Hepatitis C: Special Symptoms and Their Management


o a common symptom in patients with Hep C
o actually no more frequent than in other patient populations
o may antecede the diagnosis of Hep C
o may occur after patient aware of the diagnosis
o manifested as feeling exhausted, rather then ”tired”
o sometimes felt as lack of stamina, lack of motivation
o patient may take extra naps but still feel fatigued
o may fluctuate in intensity being marked for periods of time and absent for other periods of time
o is not related to the levels of the enzymes and can be seen with normal enzymes
o is not related to the viral load or the genotype
o is not related to the hepatic pathology
o may be associated with decreased libido and partners should be aware of this
o pre-treatment fatigue often worsens during treatment


o patient must control symptoms rather than symptoms control patient
o there is no evidence that exercise makes Hep C worse
o a graduated activity program is helpful
o regular exercise is helpful
o consistency of activity and exercise is important
o regular meals and rest are important
o maintenance of good nutrition is important
o no evidence that vitamins or supplements have any beneficial effect
o many patients try herbal and hemeopathic remedies and may feel better


o common in chronic Hep C
o manifested as both difficulty falling asleep and frequent waking
o may be associated with mild depression but not always
o may antedate diagnosis of Hep C


o regular daily schedule important
o simple remedies best
o over the counter preparations may be tried
o sleeping pills not routinely used except when on treatment
o antidepressant may be tried
o antihistamines (such as Gravol, Dimendyramine) may also be tried


o usually generalized, dull and aching
o often stated to be continuous
o does not usually interfere with work or activity
o sometimes manifested as an accentuation of pre-existing migraines
o frequency may vary over time


o narcotics, codeine should be avoided
o taking extra fluids may be helpful, 8 glasses of liquid a day
o improved sleep may help
o antidepressants may help
o small doses of acetaminophen may be used, 1000 milligrams a day for short periods of time in non cirrhosis


o good nutrition is essential in both untreated patients and patients undergoing treatment
o previous nutritional state and dietary habits must be determined
o food fadism should be avoided
o special homeopathic and naturopathic diets have not been shown to have any benefit in chronic viral hepatitis

Dietary and nutritional principles

o regular meals are important, fasting is not recommended
o fatty foods may cause anorexia and nausea but do not damage the liver
o protein restriction is not recommended unless the patient is encephalopathic
o patients undergoing treatment with interferon may lose up to 20 pounds in weight
o nutritional status must be monitored in all patients
o steps must be undertaken to minimize weight loss and maintain adequate nutrition
o small frequent meals and snacking may be helpful
o nutritional supplements (meal replacement products such as Boost, Ensure, etc.) are simply liquid meals and have no special benefit in chronic viral hepatitis, unless the patient has a problem with regular solid food
o megavitamins, particularly vitamin A may damage the liver
o simple vitamins can be used such as a multivitamin
o alcohol accelarates hepatitis C and use should be minimized
o sodium restriction is required in patients with fluid retention
o body building hormones should be avoided
o oral hygiene is extremely important, patients on treatment may have decreased saliva and are more prone to mouth ulcers, increased cavities, and tooth decay

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