Back to Hepatitis
B
Christine M. Kukka
HBV Project Manager
Almost everyone who uses conventional or
pegylated interferon to boost their immune system and/or antiviral
medications such as lamivudine (Epivir) or adefovir (Hepsera)
to stop the hepatitis B virus (HBV) from replicating notices
some side-effects.
Often, these side effects may be hard to
distinguish from the fatigue, abdominal discomfort and other
symptoms people with hepatitis B may experience.
When people take only an antiviral medication,
some report an immediate improvement in their well-being and
more energy as the volume of HBV replicating in their livers
declines.
Others may experience no side effects at
all. Side effects from lamivudine can also include stomach
aches, diarrhea, headache, fatigue and chills. Side effects
from adefovir include general weakness, headache, abdominal
pain, nausea, flatulence, diarrhea and dyspepsia.
Interferon, however, can present challenging
side effects. In many children and some adults, the side effects
are minimal, but some people experience intense fatigue and
moderate to severe depression. Fortunately, there are steps
you can take to manage side-effects.
It is highly recommended that you develop
a good support system before starting treatment. On-line or
local support groups, family, and friends can help get you
or your child through the most difficult times during therapy.
You should also contact your medical provider if moderate
or severe symptoms occur. There are effective anti-depressant
medications available as well.
General Tips for Interferon:
• If at all possible, take a week or two off work
and decrease your personal responsibilities as much as possible
when you begin interferon treatment. If a child or teen requires
treatment, try to start interferon injections during the summer
or over school vacation.
• Take medication before bedtime; this allows
you to sleep through the worst of the side-effects because
the majority occur within 4 to 6 hours after injection.
• If a child requires interferon injections, designate
a “shot” room, such as a guest room, where the
child does not regularly play, eat or sleep. Have the swab
and syringe ready and perform the injection as quickly as
possible to cut down on pre-shot anxiety.
• Drink plenty of fluids (without caffeine or
alcohol) to relieve side-effects. It’s important to
drink water or clear fruit juices (apple, cranberry, or grape)
right before and right after self-injection.
• Some people take an over-the-counter pain reliever
one hour before their injection to lessen side-effects. Others
may find that taking a pain reliever 2 to 3 hours after the
injection works better to relieve pain. Caution:
Alcohol and acetaminophen, such as Tylenol (acetaminophen
is an ingredient found in many over-the-counter cold preparations)
taken together can cause fulminant hepatitis, and may lead
to liver failure.
• Headaches can often be relieved by rest, massage,
or application of heat to the back of the neck.
• Fever can sometimes be reduced by sponging with
lukewarm water (do not use hot or cold water).
• Interferon can induce dry mouth, which can result
in tooth decay and gum disease. Regular dental check-ups and
good oral hygiene are extremely important.
Flu-like symptoms
• Use pain relievers as recommended by a physician;
drink plenty of clear fluids each day; self-inject at bedtime
to sleep through the symptoms.
Skin irritation
• If it occurs at injection site, rotate injection
site and use local topical creams.
• Keep hands moisturized and use small bandages
if nail cuticles become raw or bleed. Some children, who experience
anxiety on interferon, may pick at their cuticles.
Fatigue
• Rest as much as possible.
• Get regular, moderate exercise.
• Change work or school schedule, if possible.
Irritability, depression anxiety
• Anxiety and depression can occur in those taking
interferon. Get help from support groups, family, and friends
if you notice excessive sleeping, anxiety or depression in
yourself or other family members who are receiving therapy.
Try relaxation techniques. Anxiety may be treated with medications
recommended by a doctor; depression may be treated with antidepressants
(allow enough time to become effective); consider professional
help if symptoms become severe.
Loss of appetite
• Eat small meals regularly, even if you have
little or no appetite; treat foods as medicine (they are necessary
for good health); drink clear juices in addition to water;
brush teeth often to help eliminate any metallic taste in
your mouth.
Weight loss
• Choose foods that are high in calories and protein;
drink clear juices in addition to water for extra calories;
try products designed to promote weight gain, such as nutritional
supplements, canned formulas, instant breakfast powders, high-calorie
puddings, etc.; add ingredients to increase nutritional value.
For example:
• Add powdered milk to regular milk, milkshakes,
casseroles, soups, eggs, mashed potatoes, hot cereal, and
puddings;
• Spread peanut butter on bread;
• Add cooked beans or hard-boiled eggs to soups,
casseroles and pasta which already contain cheese or meat;
• Melt cheese on sandwiches, hamburgers, vegetables,
rice or noodles.
Nausea/Vomiting
• Take over-the-counter medication for nausea
as recommended by a doctor; avoid foods or odors that trigger
nausea; avoid foods that are spicy, greasy, or deep-fried;
eat small amounts of food every 2-3 hours; during periods
of nausea, avoid citrus juices (orange, pineapple, and grapefruit)
— instead, try clear juices, ginger ale, weak tea, or
sports drinks; eat slowly and sip drinks slowly; eat foods
at room temperature (neither very hot nor very cold); if morning
nausea is a problem, eat some dry crackers when first awakening
and get out of bed slowly.
Diarrhea
• Diarrhea is more common when taking high doses of
interferon
• Ask your medical provider about dosage; try medications
such as Immodium and bulking agents such Metamucil or psyllium
bran.
Dry Mouth/Dental Care
• Visit your dentist before, during, and after treatment;
drink plenty of water or clear fluids (avoid soda, coffee,
tea); use artificial saliva; brush and floss your teeth, and
rinse your mouth after every meal; use a soft toothbrush.
Rashes
• Moisturize daily with over the counter lotions; use
oatmeal based lotions; over the counter hydrocortisone creams,
oral antihistamines and other anti-itch medications. Avoid
perfumed soaps or lotions; apply sunscreen when needed; consult
with a dermatologist for more serious skin problems or rashes.
Insomnia
• Use relaxation techniques that include meditation,
warm baths, visualization, and massage; develop consistent
routines before going to bed; try over the counter medications
such as Benadryl as recommended by a physician. Avoid exercise,
vigorous activity, caffeinated drinks or medications that
contain stimulants prior to bedtime; consult with a physician
for prescription medication if insomnia persists for more
than a few days.
The information in this fact sheet discusses
a wide variety of side effects that some people may experience
while on therapy. It is important to remember, though, that
side effects vary considerably from person to person. Everyone
experiences some side effects, but few experience severe or
life-threatening side effects. While unpleasant, the majority
of people can get through treatment if given proper care and
support.
It is important to be proactive in dealing with the potential
sides and to plan in advance for any potential problems that
may come up during therapy or as a result of therapy. This
can be accomplished by enlisting the help and support of family,
friends, loved ones, employers and health care providers.
Prepare others around you well in advance before starting
therapy so you can be assured of their support and care. It
is also a good idea to designate at least one person who can
watch for anxiety and/or depression and who can contact family
and/or medical professionals if the side effects become severe
or life-threatening.
Getting through treatment is a process
that may require you to draw on every reserve and resource
available to you. It can be done, and it doesn’t have
to be done alone.
Here are some on-line support groups for individuals and
families touched by HBV.
Hepatitis B Information and Support List (HB-L)
www.hblist.org
This is the only adult support group for hepatitis B on the
Internet. There are many adults and families who subscribe
from all over the world. It is a well-supervised list with
reliable information. All those affected by or concerned about
hepatitis B are invited to participate.
HBV Adoption Support List http://health.groups.yahoo.com/group/
hbv-adoption/
Adoptive or biological parents of children living with hepatitis
B are invited to participate. This is a restricted list to
protect the privacy of parents and children, and requires
pre-approval by the list owners to join.
PKIDs Email Support List
www.pkids.org
Adoptive and biological parents of children living with chronic
hepatitis B or C, and HIV are invited to participate. This
is an unsupervised list sponsored by the national non-profit
organization PKIDs.
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B
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