Medications to Avoid With Hepatitis C

Common medications can produce side effects in hepatitis C patients

Medically reviewed by Jay N. Yepuri, MD

If you have hepatitis C, there are certain medications you need to avoid or take with caution. That's because hepatitis C affects the liver, which plays a large role in metabolizing drugs.

Hepatitis C can damage the liver and lead to complications such as liver cirrhosis (scarring), liver cancer, or liver failure. When this happens, certain medications can become dangerous to take. Tylenol (acetaminophen), for example, is one medication that can also affect the liver and should be used cautiously if you have hepatitis C.

Drug interactions—when medications interact in a harmful way—can also be a problem if you have hepatitis C and are taking direct-acting antivirals (DAAs) to treat it.

This article will discuss what you should know about taking medications if you have hepatitis C. You will also learn about medications you may need to avoid if you have hepatitis C—or are taking DAAs for hepatitis C.

Related: Symptoms of Hepatitis C Virus

Other Medications and Hepatitis C: What Are the Risks?

Having hepatitis means your liver is inflamed (in the case of hepatitis C, because of the hepatitis C virus). You may not experience any symptoms, but hepatitis C can still lead to liver disease.

The liver plays a valuable role in metabolizing many medications, so to protect it, these medications need to be limited or avoided for people who have hepatitis C. This can apply to medications sold over-the-counter (OTC) or with a prescription.

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

Takeaway

Alcohol can be toxic to your body if you have liver disease. If you have liver damage from hepatitis C, it can progress if you use alcohol.

Related: Which Hepatitis C Medications Are FDA Approved?

Acetaminophen

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 liver toxicity levels.

Ibuprofen

Another OTC medication that you may need to avoid if you have hepatitis C is ibuprofen. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for pain relief. It is the active ingredient in many well-known OTC drugs such as Advil (ibuprofen), Motrin, Midol, and others. The standard dose of ibuprofen is 200–400 mg every four to six hours.

Though often a go-to for treating pain, this drug may be harmful to some people. In very rare cases, studies have found asymptomatic (without symptoms) flare-ups in liver enzymes after people with chronic hepatitis C took ibuprofen. The enzyme levels went down quickly once ibuprofen was stopped.

Ibuprofen and other NSAIDs may be tolerated in people with mild chronic liver disease, but they should be avoided if cirrhosis develops.

Takeaway

NSAIDs can cause nephrotoxicity (toxicity in the kidneys). Hepatitis C, while primarily a liver disease, can also harm the kidneys.

Related: Does Hepatitis C Damage Your Kidneys?

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.

Naproxen has, in rare cases, been linked to liver injury—it's the least likely NSAID to cause serious liver injury.

Like other NSAIDs, naproxen can be especially damaging in cases of cirrhosis.

Corticosteroids

Corticosteroids are prescription medications that mimic the structure of the human hormone cortisol. They're known to be particularly effective as anti-inflammatory and immunosuppressive agents. Corticosteroids—including cortisone, hydrocortisone, and prednisone, among others—are used to treat autoimmune diseases and symptoms such as swelling, itching, allergies, asthma, and arthritis.

Long-term use of corticosteroids can increase the risk of other medical conditions, including infections and diabetes.

Studies have shown that corticosteroids can raise the levels of the hepatitis C virus, worsening the progression of the disease. If possible, people with hepatitis C should avoid taking corticosteroids. Those who require corticosteroid treatment will need close monitoring from a healthcare provider.

Psychiatric Medications

Some mental illnesses, such as anxiety and mood disorders, can be associated with hepatitis C, and schizophrenia is a risk factor. If you're prescribed psychiatric medications, make sure to mention that you have hepatitis C to your healthcare provider. The following drugs can be toxic to your liver:

• Some selective serotonin reuptake inhibitors (SSRIs), commonly used as antidepressants, such as Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), and Celexa (citalopram)

• Some serotonin and norepinephrine reuptake inhibitors (SNRIs), also used as antidepressants, such as Effexor (venlafaxine), Pristiq (desvenlafaxine), and nefazodone

• Antipsychotic medications for schizophrenia treatment are often associated with fat buildup in the liver (steatosis) and some can raise your liver enzymes, including Thorazine (chlorpromazine), Haldol (haloperidol), Zyprexa (olanzapine), Risperdal (risperidone), and Clozaril (clozapine). Seroquel (quetiapine) can be associated with liver swelling.

• Some mood stabilizers, such as valproate, Tegretol (carbamazepine), and Lamictal (lamotrigine)

Your healthcare provider may suggest an alternative medication that affects the liver less—or request regular lab tests to monitor your liver as you take these psychiatric medications.

Sleeping Pills/Tranquilizers

One of the challenges of hepatitis C is that some of the anti-viral drugs prescribed can cause insomnia. Unfortunately, certain classes of sleeping pills can react poorly when taken in conjunction with hepatitis C medications.

Some sedating drugs like Belsomra (suvorexant) aren't recommended in people who have a liver impairment or are taking certain antiviral drugs like ribavirin. However, other types—such as Ambien (zolpidem)—can be helpful. It’s important to talk to your healthcare provider about your options.

Related: Is Ambien a Safe Insomnia Treatment?

HIV Medications

Human immunodeficiency virus (HIV), the precursor to AIDS, has a high coinfection rate with hepatitis C. In 2009, about 21% of adults with HIV also tested positive for past or current hepatitis C virus.

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

For example, Norvir (ritonavir) is used in combination with other medications to treat HIV infection. If you're prescribed Norvir, let your healthcare provider know that you have hepatitis C and if you're taking medications such as Mavyret (glecaprevir/pibrentasvir).

Other HIV medications may also negatively affect people with a history of chronic hepatitis C, including:

• Aptivus (tipranavir), always used with ritonavir

• Edurant (rilpivirine)

• Kaletra (lopinavir and ritonavir)

Heartburn Medications

Some acid-reducing medications can interact with your hepatitis C DAA treatment. These include both over-the-counter and prescription acid reducers, such as:

• Prilosec (omeprazole)

• Pepcid (famotidine)

• Zantac (ranitidine)

• Tagamet (cimetidine)

Prilosec is a proton pump inhibitor medication; the rest are H2 blockers. They can reduce the absorption of certain DAAs, potentially making your hepatitis C treatment potentially less effective. Affected DAAs include:

• Harvoni (ledipasvir/sofosbuvir)

• Epclusa (sofosbuvir/velpatasvir)

• Vosevi (sofosbuvir/velpastavir/voxilaprevir)

Your healthcare provider may recommend that you separate your hepatitis C and acid-reducing medications in time or avoid heartburn medications for the duration of your treatment.

Immunosuppressive Medications

People with hepatitis C are at risk of developing liver cirrhosis—a condition that may require a liver transplant and, with that, a course of medications that suppress your immune system to help prevent it from rejecting the new organ. Some immunosuppressive medications can interact with DAAs for hepatitis C treatment.

Your healthcare provider will likely monitor you closely if you need to start an immunosuppressive medication with cyclosporine (Gengraf, Neoral, or Sandimmune) while taking DAAs such as Mavyret or Zepatier (elbasvir/grazoprevir). Immunosuppressive medications with tacrolimus (Astagraf XL, Envarsus XR, or Prograf) may also interact with some DAAs.

Anti-Seizure Medications

Anticonvulsant medications are used to treat epileptic seizures—and sometimes also symptoms of bipolar I disorder, anxiety, and other psychiatric conditions. Some of them can also reduce the effectiveness of DAAs, particularly those considered first-generation anticonvulsant medications, including:

• Carbamazepine—brand names Carbatrol, Epitol, Equetro, Tegretol, and Teril. Carbamazepine can also be toxic to the liver.

• Phenytoin—brand names Dilantin and Phenytek

• Phenobarbital—brand names Luminal, Solfoton, and Sezaby
  

Cardiovascular Medications

Medications you take for heart-related conditions may interact with your hepatitis C DAA treatment. One example is medications used to lower cholesterol called statins, such as Lipitor (atorvastatin), Crestor (rosuvastatin), and Pravachol (pravastatin). Taking DAAs for hepatitis C can increase how much of the statins reaches your bloodstream, leading to potential side effects such as muscle issues.

Statins may not be recommended for people with liver disease. If you have chronic liver disease and require statin treatment, your healthcare provider may recommend switching to statin medications that metabolize in the liver less, such as Pravachol or Crestor.

Medications in the class of novel oral anticoagulants (blood thinners), such as Eliquis (apixaban) and Xarelto (rivaroxaban), may also interact with DAAs to cause side effects such as bleeding.

Cordarone (amiodarone), a medication used for certain abnormal heart rhythm conditions, may interact with DAA medications containing sofosbuvir, such as Sovaldi or Harvoni—and can potentially cause a dangerously slow heart rate. Cordarone has also been linked to drug-induced liver injury, especially at higher doses.

Your healthcare provider may ask you to temporarily pause your cardiovascular medications for the 8–12 weeks it takes to go through the hepatitis C treatment.

Summary

Hepatitis C affects your liver, and so do many medications, including pain relievers such as ibuprofen and acetaminophen, corticosteroids, and more. Direct-acting antivirals (DAAs), taken to treat hepatitis C, may also interact with other medications, including some taken for HIV, seizures, and heartburn.

It's essential to be careful about the medications you take if you have hepatitis C. Make sure to tell your healthcare provider about all your prescription and over-the-counter medications, as well as any supplements.

Read the original article on Verywell Health.