Hi @klk370, we took your questions to a Mayo Clinic Specialty Pharmacist. Here is her response:

"Neuropsychiatric side effects of Hepatitis C treatment with interferon like fatigue, insomnia and pain can occur. Strategies for dealing with fatigue include taking frequent rest periods, napping when possible, and spreading tasks throughout the day based on energy levels. A gradual exercise program like a daily walk can help improve energy levels and improve the patient condition. It is important to maintain adequate hydration with caffeine-free drinks as dehydration can contribute to fatique. Medications that increase dopamine like ropinirole, pramiprexole or amantadine could be tried as there is some indication they may be of benefit in fibromyalgia and fatigue. More research is needed to determine optimal treatment.

Insomnia can contribute to fatigue. Sleep hygiene is the first step in treating insomnia. Sleep hygiene strategies can be found on the Mayo Clinic website (http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379). In patients with severe or refractory insomnia a sleep aid like melatonin or zolpidem can be used during implementation of sleep hygiene strategies train the body back into a natural sleep cycle.

The sedating antidepressant mirtazapine could be used for sleep, mood and pain although there is not as much evidence for use in treating pain. Low-dose Effexor or Pristiq can be used to treat both pain associated with ribavirin treatment and to improve mood. Pain, fatigue and insomnia can often be associated with depression.

Celiac disease could be considered in HCV patient who have been on interferon therapy who present with weight loss, diarrhea and malabsorption that causes nutritional deficiencies. It can present atypically with symptoms of IBS, fatigue, recurring abdominal pain, bloating or excessive gas. Celiac disease is managed by avoidance of gluten which improves symptoms over 2 to 6 weeks.

We found one article that mentioned a dementia-like condition following Peg-Interferon and ribavirin treatment for Hepatitis C although it seems more research is necessary to determine the incidence and optimal treatment for this.

I have searched for any open trials regarding “Post-Interferon Syndrome” or related and couldn’t find anything currently. Clinicaltrials.gov (http://bit.ly/2s7rLZL) is a good place to look for this type of thing.

@klk370 I hope this gives you some hope that there options for treatment and that although more research is needed to provide certain resolution of your symptoms you can feel some comfort that there are others who are working through the same issues. Mayo Clinic Specialty Pharmacists can help patients with Hepatitis and other serious conditions to create optimal drug regimens which maximize the benefit of their treatment while limiting side effects. More information about Mayo Clinic Specialty Pharmacy can be found here http://mayocl.in/2s7pT2S.

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