate.

Unlike Hepatitis A and Hepatitis B, a vaccine for Hepatitis C is not available.

Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body.  Your doctor may recommend one medication or a combination of two to three medications to be taken for 12 – 24 weeks or longer.  Blood tests and doctor visits are necessary during this time so that your response to treatment can be carefully monitored and evaluated.

The purpose of using medications to treat Hepatitis C is to:

  • Clear the Hepatitis C virus from your bloodstream
  • Slow down progression of inflammation and scarring of your liver
  • Reduce the chances of developing cirrhosis and liver cancer

The most important factors affecting treatment results are:

  • Your Hepatitis C genotype
  • Whether or not you have cirrhosis (severe scarring of the liver)
  • Taking medications as prescribed; not missing doses

Before visiting your healthcare professional to discuss treatment options, it’s a good idea to prepare a list of questions so that you make the best use of your time during the appointment.  Some questions to ask include:

  • How much Hepatitis C virus do I have in my body?
  • What is my genotype?
  • Has the virus damaged my liver?
  • With treatment, can I be cured of the Hepatitis C virus?
  • What treatment options are available?
  • What are the benefits and risks of each option?
  • Do I have any conditions that affect my options?
  • Which option do you think is best for me and why?
  • How long will treatment last?
  • What side effects will I have? Are the side effects different between the treatment options?
  • Will my past medical history have any impact on how I will react to the different treatments (be prepared to tell your doctor of all the medical conditions that you have had or currently have, including any allergic reactions)?
  • How will treatment affect my daily life?
  • Will treatment affect my ability to work?
  • What will the treatment cost and will my insurance cover it?
  • What else can I do to keep healthy and minimize damage to my liver?
  • What is the next step?

Download this list and take it to your doctor’s appointment.

The good news is that there are now more medications available to treat Hepatitis C than ever before.  Based on you medical history, physical exam, laboratory and other test results, your healthcare provider will suggest which medications are right for you, as well as determine the length of time you need to be treated.  This decision will depend upon a number of factors including:

  • Your Hepatitis C virus (HCV) genotype
  • Whether or not you have cirrhosis, and if it’s mild (compensated) or severe (decompensated)
  • If you’ve received treatment before and which medications were used
  • If you’re waiting for or you’ve already had a liver transplant
  • Other health conditions you may have

Treatment regimens are usually 6 to 24 weeks, but sometimes longer, depending on your particular circumstances.

What follows is a basic outline of recommended treatment protocols organized by HCV genotype.  HCV genotypes are 1 (1a and 1b), 2, 3, 4, 5, and 6.  About 75% of the people with HCV in the U.S. have either genotype 1a or 1b.  Between 10% – 20% of people with HCV in the U.S. have either genotype 2 or 3.

Use this information as a starting point to talk with your healthcare provider about which treatment protocol is best for you.  Keep in mind that these are general guidelines and they do not cover alternative treatment protocols or special situations.  It’s important to follow your healthcare provider’s instructions regarding what, when, how and for how long to take your medication(s), as this will depend upon your specific circumstances.

Recently, it has been discovered that new anti-viral therapies can re-activate past Hepatitis B infections. For this reason, it is important that your healthcare provider tests you for infectious disease including Hepatitis B prior to starting treatment. Black box warning have been issued and can be found on the prescribing insert for your medication.


PAN-GENOTYPIC MEDICATIONS
Medications which treat all genotypes.

  • Epclusa (sofosbuvir/velpatasvir); only given with ribavirin in cases of decompensated (advanced) cirrhosis.
    • Recommended dosage: One tablet (sofosbuvir 400 mg/velpatasvir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12 weeks.
    • The most common side effects are headache and fatigue.
    • When given with ribavirin, the most common side effects include headache, fatigue, nausea, diarrhea, insomnia and anemia.
  • Mavyret (glecaprevir and pibrentasvir):
    • Recommended dosage: Three tablets (glecaprevir 100 mg/pibrentasvir 40 mg) taken orally once daily with food
    • Length of treatment is 8, 12 or 16 weeks depended on genotype, previous HCV treatment experience and having compensated cirrhosis.
    • The most common side effects are headache and fatigue.
  • Vosevi (sofosbuvir/velpatasvir/voxilapresvir tablet):
    • Recommended dosage: One tablet (400 mg of sofosbuvir, 100 mg of velpatasvir, and 100 mg of voxilapresvir) taken orally once daily with food.
    • Length of treatment is 12 weeks for patients without cirrhosis and patients with compensated cirrhosis.
    • The common side effects for Vosevi include headache, tiredness, diarrhea, and nausea.

GENOTYPE SPECIFIC MEDICATIONS
Medications that are genotype specific.

HCV Genotype 1

  • Daklinza (daclatasvir) with Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage: Daclatasvir 60 mg with sofosbuvir 400 mg once a day.
    • Length of treatment is 12 weeks.
    • The most common side effects are fatigue and headache.
  • Harvoni (ledipasvir/sofosbuvir); sometimes given with ribavirin. 
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • In clinical trials, the most common side effects observed with Harvoni treatment for 8, 12, or 24 weeks were fatigue and headache.
    • When Harvoni was given with ribavirin the most common side effects observed were weakness, headache and cough.
  • Olysio (simprevir) plus Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage of simeprevir: One 150-mg capsule once a day with food.
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • In clinical trials, the most common side effects observed during 12 weeks of treatment with simprevir/sofosbuvir combination therapy were fatigue, headache, nausea, insomnia, itching, rash and photosensitivity.  During 24 weeks of treatment, dizziness and diarrhea were also observed.
  • Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets); given with ribavirin if genotype 1a.
    • Recommended dosage: Two ombitasvir 12.5 mg/paritaprevir 75 mg/ritonavir 50 mg tablets once daily (in the morning) and one dasabuvir 250 mg tablet twice daily (morning and evening) with a meal.
    • Length of treatment is usually 12 or 24 weeks.
    • The common side effects for Viekira Pak without ribavirin include nausea, itching, and sleep problems.  If taken with ribavirin side effects include tiredness, nausea, itching, sleep problems, feeling weak and skin reactions such as redness or rash.
  • Viekira XR (ombitasvir, paritaprevir, ritonavir, dasabuvir tablet); given with ribavirin if genotype 1a.  Viekira XR is a once-daily, extended release formulation that contains the same ingredients as Viekira Pak, which is dosed twice a day.
    • Recommended dosage: Three tablets once daily with a meal.
    • If you also need ribavirin, this is an additional medication that will be taken twice a day.
    • Length of treatment is 12 weeks (patients without cirrhosis) or 24 weeks (patients with compensated cirrhosis).
    • The common side effects for Viekira without ribavirin include nausea, itching, and sleep problems.  If taken with ribavirin side effects include tiredness, nausea, itching, sleep problems, feeling weak and skin reactions such as redness or rash.
  • Zepatier (elbasvir/grazoprevir): sometimes given with ribavirin.
    • Recommended dosage: One tablet (elbasvir 50 mg/grazoprevir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12-weeks for the vast majority of people, although a 16-week course has been approved for a certain subset of patients.
    • The most common side effects of Zepatier without ribavirin include fatigue, headache and nausea.  If taken with ribavirin, common side effects include low red blood counts (anemia), headache, fatigue, shortness of breath, and rash or itching.

HCV Genotype 2

  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is usually 12 or 16 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.

HCV Genotype 3

  • Daklinza (daclatasvir) with Sovaldi (sofosbuvir); sometimes given with ribavirin.
    • Recommended dosage: Daclatasvir 60 mg with sofosbuvir 400 mg once a day.
    • Length of treatment is 12 weeks.
    • The most common side effects are fatigue and headache
  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir: One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment with sofosbuvir/ribavirin combination therapy is usually 24 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.

HCV Genotype 4

  • Harvoni (ledipasvir/sofosbuvir); sometimes given with ribavirin. 
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects of Harvoni are fatigue and headache.
    • When co-administered with ribavirin the most common side effects are weakness, headache and cough.
  • Sovaldi (sofosbuvir) plus ribavirin
    • Recommended dosage of sofosbuvir:   One 400-mg tablet once a day with or without food.
    • Ribavirin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is usually 24 weeks.
    • The most common side effects for sofosbuvir/ribavirin combination therapy are fatigue and headache.
  • Technivie (ombitasvir/paritaprevir/ritonavir) plus ribavarin
    • Recommended dosage of Technivie: One tablet once daily with a meal.
    • Ribavarin is a pill taken by mouth with food. The dose is individualized based on your weight.
    • Length of treatment is 12 weeks.
    • The common side effects for Technivie with ribavirin include fatigue, nausea, sleep problems, feeling weak, itching and other skin reactions such as redness or rash.
  • Zepatier (elbasvir/grazoprevir): sometimes given with ribavirin.
    • Recommended dosage: One tablet (elbasvir 50 mg/grazoprevir 100 mg) taken orally once daily with or without food.
    • Length of treatment is 12-weeks for the vast majority of people, although a 16-week course has been approved for a certain subset of patients.
    • The most common side effects of Zepatier without ribavirin include fatigue, headache and nausea.  If taken with ribavirin, common side effects include low red blood counts (anemia), headache, fatigue, shortness of breath, and rash or itching.

HCV Genotype 5

  • Harvoni (ledipasvir/sofosbuvir)
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects are fatigue and headache.

HCV Genotype 6

  • Harvoni (ledipasvir/sofosbuvir)
    • Recommended dosage: One tablet (ledipasvir 90 mg/sofosbuvir 400 mg) taken orally once daily with or without food.
    • Length of treatment is usually 12 weeks.
    • The most common side effects are fatigue and headache.

After you and your doctor decide on a treatment regimen, it’s important to take these medications exactly as prescribed.  That means taking the correct dose of each drug for the full duration that your doctor prescribes them.  Adhering to your medication regimen is an important factor in treatment success.

Discuss any side effects you experience with your doctor.  He or she may be able to treat them by giving you other medicines to treat the side effects.  If you experience serious side effects or complications from other health conditions, contact your doctor before stopping any of your Hepatitis C medications.  Your doctor will determine if you need to stop or change treatment.

Many hepatitis C medications have important considerations that you should be aware of before starting a course of treatment for your HCV infection.  Some considerations are specific to a particular drug, while others are more general in nature.

Before starting treatment, it’s important to tell your healthcare provider if you:

  • Have other medical conditions, including liver problems not due to HCV
  • Take other medicines, including prescription and over-the-counter medicines, vitamins, and herbal supplements.  They may affect how well your hepatitis C treatment works, and your hepatitis C treatment may affect the way other medicines work.
  • Are breastfeeding or plan to breastfeed; it’s not known if some of the hepatitis C medications pass into your breast milk.
  • Are pregnant or plan to become pregnant; it’s not known if some of the hepatitis C medications will harm your unborn baby.

Below we’ve listed some important considerations you should be aware of related to specific medications.  This is not a comprehensive list and does not take the place of talking with your healthcare provider.

Recently, it has been discovered that new anti-viral therapies can re-activate past Hepatitis B infections. For this reason, it is important that your healthcare provider tests you for infectious disease including Hepatitis B prior to starting treatment. Black box warning have been issued and can be found on the prescribing insert for your medication.


Ribavirin

  • Ribavirin can cause birth defects and must not be taken by pregnant women or the male partners of pregnant women.
  • Extreme care must be taken to avoid pregnancy during treatment and for six months following treatment in both female patients and female partners of male patients who are taking ribavirin.
  • You and your partner should use two forms of birth control during this period.  For example, a man could use a condom and a woman could use a diaphragm or birth control pills.

Olysio (simprevir) 

  • Simprevir – a protease inhibitor – cannot be used with any hormonal birth control because the protease inhibitors stop hormonal birth control from working well.  These include:
    • Birth control pills
    • Uterine implants
    • Depo-Provera injections
    • Vaginal rings

When taking a protease inhibitor, you would need to use two non-hormonal forms of birth control, like a condom and diaphragm plus spermicidal jelly.

  • Increased chance of sunburn (photosensitivity): This has been observed with simprevir combination therapy.  Use sun protective measures, limit sun exposure and avoid tanning devices during treatment with simprevir.
  • Simprevir should not be taken alone; it is used in combination with other antiviral drugs. It’s important to review the considerations related to other HCV medications you’re taking in combination with simprevir.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Sovaldi (sofosbuvir)

  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, at the same time as Sovaldi.  It can lead to dangerous slowing of the heart rate.
  • If you take any medications for seizures, let your doctor know.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with sofosbuvir as this can decrease its effectiveness.
  • Sofosbuvir should not be taken alone; it is used in combination with other antiviral drugs. It’s important to review the considerations related to other HCV medications you’re taking in combination with sofosbuvir.

Harvoni (ledipasvir/sofosbuvir)

  • Taking other drugs containing sofosbuvir, including Sovaldi, is not recommended.
  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, at the same time as Harvoni.  It can lead to dangerous slowing of the heart rate.
  • If you take any medications for seizures, let your doctor know.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with Harvoni as this can decrease its effectiveness.
  • Drugs that reduce the amount of acid your stomach produces may affect the levels of Harvoni in your blood.  There are two types of acid-reducing medications: protein pump inhibitors like omeprazole (Prilosec), and H2 blockers such as famotidine (Pepcid), ranitidine (Zantac) and cimetidine (Tagamet).  If you’re taking an acid-reducing medication, talk with your doctor about proper dosing and timing of when to take it while being treated with Harvoni.
  • If you take an antacid that contains aluminum (such as Amphojel) or magnesium hydroxide (such as Phillips’ Milk of Magnesia), take it fours hours before or fours hours after you take Harvoni.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Viekira Pak (ombitasvir/paritaprevir/ritonavir tablets; dasabuvir tablets); Viekira XR

  • Viekira can cause an increase in your liver function blood test results, especially if you use ethinyl estradiol-containing medicines, such as some birth control products (for example, Lo Loestrin FE, Norinyl, Ortho Tri-Cyclen Lo, etc.) and hormone replacement therapy (Fem HRT).
  • You must stop using these products before you start treatment with Viekira.
    You’ll need to use another method of birth control during treatment and for about 2 weeks after treatment ends.  Your healthcare provider will tell you when you may begin taking ethinyl estradiol-containing medicines.
  • If you take any medications for seizures, let your doctor know.
  • If you’ve had a liver transplant and take the medicines tacrolimus (Prograf) or cyclosporine (Gengraf, Neoral, Sandimmune), your healthcare provider should check your blood levels and, if needed, may change your dose of these medicines or how often you take them, both during and after treatment.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Technivie (ombitasvir/paritaprevir/ritonavir)

  • Technivie can cause an increase in your liver function blood test results, especially if you use ethinyl estradiol-containing medicines, such as some birth control products (for example, Lo Loestrin FE, Norinyl, Ortho Tri-Cyclen Lo, etc.) and hormone replacement therapy (Fem HRT).
  • You must stop using these products before you start treatment with Technivie.  You’ll need to use another method of birth control during treatment and for about 2 weeks after treatment ends.  Your healthcare provider will tell you when you may begin taking ethinyl estradiol-containing medicines.
  • If you take any medications for seizures, let your doctor know.
  • If you’ve had a liver transplant and take the medicines tacrolimus (Prograf) or cyclosporine (Gengraf, Neoral, Sandimmune), your healthcare provider should check your blood levels and, if needed, may change your dose of these medicines or how often you take them, both during and after treatment.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Daklinza (daclatasvir)

  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, at the same time as Daklinza with sofosbuvir.  Taking amiodarine with sofosbuvir can lead to dangerous slowing of the heart rate.
  • You should not take the following drugs with Daklinza as they can decrease its effectiveness: rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), phenytoin (brand name Dilantin), carbamazepine (brand name Tegretol), St. John’s wort, or a product that contains St. John’s wort.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Zepatier (elbasvir/grazoprevir)

  • Drugs that should not be taken with Zepatier include St. John’s wort, rifampin, and the seizure medications phenytoin and carbamazepine.
  • Co-administration of the antifungal drug ketoconazole is not recommended with Zepatier.
  • If you have HIV/AIDS, review your HIV medicines with your physician to make sure there are no drug-drug interactions.
  • Co-adminstration of Zepatier with moderate CYP3A inducers (nafcillin, modafinil, etc.) is not recommended.
  • Tell your doctor if you take a statin medication to control your cholesterol (e.g., atorvastatin, rosuvastatin, fluvastatin, lovastatin, simvastatin), as the dose may need to be adjusted.
  • If you’ve had a liver transplant, you should not take Zepatier if you take cyslosporine.  If you take tacrolimus (Prograf), it’s recommended that your healthcare provider frequently check your blood level of tacrolimus, your kidney function, and watch for tacrolimus associated side effects.
  • Zepatier can cause an increase in your liver enzymes. Your healthcare provider will do blood tests to check your liver enzymes before and during treatment with Zepatier.

Epclusa (sofosbuvir/velpatasvir)

  • Taking other drugs containing sofosbuvir, including Sovaldi, is not recommended.
  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, with Epclusa.  It can lead to dangerous slowing of the heart rate.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with Epclusa as this can decrease its effectiveness.
  • Tell your doctor if you take a statin medication to control your cholesterol (e.g., atorvastatin, rosuvastatin), as the dose may need to be adjusted.
  • If you take any medications for seizures, let your doctor know.
  • Drugs that reduce the amount of acid your stomach produces can decrease the level of Epclusa in your blood.  There are two types of acid-reducing medications: protein pump inhibitors like omeprazole (Prilosec), and H2 blockers such as famotidine (Pepcid), ranitidine (Zantac) and cimetidine (Tagamet).  If you’re taking an acid-reducing medication, talk with your doctor about proper dosing and timing of when to take it while being treated with Epclusa.
  • If you take an antacid that contains aluminum (such as Amphojel) or magnesium hydroxide (such as Phillips’ Milk of Magnesia), take it fours hours before or fours hours after you take Epclusa.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.

Mavyret (glecaprevir and pibrentasvir)

  • Taking other drugs including with atazanavir or rifampin at the same time as Mavyret. Taking these medications can reduce the success of the medication
  • You should not take Digoxin (brand names Lanoxin, Digox) a drug used to treat heartbeat irregularities, at the same time as Mavyret.
  • If you take any medications for seizures, let your doctor know.
  • Taking oral contraceptives at the same time as Mavyret can increase ALT levels and is not recommended
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.
  • Tell your doctor if you take a statin medication to control your cholesterol (e.g., atorvastatin, rosuvastatin), as the dose may need to be adjusted.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with Vosevi as this can decrease its effectiveness.
  • Not recommended for those taking immunosuppressants ( drugs or medicines that lower the body’s ability to reject a transplanted organ) such as Cyclosporine on a daily basis.

Vosevi (sofosbuvir/velpastavir/voxilaprevir)

  • Taking other drugs containing sofosbuvir, including Sovaldi, Harvoni and Epclusa, is not recommended.
  • Before taking Vosevi, your healthcare provider should test you for hepatitis B infection. If you have hepatitis B, Vosevi treatment may activate hepatitis B infection.
  • You should not take rifampin (brand names include Rifadin, Rifamate, Rifater, Rimactane), St. John’s wort, or a product that contains St. John’s wort, with Vosevi as this can decrease its effectiveness.
  • You should not take amiodarone (brand names Cordarone, Pacerone), a drug used to treat heartbeat irregularities, with Vosevi.
  • Tell your doctor if you take a statin medication to control your cholesterol (e.g., atorvastatin, rosuvastatin), as the dose may need to be adjusted.
  • If you take any medications for seizures, let your doctor know.
  • Drugs that reduce the amount of acid your stomach produces can decrease the level of Vosevi in your blood.  There are two types of acid-reducing medications: protein pump inhibitors like omeprazole (Prilosec), and H2 blockers such as famotidine (Pepcid), ranitidine (Zantac) and cimetidine (Tagamet).  If you’re taking an acid-reducing medication, talk with your doctor about proper dosing and timing of when to take it while being treated with Vosevi.
  • If you take an antacid that contains aluminum (such as Amphojel) or magnesium hydroxide (such as Phillips’ Milk of Magnesia), take it four hours before or four hours after you take Vosevi.
  • There are drug interaction issues with some of the medications used to treat HIV, so tell your Hepatitis C provider if you’re taking any HIV medications so that he or she can confer with your HIV provider before you begin Hepatitis C treatment.
  • You should not take BCRP substrates (e.g., methotrexate, mitoxantrone, imatinib, irinotecan, lapatinib, rosuvastatin, sulfasalazine, topotecan), drugs used to treat cancer, with Vosevi.

Now that you’ve made the decision to pursue treatment for your Hepatitis C infection, you’ll want to do everything you can to make it a success. Adherence to Hepatitis C therapy is an important predictor of successful treatment. Adhering to other aspects of your treatment plan – like keeping medical appointments and getting the necessary lab tests – is also important. In this section we give you helpful tips on how to minimize side effects of therapy, deal with depression, manage your health and continue to work and travel while on treatment, all with the goal of maximizing your chance of treatment success and minimizing potential problems.

Once you begin treatment for your Hepatitis C infection, you’ll want to do everything you can to make it a success.  Adherence to your Hepatitis C medication regimen is an important predictor of successful treatment.  When it comes to medications, this means that you want to “adhere” to taking them as prescribed – meaning taking the right dose, the right way, at the right time, for as long as prescribed.

The goal of using medications to treat Hepatitis C is to:

  • Clear the Hepatitis C virus from your body
  • Prevent or slow down scarring of your liver
  • Reduce your chance of developing cirrhosis and liver cancer

Proper adherence to Hepatitis C therapy will increase your chance of being cured and decrease the long-term complications of Hepatitis C.

Adhering to other aspects of your treatment plan is also important.  Keeping your medical appointments and getting the necessary lab tests will help to maximize your chance of treatment success and minimize potential problems.

Keeping your medical appointments and regularly communicating with your healthcare provider is important to staying healthy, minimizing treatment-related side effects and maximizing your chance of treatment success.  Here are some things you can do to get the most out of your medical appointments:

  • Prepare, prepare, prepare.  Write down your questions and concerns in advance of your appointment and prioritize them.  This should include any problems or symptoms you are having, all medications you are taking (including herbs and vitamins), and any changes in your living or work situation.
  • If you’re having troublesome symptoms, try to be specific when describing them: What do they feel like, when do they happen, how long do they last, does anything make them better, and what have you tried to make them go away?  It helps to keep a diary of your symptoms with dates and notes.
  • Be honest.  Your doctor needs to know exactly what’s going on in order to provide you with the best care.  For instance, if you’re feeling particularly depressed or have used drugs or alcohol, let him or her know. They are not there to judge you, but to help you. Otherwise, you may be harmed by treatment or not get the best result from treatment.
  • Maintain your own health records.  It helps if you always ask for copies of the most recent reports and take them with you to visits, particularly if you have questions about them.
  • Medical tests and lab work are a very important step in treatment. If your doctor is sending you for medical tests or lab work, make sure you understand what they are for and what the results might indicate in terms of your treatment.  Be sure to follow through on all of your appointments and ask to talk to your doctor about the results.
  • If you’re given any new medications get specific information about how and when they should be taken, what the common side effects are, and if there are any signs or symptoms that need to be reported immediately. This is especially important if you see other doctors for unrelated reasons. You should always call your Hepatitis C doctor to check with her or him before starting any new medications while you’re on treatment. You might also consider getting a pill dispenser to help you keep track of medications throughout the day and week.
  • Take notes during the appointment.  If your doctor makes suggestions, write them down.  If you don’t understand something, ask for clarification.
  • Take a family member or friend with you.  It helps to have someone else listening, particularly during longer appointments or those where important decisions will be made.  Ask that person to take notes so you can concentrate on what the doctor is saying.
  • If your doctor suggests a plan that you have reservations about, communicate your concerns right away.  Sometimes they can be easily addressed.  If you’re still hesitant, ask if there are any alternatives.

If you run out of time during your appointment and still have questions, ask if there’s someone else on your healthcare team who can talk with you.  If not, ask if you can leave a copy of your questions and request a time to discuss them on the phone.

In order to adequately monitor your response to treatment, you’ll need to visit your healthcare provider so he or she can examine you in person and discuss how you’re feeling.  The level of Hepatitis C virus in your bloodstream will be checked to monitor your response to treatment.  The potential outcomes of treatment are the following:

  • Sustained virologic response (SVR): You are considered cured if the Hepatitis C virus is not detected when measured with a blood test three months after you’ve completed treatment.  This is called a sustained virologic response and data suggest that you will stay virus free indefinitely.
  • Nonresponse: The Hepatitis C virus does not become undetectable as a result of treatment. This can be further categorized as partial response, when the viral levels become lower but not undetectable, or null-response which is when the viral level never drops significantly.
  • Relapse: The Hepatitis C virus becomes undetectable on treatment, but then is detectable again, either during treatment or after treatment is stopped.
  • Incomplete treatment: Treatment ended earlier that the prescribed duration.

The goal of treatment is to have an SVR.  This is when you are considered cured. Taking your medication as prescribed will increase your chance of being cured and decrease the long-term complications of Hepatitis C.

Keeping your medical appointments, taking every dose of your Hepatitis C medicine, and getting the necessary lab tests are the keys to maintaining your health, identifying and managing side effects, and monitoring your response to treatment.  Communicating with your healthcare providers on a regular basis will help you promptly address side effects before they become problems.  Try to develop a relationship with all members of your healthcare team – nurses, case managers, pharmacists, etc.  They are often the ones providing the ongoing education and support needed to help you proactively manage your disease and its treatment.

Something you should keep in mind is that even if you are cured, it’s still possible for you to become infected again – called reinfection – if you are re-exposed to the virus.  Having Hepatitis C once doesn’t make you immune from getting it again.  The best way to avoid reinfection is not to engage in risky behaviors: Do not use injection drugs, do not share needles, and use condoms if you are sexually active with a new partner or with a partner who has used injection drugs.  Preventing re-exposure to the Hepatitis C virus by avoiding blood-to-blood contact is the only sure way of avoiding reinfection.

While recognizing that no one is perfect, striving for complete adherence to Hepatitis C medications is the goal.  It’s extremely important to avoid any missed doses; otherwise the medications may not cure you.  Below you’ll find some simple strategies that can help you successfully adhere to your treatment plan:

  • Buy a 7-day pill box (available at most drug stores) to organize your pills for the week.  This will help you keep track of what pills need to be taken when and if you’ve taken them.
  • Set alarms to remind you to take your medications.  Cell phones and many watches have an alarm function, most of which can be put on “vibration” when at work or in public.
  • Try to keep a regular schedule of eating and sleeping.  A regular routine will help you remember to take your medications, particularly if you take them with food or at bedtime.
  • Plan ahead for unexpected situations that may arise, like losing your house keys, severe weather, or just being on the go.  Keep a daily packet of pills and snack bars in your car or at a neighbor’s house.
  • Get as much support as possible.  Enlist the help of family and friends.  Support group peers who have been on treatment can be particularly helpful with advice and encouragement.
  • Pharmaceutical companies have many support services for people taking their medications.

Take advantage of these free services.  A list of resources follows:


AbbVie Pharmaceuticals

Mavyret
AbbVie Patient Assistance Program
877-628-9738
www.mavyret.com


Bristol Myers Squibb

Daklinza (daclatasvir)
Patient Support Connect
1-844-442-6663
http://www.daklinza.bmscustomerconnect.com/support


Genentech

Copegus (ribavirin)
1-866-4ACCESS (1-866-422-2377)
www.genentech-access.com/patients/find-support-program


Gilead

Sovaldi (sofosbuvir)
Harvoni (ledispasvir/sofosbuvir)
Epclusa (sofosbuvir/velpatasvir)
Vosevi (sofosbuvir/ – velpatasvir/voxilaprevir)
Gilead Support Path
1-855-7-MYPATH (1-855-769-7284)
www.MySupportPath.com


Janssen

Olysio (simeprevir)
Olysio Support
1-855-5-OLYSIO (1-855-565-9746)
www.olysio.com


Kadmon Pharmaceuticals

Ribasphere RibaPak (ribavirin)
KEYS (Kadmon Enabling Your Success) Program
1-888-668-3393
www.ribapak.com


Merck

Victrelis (boceprevir)
Merck ACT Patient Assistance
1-866-363-6379
www.merckhelps.com

Zepatier (elbasvir, grazoprevir)
www.merckaccessprogram-ZEPATIER.com
(primarily for privately insured patients who cannot afford the co-pay)

Merck Patience Assistance Program
(primarily for uninsured patients)
1-800-405-5810
www.merckhelps.com

Before you stop taking any of your Hepatitis C medications, contact your doctor.  The goal is to avoid the situation of needing to reduce the dose and/or discontinue Hepatitis C medication, if at all possible. Also, if you become sick and need to see a doctor in an emergency situation or are hospitalized, it is very important to tell them about your Hepatitis C medications and to immediately contact your Hepatitis C doctor as well.

In the past when interferon was used, management of side effects was critical to have success with Hepatitis C treatment.  Side effects are much less common now with the new Hepatitis C medications, but they can still happen.  Fortunately, there are many steps you can take to manage them.  It’s important to talk to your Hepatitis C provider to help you manage side effects and have a good experience on treatment.

Keep in mind that not everyone will experience the same side effects, nor are they necessarily severe.  Developing a good support system before beginning therapy – with family, friends, and peer support group members – can help you cope with treatment-related side effects.

The following tips will help you manage some of the more common side effects of Hepatitis C treatment:

Fatigue

  • Rest when you can.
  • Modify your work schedule if possible.
  • Get regular low-impact exercise such as walking.
  • Eat well-balanced meals and drink enough fluids.

Insomnia

  • Develop a regular routine; go to bed and get up the same time every day.
  • Use relaxation techniques such as meditation, warm baths or massage; read or listen to music.
  • Avoid exercise, caffeinated products, or heavy meals close to bedtime.
  • Limit fluid intake about 2 hours before bedtime so you don’t have to get up to go to the bathroom.
  • Take over-the-counter (such as Benadryl) or prescription medications as recommended by your provider.

Poor Appetite

  • Eat smaller, more frequent meals.
  • Eat whatever appeals to you most.
  • Eat snacks high in protein (cheese, peanut butter); have protein drinks (like Ensure, Boost or Carnation Instant Breakfast).

Nausea and Vomiting

  • Eat small meals.
  • Avoid smells or foods that trigger nausea.
  • Avoid spicy, greasy, sweet or acidic (like citrus) foods.
  • If morning nausea is a problem, eat some dry crackers when first awakening.
  • Try drinking ginger ale or ginger tea.
  • Take ribavirin with food.
  • Take over-the-counter medication as recommended by your provider.

Diarrhea

  • Try the BRAT diet (Bananas, Rice, Applesauce, Toast) which will give you more soluble fiber.
  • Avoid spicy or acidic foods.
  • Drink enough fluids (6-8 glasses/day, non-caffeinated).
  • Take over-the-counter medications like loperamide (Immodium) or psyllium (Metamucil) as recommended by your provider.

Cough

  • Use a humidifier.
  • Drink more water or non-caffeinated drinks.
  • Suck on cough drops or sugar-free hard candy.

Rashes and Dry Skin

  • Use gentle soaps (like Dove or Cetaphil).
  • Avoid taking long, hot showers since that dries out your skin.
  • Moisturize daily after showers with unscented lotion for dry skin.
  • Use unscented laundry detergent for sensitive skin.
  • Apply sunscreen when needed.
  • Use over-the-counter hydrocortisone creams or other anti-itch medications as recommended by your provider.
  • Rash could be a sign of an allergic reaction, which can become severe.  If a rash develops, immediately report this to your Hepatitis C provider.

There are many things you can do to improve your health and feel better while on treatment for your Hepatitis C infection.  And by taking good care of yourself, you will increase your chances of be able to take your medication as prescribed.


IMPORTANCE OF DIET AND NUTRITION

Contrary to some claims you might read on the Internet, there is no special “Hepatitis C diet.”  However, a healthy diet can improve liver health in a person with Hepatitis C.

A well-balanced diet can lead to better liver functioning and lowered risk of cirrhosis (advanced scarring) of the liver.  It can also help your immune system fight off illness.  People with Hepatitis C tend to have higher rates of diabetes, but a good diet can help control blood sugar and reduce body fat, thereby lowering your risk for becoming diabetic.

Multiple studies have now demonstrated the benefit of drinking coffee to improve liver health in Hepatitis C.  Studies suggest you need to drink more than two cups per day to gain this benefit.  However, the research is not strong enough to make a recommendation to start drinking coffee and some people do not tolerate it well.  But for those who currently do drink coffee – enjoy!

The important thing is to eat healthy, not be overweight, and avoid all alcohol during treatment.  By contrast, a bad diet can sometimes lead to liver problems.  Being overweight, drinking too much alcohol, having diabetes, or high levels of cholesterol or blood fats is linked to the buildup of fat in the liver, called “fatty liver” (or steatosis).  Over time, having a fatty liver in addition to Hepatitis C will increase the likelihood of developing cirrhosis.  The most effective way to lose weight is by combining calorie reduction with increased physical activity.

While following a generally healthy diet and keeping a normal body weight may not seem like a specific treatment for Hepatitis C, it’s a good way of protecting your liver.  Following the guidelines for nutrition based on the Dietary Guidelines for Americans is all that’s needed unless you have cirrhosis or another medical condition – such as diabetes or kidney disease – that may warrant specific dietary restrictions.

General dietary recommendations include the following:

  • Maintain a healthy caloric intake
  • Eat whole grain breads and cereals
  • Get enough protein (supplement with protein drinks if necessary)
  • Eat at least 5 servings of fruits and vegetables a day; eating things of varying colors can provide a range of nutrients.
  • Limit your intake of salty, sugary and fatty foods
  • Drink enough fluids (generally 6-8 glasses day).  In addition to water, you can include juice, tea, milk, soup, and frozen fruit bars.

BE CAUTIOUS ABOUT DIETARY SUPPLEMENTS

Certain vitamins and minerals – like vitamins A and D, iron and niacin – can be harmful to your liver in high doses. Before taking a vitamin or supplement, it’s best to talk with your doctor, dietician or nutritionist.


ALCOHOL

This is a toxin to the liver, even in people without Hepatitis C.  Drinking too much can led to cirrhosis and advanced liver disease.  The best thing to do is avoid alcohol completely.


IMPORTANCE OF EXERCISE

Exercise is important for many reasons: It can help with weight control, boost your immune system, improve your appetite, and alleviate stress and depression.  While the idea of exercising when you’re feeling fatigued may seem counter-intuitive, it can improve your overall sense of well-being.

Getting exercise doesn’t mean you have to go to a gym – walking, gardening and even housework counts.  Do things in moderation. Try to have 10-minute blocks of exercise throughout the day.  Low-impact exercises such as walking or swimming are the best.  You can start with a 10-minute walk at a comfortable pace, take rest breaks if needed, and slowly increase your activity level over time.  It’s a good idea to talk with your doctor before starting a diet and exercise program.


IMPORTANCE OF REDUCING STRESS AND MANAGING ANGER

Everyone has stress in life at one point or another – work, finances, children, family issues – are all examples of common stressors.  Our bodies are designed to handle stress to keep us safe from danger or get us through a difficult day.  However, stress can become a problem when it’s ongoing or intense.

Chronic stress negatively affects the immune system and contributes to other issues such as high blood pressure, heart disease, sleeping problems and substance abuse.  Having a chronic illness, like Hepatitis C, can be physically and emotionally stressful.  Undergoing Hepatitis C treatment can add additional stressors, depending on the level of side effects you experience. When people are chronically stressed it’s also common to feel angry.

Feeling anger when first diagnosed with an illness is a common reaction. You might have had thoughts like “I don’t deserve this!” and “Why did this happen to me?”  While these reactions are quite normal, anger that becomes chronic and/or turns into rage is not.  Very simply, it can ruin your relationships and rob you of the energy you need to live your life well.

Learning how to manage stress and anger is an integral part of managing your Hepatitis C infection and its treatment.  Below are some strategies to help you:

  • Find ways to relax and quiet your mind.  Some people find meditation, prayer, visualization or massage to be helpful.
  • Do something physical as a release.  Dancing, biking, walking, yoga or exercise of any kind can keep you healthy and lessen stress and anger.
  • Participate in a Hepatitis C support group.
  • Help others; sometimes helping others is the best way to forget about your own problems.
  • Set reasonable expectations for yourself.  Deal with issues one task at a time.  What must I accomplish today?  If it’s not that important, cross it off the list.
  • Learn to let others help you when you need it.
  • Spend time with people who have a positive outlook on life and limit your exposure to people and places that induce negativity.
  • Attend a stress and/or anger management class. These are often offered by employers, health insurance companies or community centers.
  • Find ways to laugh.  Whether you see a funny movie or spend time with a good buddy, remember that laughter is therapeutic for both body and mind.
  • Try to put a positive spin on things and don’t sweat the small stuff. Practice positive thinking by replacing negative thoughts with messages of hope and affirmation.
  • Discuss your feelings with people you trust.  Sometimes others can offer a different perspective or solution to something that’s on your mind.  Or consider seeking the help of a mental health professional.

Some people seek out complementary or alternative ways to treat their Hepatitis C.  Complementary and alternative medicine, known as CAM, includes a variety of interventions.  Some common complementary therapies include the following:

Relaxation techniques, such as meditation and visualization

  • These focus on how a person’s mind and imagination can promote overall health and well-being.

Physical techniques, such as massage, yoga, and tai chi

  • These focus on using a person’s body and senses to promote healing and well-being.

Herbal medicine

  • These are substances that come from plants. They can be taken from all parts of a plant, including the leaves, roots, flowers and berries.

These therapies, which are based on different traditions and disciplines, are generally considered to be outside the realm of conventional Western medicine.  When used with conventional medicine, they are referred to as “complementary.”  When used instead of conventional medicine, they are considered “alternative.”

Generally, physical and relaxation therapies are safe.  However, some complementary medicines (like herbs, mega-vitamins, and other dietary supplements) can be dangerous, particularly for people who have liver disease. Many people use complementary medicines because they believe that it’s “natural” and therefore healthy and harmless.  But natural does not equal healthy or safe.  Poison ivy is natural, but it’s certainly not harmless.

Unlike conventional medical treatments – which are tested and regulated by the FDA (Food and Drug Administration) – most complementary therapies have undergone very little, if any, scientific study.  And since herbal medicines are not subject to the same regulations as prescription medicines, the amount of medication in a pill or other quantity of herbal medicine can vary in potency by five, ten or one hundred fold from one brand to another and there’s no way of you knowing what that factor is.

So while some products may be safe others may actually pose significant risks – for example, by producing serious side effects or interacting badly with other medications you’re taking.

Studies have looked at the use of CAM among people with Hepatitis C.  A survey of 1,145 participants in the HALT-C (Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis) trial found that 23 percent of participants were using a variety of herbal products, the most common being silymarin (milk thistle). Another study, which surveyed 120 adults with Hepatitis C, found that many used a variety of complementary health approaches, including multivitamins, herbal remedies, massage, deep breathing exercises, meditation, progressive relaxation, and yoga.

Fortunately, a greater effort is being made to find ways to evaluate the safety and effectiveness of various types of CAM through the National Center for Complementary and Integrative Health (NCCIH) – formerly called the National Center for Complementary and Alternative Medicine – a center of the National Institutes of Health (NIH).

The following section summarizes some key findings from the NCCIH about the use of dietary supplements in people with Hepatitis C:

  • No dietary supplement has been shown to be effective for Hepatitis C or its complications.
  • The results of research supported by the NIH have shown that silymarin, the active extract of milk thistle – and the most popular complementary health product taken by people with liver disease – was no more effective than placebo in people with Hepatitis C.
    • A 2012 controlled clinical trial showed that two higher-than-usual doses of silymarin were no better than placebo in reducing the high blood levels of an enzyme that indicates liver damage.  In the study, 154 people who hadn’t responded to standard antiviral treatment for chronic Hepatitis C were randomly assigned to receive 420 mg of silymarin, 700 mg of silymarin, or placebo three times per day for 24 weeks.  At the end of the treatment period, blood levels of the enzyme that indicates liver damage were similar in all three groups. Refer here for more information.
  • Colloidal silver is sometimes promoted for treating Hepatitis C, but there’s currently no research to support its use for this purpose, and it is not safe.  Colloidal silver can cause serious side effects, including a permanent bluish discoloration of the skin called argyia.
  • Research on other dietary supplements for Hepatitis C, such as zinc, licorice root (or its extract glycyrrhizin), SAMe, and lactoferrin, is in its early stages, and no firm conclusions can be reached about the potential effectiveness of these supplements.

For more detailed information about Hepatitis C and complementary therapies, you can visit the NCCIH website.

Unlike conventional medical treatments, most herbal therapies have not undergone rigorous scientific study.  Fortunately, a greater effort is being made to evaluate the safety and effectiveness of various types of dietary supplements, including herbs, through the National Center for Complementary and Integrative Health (NCCIH) – formerly called the National Center for Complementary and Alternative Medicine – a center of the National Institutes of Health (NIH).

So while some products may be safe others may actually pose significant risks – for example, by producing serious side effects or interacting badly with your Hepatitis C medication.  Because herbs can interfere with the action of Hepatitis C medications, it’s important to tell your doctor about everything you’re taking before starting treatment for Hepatitis C.  And while getting treated, it’s important not to take any new herbs or supplements before consulting with your healthcare provider.  For example, you should NOT take St. John’s wort (Hypericium perforatum), or a product that contains St. John’s wort, with several of the medications used to treat Hepatitis C, including Olysio, Sovaldi, Harvoni, and Daklinza.


CERTAIN HERBS ASSOCIATED WITH LIVER DAMAGE

It’s also important to be aware that several common herbs can cause liver damage, especially in people with an existing liver disease such as Hepatitis C.  These include:

  • Kava
  • Comfrey
  • Shark cartilage
  • Skullcap
  • Valerian

Additionally, the following groups of people should avoid the use of herbs in general unless ordered by their medical provider:

  • Women who are pregnant or nursing
  • Children
  • Organ transplant recipients
  • People with decompensated liver cirrhosis
  • People with a serious medical condition

If you plan to travel while on treatment, there are several considerations you need to think about when making arrangements:

  • If you’re traveling by car, do not leave medications in a hot vehicle.
  • If you’re traveling by air, carry on all medications with you in the cabin.  Keep them in their original containers with the prescription label.
  • Make sure to bring contact information for your healthcare providers with you in case you need to contact them with a question or concern.
  • Keep a card in your wallet that indicates who to call in an emergency.  This should include contact information for a family member and your doctor.

There are a number of things you can do to improve your health and increase your chances of being able to take your medications as prescribed:

  • Avoid alcohol and drugs.  If you cannot quit, seek help.
  • Talk to your doctor about getting the Hepatitis A and Hepatitis B vaccines.
  • Aim for 7-9 hours of sleep every night and rest when tired.
  • Maintain a healthy weight.
  • Eat healthy meals: Strive for a diet low in fat and high in fiber.  Include fruit, vegetables, and whole grains. Avoid trans fatty acids and saturated fats.
  • Avoid dietary supplements that may harm the liver, such as iron or vitamin A, kava, and valerian.  Take only the medications recommended by your doctor.
  • Drink 6-8 glasses of water per day.
  • Exercise: Be as physically active as possible on a regular basis, balancing rest and activity.
  • Avoid or reduce stress.  Some people find meditation, prayer, or simply a quiet walk to be helpful.
  • Engage in activities that give you pleasure and make you laugh.
  • Discuss your feelings with family and close friends.
  • Join a Hepatitis C support group.

In addition, it’s important to become an effective healthcare consumer and advocate for yourself.  You can do this by:

  • Learning all you can about your disease and its treatment.  Seek information from Hepatitis C related organizations.
  • Getting all your medical and insurance information organized in one place.  This should include:
    • Recent test results
    • Important doctor’s notes from your medical record
    • A log with dates and results of surgeries or major procedures
    • A list of all the medications you’re taking
    • Your immunization records
    • A list of any allergies to food, medications, latex, etc.
    • Upcoming appointments and reminders for required lab work
    • Contact information for all your healthcare providers
    • Health insurance information
    • Emergency contact numbers

Writing down a list of questions will help you make the best use of your time during your appointment.  List your questions from most important to least important, in case time runs short. Some basic questions to ask your doctor include:

  • What can I expect to happen next now that I’ve been diagnosed?
  • Do I need treatment for my Hepatitis C infection? What treatments options are available?
  • Can I be cured of the Hepatitis C virus?
  • What should I do to minimize damage to my liver?
  • Are there any over-the-counter medications or supplements I should avoid?
  • Should my family be tested for Hepatitis C?
  • How can I protect people around me from getting it?
  • Where can I find out more information?
  • Are there organizations that provide information and support?
  • What other resources would you recommend?
  • Is it possible to have a positive antibody but not have the actual virus?
  • What is my viral load? (Does my viral load mean I am more or less infectious?)
  • What is my genotype?
  • Should my partner also seek out testing to see if exposure has happened?
  • What kinds of medication options are there for my genotype?
  • Have I been screened for Hepatitis B and Liver Cancer?
  • If I have had past exposure to Hepatitis B or have liver cancer, can you explain the black box warning I have heard about
  • Do you need to know what my insurance company covers for treating Hepatitis C?
  • If my insurance declines therapy – will you be doing an appeal or will you be having a specialty pharmacy assist with the appeal process?
  • How long will therapy be?
  • What are the possible side effects of treatment?
  • Can we review the medications and supplements I am taking?
  • Are there any medications which can cause an adverse reaction with therapy?
  • What medications can’t I take while on therapy?
  • Should alcohol be avoided while on therapy?
  • Where can I find local support groups to connect to others whom have gone through therapy?
  • Have many of the patients you’ve treated been successfully cured?

In addition to the questions you’ve prepared, don’t hesitate to ask other questions during your appointment when you don’t understand something.

Download these questions and take them to your doctor’s appointment.


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