Medications to Avoid If You Have Hepatitis C

Common medications can produce side effects in hepatitis C patients

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The effects of hepatitis C on the body are wide-ranging and drastic. What makes this disease particularly difficult is that it affects the liver, which plays a big role in metabolizing drugs. As such, those with this condition need to be very careful about what medications they’re taking. Further complicating matters is the fact that it takes a while for hepatitis C to produce symptoms, and many aren’t even aware they have it until this infection has become relatively advanced.

Why would certain medicines do more harm than good when taken alongside prescriptions for hepatitis C? There are a couple of reasons. First off, if you’re already taking a medication, there’s a chance that introducing something new will either lead to dangerous side effects or limit the efficacy of the original medicine due to interactions between the drugs. Secondly, because the liver is damaged due to this disease—advanced cases can lead to liver cirrhosis (scarring), cancer, or failure—certain pills can actually become dangerous to take.

Drugs Contraindicated for Hepatitis C Patients

The standard course of treatment these days involves the use of a class of drug called direct-acting antivirals (DAA). If you are prescribed one, your doctor will be sure to inform you what to avoid. DAAs are very effective—some of the newer ones have an efficacy rate upwards of 90 percent —but it’s up to you to ensure that you’re taking them properly and not hindering progress. As you go through treatment, make sure to get your physician’s OK before taking any new medications, supplements, or making dietary changes.

So what should you be avoiding? What follows is a quick breakdown of common drugs to steer clear of if you have hepatitis C.

Acetaminophen

Available both over-the-counter and in a prescription-strength form, acetaminophen is the pain reliever and fever reducer that’s the active ingredient in Tylenol and Panadol, among others. It’s well documented that if these are taken beyond the recommended amount or even when taken consistently for long periods of time, liver damage—most often liver cirrhosis—can result. Problems like this get even worse if alcohol is consumed while taking this drug.

Patients taking medications for hepatitis C should carefully monitor the amount of acetaminophen they’re taking, if not cease use altogether. Doctors note that no more 2 milligrams a day of this drug should be taken to prevent the formation of cirrhosis. In those who have hepatitis C as well as liver cirrhosis, this number drops to 1 mg. Hepatitis C patients who continue to take this drug require regular monitoring of toxicity levels.

Ibuprofen

The active ingredient in a whole host of well-known over-the-counter drugs such as Aspirin, Advil, Ibuprofen IB, Caldolor, and others, ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for pain relief. Though often a go-to when there are pain problems, this drug can cause problems. Primarily, the issue is that ibuprofen can increase nephrotoxicity (toxicity in the kidneys) as well as bleeding in the gastrointestinal tract.

When taken in smaller, standard doses—usually about 1 mg a day—this drug is considered safe for those that have hepatitis C without liver cirrhosis, though experts caution against use. The real issue is if hepatitis C becomes chronic or cirrhosis does develop; in these cases ibuprofen is to be avoided.

Naproxen

Another NSAID, naproxen, is often taken to provide relief for patients with joint pain and arthritis, and it’s this that’s the active ingredient in Aleve, Anaprox, Naprosyn, and many other over-the-counter and prescription drugs. Since it’s of the same class as ibuprofen—these drugs are sometimes sold in combination with each other—similar concerns arise when those with hepatitis C. Namely, use of this drug can lead to increased risk of toxicity in the liver, and can be especially damaging in cases of cirrhosis.

Corticosteroids

This class of drug mimics the structure of the human hormone cortisol, and is known to be particularly effective as an anti-inflammatory and immunosuppressive agent. These drugs—including cortisone, hydrocortisone, and prednisone, among others, can work wonders for those suffering with autoimmune reactions such as swelling, itching, allergies, asthma, and arthritis. However, long-term use can make existing injury or problems worse, while making chronic cases even more difficult to manage.

As above, use among those with hepatitis C needs to be very closely monitored and is generally contraindicated. In fact, studies have shown that use of corticosteroids can actually worsen the progression of the disease.

Sleeping Pills/Tranquilizers

One of the challenges of hepatitis C is that some of the main anti-viral drugs prescribed—especially peginterferon alfa and ribavirin—can cause insomnia and disrupt sleep. It’s a tricky situation, and patients may seek out pharmaceutical help to get the rest they need. However, certain classes of sleeping pills can react poorly when taken in conjunction with hepatitis C medications. Some sedating drugs like suvorexant (Belsomra) can hinder the efficacy of treatment; however, other types—such as zolpidem (Ambien)—can be helpful. It’s important to talk to your doctor about your options.

HIV Medications

Human immunodeficiency virus (HIV), the precursor to AIDS, has a very high coinfection rate with hepatitis C; about 25 percent of those with HIV also have hepatitis C. As more and more drugs taking on HIV have been developed, the good news is that there are more options than ever for this very difficult condition. That said, some HIV-managing drugs react poorly with those that take on hepatitis C, including Aptivus, Edurant, Invirase, Kaletra, among others.

Finding the Right Approach

Drug interactions can be very complex, and there are always individual differences in how they work. What’s perfect in one dosage for one patient, may not be at all for another. Ultimately, finding the right pharmaceutical therapy may involve some aspects of trial and error. This being the case, patients absolutely must be open and honest with their doctors about what they’re taking and how they’re feeling. Be mindful of what you’re experiencing and stay vigilant as you move towards recovery.

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Article Sources

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  4. Coinfection with HIV and Viral Hepatitis | Division of Viral Hepatitis | CDC. Published 2018.