Medications to Avoid With Hepatitis C

There are certain medications you need to avoid if you have hepatitis C. There are many reasons why, since the effects of hepatitis C on the body are wide-ranging and serious. Hepatitis C affects the liver, which plays a big role in metabolizing drugs. That means that some medications are contraindicated or should be taken with caution if you have hepatitis C.

Hepatitis C can also damage the liver and lead to liver cirrhosis (scarring), cancer, or liver failure. When this happens, certain medications can actually become dangerous to take. Drug interactions—when medications interact in a harmful way— can also be a problem if you have hepatitis C.

This article will go over what you should know about taking medications if you have hepatitis C. You will also learn about medications you should avoid if you have hepatitis C.

Drugs Contraindicated for Hepatitis C Patients

If you have hepatitis C, you need to know which medications are not safe to take—especially if you are taking medications to treat the infection.

The standard course of treatment for hepatitis C involves the use of a class of drugs called direct-acting antivirals (DAA). As you go through treatment, you'll need your provider and/or pharmacist's approval before starting any new medications, supplements, or herbs, or making dietary changes that could interfere with the actions of these medications.

Acetaminophen

There are also some medications you can get over-the-counter (OTC) that may not be safe if you have hepatitis C. OTC and prescription-strength acetaminophen is a pain reliever and fever reducer that’s the active ingredient in Tylenol and Panadol, among others. If these medications are taken beyond the recommended amount or taken consistently for a long time, liver damage can result.

Healthcare providers note that no more than 2 grams (g) 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 g.

Patients who have hepatitis C should carefully monitor the amount of acetaminophen they’re taking, or cease use altogether. Hepatitis C patients who continue to take acetaminophen require regular monitoring of toxicity levels.

Ibuprofen

Another OTC medication that you may need to avoid if you have hepatitis C is ibuprofen. The active ingredient in a whole host of well-known OTC drugs such as Advil (ibuprofen), Caldolor, and others, ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for pain relief. Though often a go-to for treating pain, this drug can be harmful to some people.

The standard dose of ibuprofen is 400 milligrams (mg) every four to six hours. When taken in smaller, standard doses—usually about 1 g a day—this drug is considered safe if you have hepatitis C without liver cirrhosis, though experts caution against use.

If hepatitis C becomes chronic or cirrhosis does develop, ibuprofen is to be avoided.

Naproxen

Another NSAID, naproxen, may need to be avoided if you have hepatitis C. It is often taken to provide relief for joint pain and arthritis. Naproxen is the active ingredient in Aleve, Anaprox, Naprosyn, and many other OTC and prescription drugs.

This drug can lead to an increased risk of liver toxicity and can be especially damaging in cases of cirrhosis.

Corticosteroids

There are also some prescription medications that you may need to use with caution or avoid if you have hepatitis C. Corticosteroids mimic the structure of the human hormone cortisol. This class of drug is known to be particularly effective as an anti-inflammatory and immunosuppressive agent. These drugs—including cortisone, hydrocortisone, and prednisone, among others, are used to treat autoimmune diseases and symptoms such as swelling, itching, allergies, asthma, and arthritis.

However, long-term use can have side effects, including an increased risk of infections and diabetes.

People with hepatitis C who need to take corticosteroids will need to be very closely monitored, and it's generally contraindicated. In fact, studies have shown that 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 because certain classes of sleeping pills can react poorly when taken in conjunction with hepatitis C medications.

Some sedating drugs like Belsomra (suvorexant) can hinder the efficacy of treatment; however, other types—such as Ambien (zolpidem)—can be helpful. It’s important to talk to your healthcare provider about your options.

HIV Medications

Human immunodeficiency virus (HIV), the precursor to AIDS, has a very high coinfection rate with hepatitis C. About 25% of those with HIV also have hepatitis C.

It's important to be adequately treated for both conditions. However, some HIV-managing drugs react poorly with those that are taken for treatment of hepatitis C, including:

• Aptivus
• Edurant
• Invirase
• Kaletra

Summary

If you have hepatitis C, you'll need to be very careful about the medications you use. Even relatively "safe" OTC drugs may not be safe for you to take. One reason for this is that hepatitis C affects your liver. Liver disease has many systemic effects. The valuable role that the liver plays in metabolizing medications can limit the treatments that are safe for people who have hepatitis C.

Treatment for hepatitis C may interact with medications used to treat complications or other health issues. Make sure you talk with your pharmacist to ensure that hepatitis C and all treatments that you take are clearly documented in your medical and pharmacy records.