understanding your hepatitis c medications€¦ · hepatitis c medications: an overview. hepatitis...

URAC

Understanding your hepatitis C medications

URAC Walgreens specialty pharmacy locations are ACHC and URAC accredited

Table of contents

Hepatitis C medications an overview1

Interferon ribavirin and protease inhibitors1

Staying on track with your medications 3

Hepatitis C medications birth control and birth defects3

Managing medication side effects4

When to call your doctor 4

Mental health 4

Whole body5

Mouth stomach and digestion6

Hair and skin7

Other side effects8

Storing and traveling with hepatitis C medications9

Storing your medications9

Traveling with your medications9

Tracking your recovery 10

Tests to check your progress 10

Liver panel tests 10

Complete blood count 11

Liver biopsy11

To learn more12

Resources12

This publication should be used for general educational purposes only and is not intended to be a substitute for professional medical advice Although it is intended to be accurate neither Walgreen Co its subsidiaries or affiliates nor any other party assumes liability for loss or damage due to reliance on this material Advances in medicine may cause this information to become outdated invalid or subject to debate This information is not intended to create any warranty and ALL SUCH WARRANTIES EXPRESS OR IMPLIED INCLUDING ANY WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE ARE HEREBY DISCLAIMED If you are in need of immediate medical attention or have a medical question contact your medical professional

Inclusion of resources in this document does not imply endorsement by Walgreen Co or any of its subsidiaries These resources should be used for general information and educational purposes only

Brand names are the property of their respective owners

Hepatitis C medications an overview

Hepatitis C medications work by removing (or clearing) the hepatitis C virus from your body reducing it to levels where it can no longer be detected in your blood Medication can also stop or slow down the damage hepatitis C does to your liver At a time when you may feel worried or afraid there is something you can do to take charge of your healthmdashtake your medication exactly as your doctor has directed and learn about medication risks and side effects Taking your medication the right way is a key to your recovery

Interferon ribavirin and protease inhibitors

The two most commonly used medications for the treatment of hepatitis C are interferon and ribavirin Taking interferon alone may be effective for some

patients When a medication is taken alone it is called monotherapy Because ribavirin alone is not effective against hepatitis C it is used together with interferon When two medications are taken together it is called combination therapy Some patients depending on their specific circumstance may be prescribed a third medication called a protease inhibitor to be taken along with interferon and ribavirin Only taking all three medications for these patients will be effective against hepatitis C When three medications are taken together it is called triple therapy Your doctor or nurse will teach you how to prepare your medication and give yourself an injection Ribavirin comes in tablets capsules and liquid A generic version of ribavirin is available Generics have the same active ingredient as brand-name medications but usually

1

Hepatitis C medications an overview (continued)

Table 1 Medications used to treat hepatitis C

Medication Common side effects Other information

IncivekTM

(telaprevir) bull Rash which can be serious

requiring medical attention bull Anal rectal problems

(hemorrhoids anal rectal discomfort)

bull Anemia

bull Dose is two (375 mg) tablets every 7-9 hours taken with food The food should contain about 20 grams of fat and be ingested within 30 minutes prior to each Incivek dose

bull Examples of some foods that could be taken with Incivek include a bagel with cream cheese frac12 cup nuts 3 tablespoons of peanut butter 1 cup of ice cream 2 ounces of American or cheddar cheese 2 ounces of potato chips or frac12 cup of trail mix

bull Always used in combination with peginterferon and ribavirin

bull Take for first 12 weeks of therapy

Infergenreg

(interferon alfacon-1)

bull Depression bull Flu-like symptoms

bull Short-acting bull Injected three times a week when used alone bull Injected once a week when used in

combination with ribavirin

Pegasysreg (peginterferon alfa-2a)

PegIntronTM (peginterferon alfa-2b)


bull Long-acting bull Injected once a week bull Provided in vials

Pegasysreg prefilled syringe (peginterferon alfa-2a) PegIntronreg REDIPENreg

(peginterferon alfa-2b)


bull Long-acting bull Injected once a week bull Provided in a prefilled device used for injection

VictrelisTM

(boceprevir) bull Anemia bull Taste alteration

bull Dose is four (200 mg) capsules every 7-9 hours taken with food


bull Not started until fifth week of therapy after a 4-week lead-in of peginterferon and ribavirin

Ribavirin (ribavirin Copegusreg Rebetolreg RibaPakreg Ribaspherereg)

bull Anemia bull Cough bull Shortness of breath

bull Available as a capsule tablet or oral solution bull Always used in combination with interferon

for hepatitis C

Peginterferon is also referred to as interferon

2

cost less The protease inhibitors (Incivektrade and Victrelistrade) are available in an oral dosage form

Most people who have insurance coverage for prescription medications must pay for part of the medication cost themselves This may involve paying a certain dollar amount each time your prescription is filled (known as a copay) or a certain percentage of the total cost (known as coinsurance) It is important to plan ahead for these expenses so you can avoid interrupting your hepatitis C medication therapy

Staying on track with your medications

Here is what you can do to help get good results from your hepatitis C medication therapy

bull Learn about the medications you are taking including special risks and warnings

bull Never skip or change doses of medications on your own

bull Try to make your medications part of your normal schedule and routine

bull Write down the names and amounts of the medications you are taking along with your doctorrsquos name and phone number

bull Check with your doctor before starting any new medications This includes vitamins supplements herbal remedies prescription medications and over-the-counter (OTC) products which can interfere with your hepatitis C medication

bull Keep all your doctor appointments If you must cancel an appointment call your doctor and schedule a new one as soon as possible

bull Drink plenty of fluids especially before and after interferon injections to help reduce the severity of side effects Water clear fruit juices and other caffeine-free drinks are the best choices

bull Avoid alcoholic drinks completely Alcohol can reduce your medicationrsquos ability to work properly and may worsen your disease

Hepatitis C medications birth control and birth defects

It is important to remember that hepatitis C medications can make birth control less effective Because of this it is recommended to use two effective forms of birth control to avoid pregnancy For women taking Invicek or Victrelis these two drugs can make hormonal birth control such as birth control pills or vaginal rings less effective so two alternate methods should be used Check with your doctor or pharmacist for additional information Women who are taking ribavirin or Incivektrade or Victrelistrade should not breastfeed Interferon (eg Peg-Intronreg Pegasysreg or Infergenreg) should not be used during pregnancy Peg-Intron and Pegasys are each recommended for use in fertile women only when they are using effective contraception during the treatment period Birth control should be used with Infergen for both men and women being treated In addition women who are taking interferon should not breastfeed

3

Managing medication side effects

Some people may not experience any discomfort related to their medications For others one of the hardest parts of therapy is dealing with medication side effects You might find that taking medications at bedtime allows you to sleep through the strongest side effects Hepatitis C medications can affect your mental health and your body as a whole You may also experience mouth stomach and digestion problems hair and skin effects and other side effects These are described in the following section along with tips for dealing with them

When to call your doctor

If you are experiencing a symptom or side effect that is worrying you or is not going away on its own it is always best to call your doctor The sooner you call the better While you are taking hepatitis C medication call your doctor if you

bull Are extremely short of breath

bull Have chest pain

bull Have red inflamed eye (ldquopink eyerdquo)

bull Notice changes in your vision

bull Have swelling in your legs feet ankles or face

bull Have diarrhea for more than 48 hours or have blood in your stool

bull Have a skin rash with or without itching blisters or skin lesions

bull Have an unusual skin reaction in the area of an injection

bull Have mouth sores

bull Have a fever higher than 104˚F at any time or you have a fever lasting more than 48 hours

bull Are extremely tired

Mental health

Hepatitis C medications can cause sleeping problems anxiety irritability or depression If you experience these problems there are many things you can do to help yourself feel better

Sleeping problems

Many people who take hepatitis C medications have difficulty sleeping This can make it harder to cope with other side effects and to get through your daily routine If you find that itrsquos hard to fall asleep

bull Donrsquot read or watch TV in bed

bull Try to go to sleep and wake up at the same time every day

bull Limit fluids at night so you wonrsquot have to get up to use the bathroom

bull Avoid large meals caffeine and too much exercise close to bedtime

bull Donrsquot use tobacco or alcohol

Anxiety

Hepatitis C medications especially interferon can cause you to feel anxious or jittery Other people may notice this before you do If you realize that you are feeling anxious

bull Try relaxation techniques such as yoga meditation or deep breathing

bull Remind yourself that the anxious feelings are just a side effect of the medication

bull Avoid caffeine

bull If anxiety is interfering with your life talk to your doctor about medication that can help

Irritability

Interferon may cause you to get angry about little things even if you are usually a calm and patient person Being aware of this tendency toward irritability can help you control it To help deal with these feelings


4

bull Tell your friends and family members that you are taking medications that cause you to be irritable

bull Share your feelings with friends and family members

bull Join a support group

bull Be sure to get enough sleep

can cause you to feel tired and run down Having low thyroid hormone levels (called hypothyroidism) can also cause you to feel tired Interferon can cause hypothyroidism but this is not a common side effect Your doctor can tell you if anemia or low thyroid levels may be a concern for you To help overcome fatigue here is what you can do

Depression

Feeling a little sad or down is common when you take interferon If you have lost interest in your favorite activities or have feelings of hopelessness you could be depressed Depression is a common side effect of interferon But feelings of depression can be caused by other things too More information about depression is provided in the booklet A Patient Guide to Hepatitis C Depending how sad you feel here are some things that can help

bull Do something you enjoy such as reading a book going to your favorite restaurant or seeing a movie

bull Get involved with a support group

bull Spend time with family or friends

bull Talk to your doctor to see if you should change your dose of interferon or take antidepressant medication

bull If you have thoughts of suicide call 911 or your local emergency services number If you donrsquot want to do that contact a doctor mental health professional crisis center or hotline

Whole body

You may experience side effects from hepatitis C medications that affect your whole body such as fatigue (tiredness) headaches fever and muscle and body aches

Fatigue

Fatigue is a common side effect of hepatitis C therapy Hepatitis C medications can affect your red blood cells which can cause anemia Anemia occurs when your body doesnrsquot have enough red blood cells This


bull Take a short nap when you can

bull Exercise often (but not right before bedtime)

bull Eat healthy meals

bull If fatigue is worse one to two days after you take interferon talk to your doctor

Headache

Headache is a common side effect of hepatitis C medications Some people experience a constant mild soreness while others may feel sharp stabbing pain that starts and stops A migraine is a type of headache that usually hurts in one area at a time and may make you sensitive to sound light or make you feel nauseated Interferon therapy may make headaches including migraines worse so be sure to keep your doctor informed of your headache history and symptoms To ease a headache

bull Take a relaxing bath

bull Reduce your stress level

bull Lie down and rest in a quiet dark room

bull Drink fluids especially water sports drinks or juices

bull Ask your doctor about taking a nonprescription pain reliever

Fever

A fever raises your body temperature so you feel warmer than usual It may make you shiver feel chilled or feel tired Fevers are triggered by your bodyrsquos immune system Interferon jump-starts your immune system which can cause a fever within the first day or two after the injection The fever tends

5

Managing medication side effects (continued)

to be higher (101deg F to 104deg F) after the first few injections A high fever can also be a symptom of an infection unrelated to hepatitis C that may need special treatment Call your doctor if you have a fever higher than 104deg F at any time or you have a fever lasting more than 48 hours To help reduce your fever

bull Drink plenty of fluids

bull Talk to your doctor about taking acetaminophen before or after your interferon injections

Muscle and body aches

Hepatitis C medications can cause a slight swelling of your muscles This swelling causes them to feel sore and achy These feelings usually lessen as your treatment continues Meanwhile

bull Take a hot bath to relax muscles


bull Apply a warm moist washcloth to achy areas


Mouth stomach and digestion

Hepatitis C medications can cause problems with your mouth and stomach that make it hard for you to stay on a good healthy diet You may lose your appetite have a bad taste in your mouth notice that your mouth is dry or have a sore mouth and sore throat You could also experience nausea vomiting or diarrhea

Loss of appetite

Interferon can cause you to lose your appetite even for your favorite foods This can lead to poor nutrition and weight loss To boost your appetite try the following

bull Eat smaller more frequent meals

bull Indulge in your favorite foods even if just a little bit

bull Take a walk before meals to help trigger your appetite

bull Drink nutritional supplements or eat meal-replacement bars instead of skipping meals

bull Choose protein-rich foods that are high in calories such as peanut butter and cheese

More information about healthy eating is provided in the booklet A Patient Guide to Hepatitis C

Bad taste in mouth

Hepatitis C medications can cause a bitter or metallic taste in your mouth Bitter foods may help mask this taste Cold or frozen foods can help numb your taste buds Other suggestions include the following

bull Create frozen popsicles out of sports drinks

bull Use plastic utensils instead of metal ones

bull Chew lemon drops zinc lozenges mints or gum

bull Choose fresh or frozen foods instead of canned foods

bull Drink lemonade or cranberry orange or pineapple juices

bull Eat cold food such as sorbet sherbet fruit slushes ice chips or frozen yogurt

bull Rinse your mouth with tea ginger ale or water mixed with baking soda before eating

Dry mouth

Ribavirin can cause dry mouth which is uncomfortable and can take a toll on your teeth and gums To ease dry mouth

bull Start and end each day with a glass of water

bull Rinse your mouth with club soda or warm salted water

bull Moisten food with sauce gravy yogurt or salad dressing

bull Keep a cup of water next to your bed

bull Use sugar-free gum or candy or ice cubes to moisten your mouth

bull Get regular dental check-ups

Sore mouth and sore throat

You may experience an irritation of your mouth and throat while taking medications for hepatitis C If you

6

normally experience mouth ulcers they may worsen while you are on ribavirin treatment To help

bull Drink through a straw

bull Eat soft or pureed foods such as mashed potatoes or pudding

bull Eat lukewarm or cool foods instead of hot foods

bull If you have trouble eating as much as you should drink nectars instead of juices for added calories

bull Gargle or rinse your mouth out often with warm salted water

bull Ask your doctor about a prescription for a special mouthwash that can help numb the inside of your mouth

bull Avoid rough-textured foods such as dry toast granola and pretzels

Nausea and vomiting

Nausea and vomiting are common side effects Besides being bothersome vomiting repeatedly can affect your health If you experience nausea or vomiting try the following

bull Eat frequent small meals throughout the day instead of three large meals

bull Eat foods cold or at room temperature

bull Have a few dry crackers before you get up in the morning

bull Choose foods and drinks that are easy on the stomach such as

ndash Bananas rice applesauce tea and toast

ndash Crackers pretzels and dry cereal

ndash Flat soda and ginger (eg ginger snaps ginger ale)

ndash Suck on hard candy lollipops or mints

bull Donrsquot lie down for at least an hour after you eat

bull Avoid smells and foods that make you feel queasy

bull Donrsquot eat very sweet foods or foods that are hot spicy strong-smelling or greasy

Diarrhea

For some people diarrhea is the main side effect of treatment It is important to replace the fluids that are lost through diarrhea so you donrsquot become weak or dehydrated Some things you can do to help

bull Avoid greasy fried spicy or very sweet foods

bull Stay away from dairy products

bull Limit drinks with caffeine or that are carbonated

bull Replace lost fluids by sipping clear liquids throughout the day

bull Eat foods high in fiber such as oatmeal bananas rice and applesauce

bull Drink at least one cup of liquid after each loose bowel movement

bull Avoid foods that may cause cramps or bloating such as cabbage beans onions and green peppers

Hair and skin

Hepatitis C medications can cause temporary hair loss skin rashes and injection-site reactions

Hair loss

About one out of three people who take interferon experience hair loss The hair loss is usually gradual After you finish your medication your hair will grow back slowly to its normal thickness Meanwhile

bull Wear caps or scarves if you want a different look

bull Use a wide-toothed comb to prevent hair breakage

bull Donrsquot blow-dry dye perm braid or cornrow your hair

Skin rash

Rashes dry skin and itching are common problems during hepatitis C treatment Serious skin reactions can occur In some people a rash can be serious If you develop a rash with fever blisters or sores in your mouth nose or eyes or conjunctivitis (red or inflamed eyes like ldquopink eyerdquo) stop taking your hepatitis C medication and call your doctor right away If you had skin conditions such as eczema or psoriasis before treatment they may worsen

7


Be sure to discuss any changes in your skin condition with your doctor

The following tips can help keep your skin healthy

bull Apply nonalcohol-based creams or lotions to dry skin two to three times daily and after bathing

bull Use lukewarm water when bathing and limit your soaking time to 30 minutes or less

bull Add an oatmeal treatment to your bath and use an oatmeal-based lotion at the end of your bath

bull Avoid soaps bath products and deodorants that have strong perfumes

bull Drink lots of fluids

bull Use a humidifier in your bedroom

bull Always wear adequate sun protection (in every season) Use a sunscreen and lip balm with a sun protection factor (SPF) of at least 15

bull Remove any tags from clothing that could irritate your skin

bull Avoid tight-fitting garments and clothing made of wool Cotton is often a good choice for comfort

Injection-site reactions

The place where you receive an injection is called an injection site An injection-site reaction is your bodyrsquos natural response to the ldquoinjuryrdquo caused by the needle delivering the medication into the lower layers of your skin Common injection-site reactions include redness rash stinging tingling swelling itching pain and discomfort in the area The following techniques can help prevent these reactions

bull If refrigerated allow your prepared syringe to come to room temperature before injecting it Do this by setting it on a counter for five to 10 minutes or simply holding it in your hand for a few minutes

bull Use the correct injection technique for the medication you are taking If you are unsure about this call your doctor nurse or pharmacist

bull Change injection sites regularly

bull Keep a written record of where and when you received the previous injections

bull Use a new needle and never reuse needles

bull Donrsquot inject into an area that is red hard or swollen

If you experience a severe reaction after an injection such as fever nausea vomiting or low blood pressure (experienced as dizziness or fainting) contact your doctor immediately If your injection site does not heal completely within a day or two your doctor should also be notified Healing problems can be related to liver disease

Other side effects

Chest pain

Hepatitis C medications can cause discomfort in your chest esophagus (food-swallowing tube) or lungs You may experience this as a burning or aching chest pain If you develop chest pain while taking hepatitis C medications especially if it is very severe different from pain you have had before or if pain occurs when you are doing a strenuous activity such as climbing stairs seek emergency treatment immediately

Shortness of breath

When taking ribavirin many people feel a little short of breath because the medication can affect the oxygen level in your bloodstream If you feel extremely short of breath call your doctor to make sure that itrsquos not the result of other medical problems that require prompt treatment

Vision change

Although it is uncommon some people have sudden changes in vision while taking hepatitis C medication If you suddenly develop blurry or double vision or light sensitivity call your doctor right away You may need immediate treatment

8

Storing and traveling with hepatitis C medications

Storing your medications

Some hepatitis C medications need to be kept in the refrigerator others donrsquot Storage instructions for commonly used medications are provided in Table 2 It is also important to get a copy of the manufacturerrsquos instructions For more information ask your pharmacist

Traveling with your medications

bull Keep all medications away from heat and direct sunlight

bull Always carry your medication with you or in your carry-on bag

Table 2 Medication storage instructions

bull Airport X-ray machines canrsquot hurt your medication

bull You can take injection systems on board airplanes

You may need to produce your pharmacyrsquos preprinted label clearly identifying the medication Keep the original pharmacy prescription-labeled box when traveling with your medication and supplies

These are minimum requirements Each airline may have other requirements Always contact your airline before your flight to confirm their policy

Medication Storage instructions

IncivekTM (teleprevir) Store at room temperature at 77deg F excursions are permitted between 59deg F and 86deg F Once the bottle is opened use within 28 days Keep the container tightly closed

VictrelisTM (boceprevir) Medication can be stored in the refrigerator (36deg F to 46deg F) and used until the expiration date on the label Otherwise patients can store the medication at room temperature (up to 77deg F) for up to three months Keep the container tightly closed Keep container tightly closed

Infergenreg

(interferon alfacon-1) bull Store in the refrigerator at 36deg F to 46deg F until administration bull Shortly before administration Infergen can warm to room temperature bull Avoid freezing vigorous shaking and exposure to direct sunlight

Pegasysreg

(peginterferon alfa-2a) bull Store in the refrigerator at 36deg F to 46deg F bull Avoid freezing vigorous shaking and exposure to direct sunlight bull Discard any unused portion

PegIntronreg

(peginterferon alfa-2b) bull Vials should be stored at room temperature at 77deg F prior to mixing excursions

are permitted between 59deg F and 86deg F bull After mixing the solution should be used immediately but can be stored in the

refrigerator at 36deg F to 46deg F for up to 24 hours Do not freeze

PegIntronreg REDIPENreg

(peginterferon alfa-2b) bull Store in the refrigerator at 36deg F to 46deg F bull After mixing the solution should be used immediately but can be stored in the


Ribavirin (ribavirin Copegusreg RibaPakreg Rebetolreg Ribaspherereg )

bull Store at room temperature at 77deg F excursions are permitted between 59deg F and 86deg F

Celsius temperature conversions 36˚F to 46˚F = 2˚C to 8˚C 77˚F = 25˚C 59˚F to 86˚F = 15˚C to 30˚C

99

Tracking your recovery

Tests to check your progress

The primary goal of hepatitis C treatment is to reach the point where the virus can no longer be detected in your blood Another goal is to improve your liverrsquos ability to work properly This means it has begun to heal itself

While you are receiving medications for hepatitis C your doctor will check your blood regularly (at least every one to two months) The blood tests track your bodyrsquos response to medication The tests also tell your doctor if the medications have other effects on your health Talk with your doctor about your blood test

Table 3 Liver panel tests

results and be sure you understand what they mean Some of the most common blood tests are described in this booklet (Abbreviations often used on test reports are shown after the test names) Information about liver biopsy a procedure that is performed to get a sample of your liver tissue is also provided

Liver panel tests

Also known as a liver function test (LFT) this group of tests is used to detect evaluate and monitor liver disease or damage It usually includes six tests that are completed at the same time using one blood sample as shown in Table 3

Test name What it shows Why it is important

Alanine aminotransferase (ALT) also known as serum glutamic-pyruvic transaminase (SGPT)

bull A high level of this liver enzyme often means you are in the acute (early) stage of hepatitis C infection

bull ALT levels are usually normal or slightly high with chronic hepatitis C infections

bull ALT can help determine whether you have liver damage

Alkaline phosphatase (ALP) bull ALP is released by damaged liver cells bull ALP is watched carefully as your treatment continues

Total bilirubin (TBIL) bull Bilirubin is a waste product that is made when your body breaks down hemoglobin which is found in healthy red blood cells

bull Bilirubin levels may be recorded as total direct and indirect levels

bull Bilirubin can collect in the blood and cause jaundice if your liver isnrsquot working properly

Albumin (ALB) bull Albumin is a protein made in the liver and found in your blood

bull Low blood albumin levels can cause edema (or swelling) in your arms legs or belly

Aspartate aminotransferase (AST) also known as serum glutamic-oxaloacetic transaminase (SGOT)

bull AST may indicate whether you have liver damage

bull The ratio of AST to ALT can help your doctor pinpoint the cause of liver damage

Total protein (TP) bull This test measures albumin and all other proteins in your blood including antibodies (substances your body makes to fight infection)

bull Low blood protein levels can cause edema (or swelling) in your arms legs or belly

10

Complete blood count

A complete blood count (CBC) is used as a screening test to check for many conditions including anemia and infections It is actually a group of tests that are performed together with the same blood sample Tests that are often included in a CBC are shown in Table 4

Liver biopsy

Your doctor may have decided to perform a liver biopsy if other tests showed your liver was not working properly For example tests might have

Table 4 Tests included in a CBC

shown that your blood contained higher than normal levels of liver enzymes or an X-ray might have shown that your liver was swollen

In a liver biopsy a special needle is used to remove a small piece of your liver tissue This tissue is examined under a microscope for signs of damage or disease This is the best way to determine whether your liver is healthy or what is causing it to be damaged


Red blood cell test (RBC) bull Measures the number of red blood cells in your blood

bull Can determine if you have anemia

bull Your doctor may recommend medication to help raise your RBC

White blood cell test (WBC)

bull Measures all five types of WBCs in your blood

bull Includes count of neutrophils an important type of WBC

bull A low neutrophil count called neutropenia can lower your bodyrsquos ability to fight infection

bull You may receive medications to help raise your neutrophil level

Platelet count bull Measures the number of platelets in your blood

bull Platelets help your blood form a clot bull Low platelet counts can increase your risk

of bleeding bull Liver disease and hepatitis C medications

can both cause low platelet counts bull Watch for bleeding especially nosebleeds

and bruising if you canrsquot stop a cut from bleeding seek medical attention

Hemoglobin (Hgb) bull Measures the amount of oxygen-carrying protein in your blood

bull If hemoglobin is too low it could indicate anemia

Hematocrit (Hct) bull Measures the amount of space that red blood cells take up in your blood

bull Hematocrit can tell your doctor if you have anemia or you need extra fluids because of dehydration

Viral load test (HCV RNA)

bull Measures the amount of hepatitis C virus in your blood

bull Tells your doctor how your body is responding to treatment

bull High viral load means the virus is making more of itself in your body

bull Viral load can range from undetectable levels to amounts in the millions

11

To learn more

The more informed you are the better you can manage your health Our specialty pharmacy Care Team provides personalized supportive and dependable care to help you achieve the best results from your prescribed therapy

Resources

Genentech

A member of the Roche Group

wwwgenecom 877-436-3683

Manufacturer of Copegusreg and Pegasysreg

Merck

wwwmerckcom 888-437-2608

Manufacturer of PegIntronreg PegIntronreg REDIPENreg Rebetolreg and VictrelisTM

Three Rivers Pharmaceuticalsreg

www3riverspharmacom 800-405-8506

Manufacturer of Infergenreg RibaPakreg and Ribaspherereg

Vertex PharmaceuticalsTM

wwwvrtxcom 855-837-8394

Manufacturer of IncivekTM

12

WalgreensHealthcom

copy2011 Walgreen Co All rights reserved 11SP0051-10711

Table of contents

Hepatitis C medications an overview1

Interferon ribavirin and protease inhibitors1

Staying on track with your medications 3

Hepatitis C medications birth control and birth defects3

Managing medication side effects4

When to call your doctor 4

Mental health 4

Whole body5

Mouth stomach and digestion6

Hair and skin7

Other side effects8

Storing and traveling with hepatitis C medications9

Storing your medications9

Traveling with your medications9

Tracking your recovery 10

Tests to check your progress 10

Liver panel tests 10

Complete blood count 11

Liver biopsy11

To learn more12

Resources12

This publication should be used for general educational purposes only and is not intended to be a substitute for professional medical advice Although it is intended to be accurate neither Walgreen Co its subsidiaries or affiliates nor any other party assumes liability for loss or damage due to reliance on this material Advances in medicine may cause this information to become outdated invalid or subject to debate This information is not intended to create any warranty and ALL SUCH WARRANTIES EXPRESS OR IMPLIED INCLUDING ANY WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE ARE HEREBY DISCLAIMED If you are in need of immediate medical attention or have a medical question contact your medical professional

Inclusion of resources in this document does not imply endorsement by Walgreen Co or any of its subsidiaries These resources should be used for general information and educational purposes only

Brand names are the property of their respective owners






1




IncivekTM




bull Anemia





Infergenreg













VictrelisTM








for hepatitis C


2















3
















Mental health


Sleeping problems







Anxiety




bull Avoid caffeine


Irritability



4






Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom







1




IncivekTM




bull Anemia





Infergenreg













VictrelisTM








for hepatitis C


2















3
















Mental health


Sleeping problems







Anxiety




bull Avoid caffeine


Irritability



4






Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom





IncivekTM




bull Anemia





Infergenreg













VictrelisTM








for hepatitis C


2















3
















Mental health


Sleeping problems







Anxiety




bull Avoid caffeine


Irritability



4






Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom
















3
















Mental health


Sleeping problems







Anxiety




bull Avoid caffeine


Irritability



4






Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom

















Mental health


Sleeping problems







Anxiety




bull Avoid caffeine


Irritability



4






Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom







Depression







Whole body


Fatigue







Headache







Fever


5













Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom














Loss of appetite








Bad taste in mouth









Dry mouth










6









Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom










Nausea and vomiting













Diarrhea









Hair and skin


Hair loss





Skin rash


7






















Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom























Other side effects

Chest pain


Shortness of breath


Vision change


8















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom
















Infergenreg


Pegasysreg


PegIntronreg










99







Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom








Liver panel tests


















10



Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom




Liver biopsy




























11

To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom


To learn more


Resources

Genentech




Merck









12

WalgreensHealthcom


WalgreensHealthcom


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