Managing Side Effects of Sofosbuvir and Ribavirin

® Managing Side Effects of Harvoni and Ribavirin June 2015 Additional Instructions While on Treatment Ledipasvir/Sofosbuvir = Harvoni® www.hepatitis.va.gov Close monitoring and follow-up EVERY 2 weeks with your provider may be necessary in the beginning of treatment to prevent complications. It is important to take your medications, have laboratory tests, and return for clinic appointments as instructed. Inform your provider if you need to reschedule an appointment. Cough (ribavirin; 6-10% of patients) Insomnia (Harvoni®, ribavirin; 12-21% of patients) Notify your provider about all medications including over-the-counter products and dietary/herbal supplements that • Go to sleep and wake up at the same time daily you are taking. Ask you provider before taking any new medications while on treatment. • Increase intake of water or non-caffeinated beverages • Do not read or watch TV in bed • Use a humidifier Ribavirin can cause birth defects and/or fetal death. To avoid pregnancy, use at least 2 forms of contraception that • Limit daytime naps • Try sugar-free hard candy or cough drops includes a barrier method (such as condoms plus an IUD or diaphragm) during treatment and for at least 6 months • Try a glass of warm milk (contains tryptophan, a after treatment has finished. Dry Skin, Rash, Sun Sensitivity natural sleep agent) (ribavirin; 7-10% of patients) • If you take ribavirin and feel jittery, take it at 4-5 Notify your provider of any adverse effects during treatment. Seek immediate medical attention if you develop any p.m. instead of before bedtime serious side effect such as chest pain; shortness of breath; swelling of the mouth, face, lips, tongue or throat; blistered • Use sunscreen, wear long sleeves/hat and limit sun or peeling skin; rash on more than half of your body; sores in your mouth or throat; black or bloody stool; unusual exposure • Limit fluid intake for 2 hours before bedtime to bleeding or bruising; vision changes; dark urine; yellowing eyes or skin; or thoughts of harming yourself or someone avoid getting up to go to the bathroom in the • Avoid long, hot showers or baths else. middle of the night • Use moisturizing soaps (Dove®, Oil of Olay®, Avoid caffeinated products after 4 p.m. Cetaphil®)* • Helpful Telephone Numbers Avoid eating heavy meals close to bedtime Telephone Advice Nurse: ______Clinic: ______• Use moisturizing lotion after showers (Aquaphor®, • Absorbase®, Lac-Hydrin®)* • Take warm baths, read or listen to music, get a Provider: ______Sofosbuvir Support Line: 1-855-769-7284 massage • Use mild unscented laundry detergents and avoid fabric softeners • Diphenhydramine (Benadryl®)* or other Other Medications Approved for Your Use if Checked Off by Your Provider medications may be recommended by your • Try rubbing or pressing on the itchy areas rather than For Aches/Pains provider scratching o Acetaminophen (Tylenol®): Take 1-2 tablets every 4-6 hours later if needed, up to maximum of 2,000 mg a day. DO NOT TAKE MORE THAN 6 tablets a day of 325 mg OR 4 tablets a day of 500 mg acetaminophen (Tylenol®). • Use petroleum jelly on dry, itchy areas; your provider Nausea (Harvoni®, ribavirin; 17-18% of patients) may recommend other agents to help o Ibuprofen (Advil® or Motrin®) _____mg: Take ___ tablet every 6 hours with food. • Take ribavirin with food o Naproxen (Aleve®) _____mg: Take ___tablet twice a day with food. Fatigue (Harvoni®, ribavirin; 35-36% of patients) • Eat smaller meals • Try low-impact exercise (walking or low-impact • Avoid foods/smells that trigger nausea; eat cold For Rash/Itching aerobics) as directed by your provider foods o Diphenhydramine (Benadryl®) _____mg: Take ___ capsule/tablet every _____ hours as needed. • Maintain adequate fluid intake (at least 6 to 8 • Eat healthy foods; avoid greasy, spicy, acidic or o Hydroxyzine (Atarax®) _____mg: Take ___ tablet/capsule every _____ hours as needed. non-caffeinated 8-oz glasses/day) sweet foods o Hydrocortisone 1% cream/ointment: Apply to affected area twice daily as needed. • Take a short nap during the day • Try ginger in ginger tea, ginger ale or gingersnaps o Triamcinolone 0.1% cream/ointment: Apply to affected area twice daily as needed. • Lessen your work schedule if possible • Eat some crackers or dry white toast if you feel sick in the morning • Eat well-balanced meals daily For Sleep • Over-the-counter antacids or other medications o Diphenhydramine (Benadryl®) _____mg: Take ___ capsule/tablet at bedtime as needed. Headache (Harvoni®, ribavirin; 23-25% of patients) may be recommended o Trazodone _____mg: Take ___ tablet at bedtime as needed. • Maintain adequate fluid intake * Generic versions are usually less expensive than • Keep lights dim, wear sunglasses or stay in darkened brand-name products. Brand names are provided as Notes rooms examples only, and their inclusion does not indicate an endorsement by the Veterans Health Administration or • Try to get plenty of rest any other Government agency. Also, if a particular brand • Take acetaminophen (Tylenol®)* as advised by your name is not mentioned, it does not mean or imply that provider; see instructions on page 2 the product is unsatisfactory. Additional Instructions While on Treatment Close monitoring and follow-up EVERY 2-4 weeks with your provider may be necessary in the beginning of treatment to prevent complications. It is important to take your medications, have laboratory tests, and return for clinic appointments as instructed. Inform your provider if you need to reschedule an appointment. If you are having a serious side effect (such as chest Insomnia (sofosbuvir, ribavirin) Notify your provider about all medications including over-the-counter products and dietary/herbal pain), please seek immediate medical attention. • Go to sleep and wake up at the same time daily supplements that you are taking. Ask you provider before taking any new medications while on treatment. Cough (ribavirin) • Do not read or watch TV in bed Ribavirin can cause birth defects and/or fetal death. To avoid pregnancy, use at least 2 forms of contraception • Increase intake of water or non-caffeinated beverages • Limit daytime naps that includes a barrier method (such as condoms plus an IUD or diaphragm) during treatment and for at least 6 months after treatment has finished. • Use a humidifier • Try a glass of warm milk (contains tryptophan, a natural sleep agent) • Try sugar-free hard candy or cough drops Notify your provider of any adverse effects during treatment and seek immediate medical attention if you develop • If you take ribavirin and feel jittery, take it at 4-5 any serious symptoms. Dry Skin, Rash, Sun Sensitivity p.m. instead of before bedtime (ribavirin) • Limit fluid intake for 2 hours before bedtime to Helpful Telephone Numbers avoid getting up to go to the bathroom in the • Use sunscreen, wear long sleeves/hat and limit sun middle of the night Telephone Advice Nurse: ______Clinic: ______exposure • Avoid caffeinated products after 4 p.m. Provider: ______Ledipasvir/Sofosbuvir Support Line: 1-855-769-7284 • Avoid long, hot showers or baths • Avoid eating heavy meals close to bedtime • Use moisturizing soaps (Dove®, Oil of Olay®, Other Medications Approved for Your Use if Checked Off by Your Provider Cetaphil®)* • Take warm baths, read or listen to music, get a massage • Use moisturizing lotion after showers (Aquaphor®, For Aches/Pains Absorbase®, Lac-Hydrin®)* • Diphenhydramine (Benadryl®)* or other medications may be recommended by your • Use mild unscented laundry detergents and avoid o Acetaminophen (Tylenol®): Take 1-2 tablets every 4-6 hours if needed, up to maximum of provider fabric softeners 2,000 mg a day. DO NOT TAKE MORE THAN 6 tablets a day of 325 mg OR 4 tablets a day of • Try rubbing or pressing on the itchy areas rather than Nausea (sofosbuvir, ribavirin) 500 mg acetaminophen (Tylenol®). scratching • Take ribavirin with food o Ibuprofen (Advil® or Motrin®) _____mg: Take ___ tablet every 6 hours with food. • Use petroleum jelly on dry, itchy areas; your provider • Eat smaller meals may recommend other agents to help o Naproxen (Aleve®) _____mg: Take ___tablet twice a day with food. • Avoid foods/smells that trigger nausea; eat cold Fatigue (sofosbuvir, ribavirin) foods For Rash/Itching • Try low-impact exercise (walking or low-impact • Eat healthy foods; avoid greasy, spicy, acidic or aerobics) as directed by your provider sweet foods o Diphenhydramine (Benadryl®) _____mg: Take ___ capsule/tablet every _____ hours as • Try ginger in ginger tea, ginger ale or gingersnaps • Maintain adequate fluid intake (at least 6 to 8 needed. non-caffeinated 8-oz glasses/day) • Eat some crackers or dry white toast if you feel sick • Take a short nap during the day in the morning o Hydroxyzine (Atarax®) _____mg: Take ___ tablet/capsule every _____ hours as needed. • Lessen your work schedule if possible • Over-the-counter antacids or other medications o may be recommended Hydrocortisone 1% cream/ointment: Apply to affected area twice daily as needed. • Eat well-balanced meals daily o Triamcinolone 0.1% cream/ointment: Apply to affected area twice daily as needed. * Generic versions are usually less expensive than Headache (sofosbuvir, ribavirin) brand-name products. Brand names are provided as • Maintain adequate fluid intake examples only, and their inclusion does not indicate an For Sleep endorsement by the Veterans Health Administration or • Keep lights dim, wear sunglasses or stay in darkened any other Government agency. Also, if a particular brand rooms name is not mentioned, it does not mean or imply that o Diphenhydramine (Benadryl®) _____mg: Take ___ capsule/tablet at bedtime as needed. the product is unsatisfactory. • Try to get plenty of rest o Trazodone _____mg: Take ___ tablet at bedtime as needed. • Take acetaminophen (Tylenol®)* as advised by your provider; see instructions on page 2