Your guide to managing chronic hepatitis C

Transcription

1 Your guide to managing chronic hepatitis C PEGASYS (peginterferon alfa-2a) is a prescription medication that is: used alone or with COPEGUS (ribavirin, USP) to treat adults and children 5 years and older who have chronic (lasting a long time) hepatitis C infection and certain types of liver problems, and have not taken alpha interferon used if you have chronic hepatitis C, you should not take PEGASYS by itself unless you are not able to take COPEGUS used to treat adults with chronic hepatitis B virus who show signs that the virus is damaging the liver It is not known if PEGASYS is safe and will work in children under 5 years of age. Important Safety Information PEGASYS, like other alpha interferons, may cause or make fatal or life-threatening problems worse (like mental, immune system, heart, liver, lung, intestinal and infections). Your doctor should monitor you during regular visits. If you show signs or symptoms of these conditions, your doctor may stop your medication. In many patients, but not all, these conditions get better after they stop taking PEGASYS (see the Medication Guide for more information and Warnings). COPEGUS can cause birth defects and/or death to an unborn baby. Female patients and the female partners of male patients should avoid getting pregnant. Ribavirin is known to cause anemia (low red blood cells), which can make heart disease worse (see the COPEGUS Medication Guide for more information and Warnings). For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a).

2 Treating my hepatitis C is a decision that I made with my healthcare provider.

3 Treating Chronic Hepatitis C This brochure is about chronic (or long-lasting) hepatitis C and the importance of being treated. You ll learn what to expect during treatment and how to manage the side effects associated with treatment. You ll also learn what you can do to help yourself get better, such as making healthy lifestyle changes. This information can help you understand the risks and get the most benefit from treatment. The information provided by this brochure is for general educational purposes only and is not intended to be a substitute for the advice of your healthcare provider. Your healthcare provider should always be your primary source of information about your health, diagnosis, and treatment. Always discuss with your healthcare provider any questions you have about your hepatitis and treatment with PEGASYS (peginterferon alfa-2a). What s Inside SECTION 1: Treatment Overview...5 SECTION 2: Side Effect Management...31 SECTION 3: PEGASSIST Support Services

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5 Section 1: Treatment Overview About chronic hepatitis C Treating chronic hepatitis C Before treatment During treatment After treatment Resources Treatment Overview For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a).

6 About Chronic Hepatitis C Chronic Hepatitis C is a disease Hepatitis C is a disease caused by a virus that attacks the liver. It enters the body through contact with infected blood. In the United States, 3 to 4 million people have chronic hepatitis C. Many people who have chronic hepatitis C don t know they have it. To understand how chronic hepatitis C harms the liver, it will help to understand what the liver does. What does my liver do? Liver The liver is an important part of your body and does a lot to help keep you healthy. It: Removes harmful substances, called toxins, from the blood Stores vitamins, minerals, iron, and sugar Controls cholesterol levels; cholesterol is the fat in your blood Your liver is important for keeping you healthy. 6

7 How does chronic hepatitis C damage my liver? Once the hepatitis C virus enters your body, it usually begins to attack liver cells. When that happens, it starts a series of events that leads to serious damage to your liver: 1. First, your body sends white blood cells (called lymphocytes) to your liver to fight the virus. This can cause inflammation, or swelling. 2. This swelling can damage liver cells. When liver cells are damaged, they don t work well and may even die. This can cause the liver to scar. This scarring is called fibrosis. 3. Without treatment, the scarring may get worse. Over many years, it can lead to severe scarring and liver damage. This is called cirrhosis (sir-oh-sis). 4. Once severe liver damage happens, it may never get better. Some people with severe liver damage need a liver transplant. Some people may also get liver cancer. Healthy liver Cirrhotic liver 7

8 Treating Chronic Hepatitis C Getting treatment can help your liver Treating chronic hepatitis C is a decision that you need to make with your healthcare provider. The goal of treatment is achieving a sustained virologic response (SVR). An SVR means that the hepatitis C virus can no longer be found in the body 6 months after you have finished treatment. There are different treatment plans and different types of hepatitis C. Healthcare providers call the different types of hepatitis C genotypes. Your genotype will help your healthcare provider decide which treatment plan is right for you. What is PEGASYS? PEGASYS is a medicine used to treat some adults and children 5 years of age and older who have chronic hepatitis C or adults with chronic hepatitis B who show signs of liver damage. PEGASYS is also used in patients coinfected with chronic hepatitis C and HIV. PEGASYS is a kind of interferon (in-ter-feer-on) called pegylated interferon. Interferon is a chemical that your body makes when you get sick from a virus, such as hepatitis C. But the hepatitis C virus is strong. It can stay in your body unless you get extra interferon to help your body fight the virus. PEGASYS works to reduce the amount of virus in your blood, helping your body fight the virus. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 8

9 What is ribavirin? Together, PEGASYS and ribavirin may work to keep the amount of virus in your body at a level that is so low it can t be measured. Ribavirin can also be used in patients coinfected with hepatitis C and HIV. Do not take ribavirin by itself. Speak with your healthcare provider about whether treatment with PEGASYS and ribavirin is right for you. Most serious side effects for treatment with PEGASYS and ribavirin PEGASYS, like other alpha interferons, can cause fatal or make life-threatening problems worse (such as mental, immune system, heart, liver, lung, intestinal, and infections). Your doctor should monitor you during regular visits. If you show signs or symptoms of these conditions, your doctor may stop your medication. In most patients, these conditions get better after the patient stops taking PEGASYS (see Medication Guide for more information and Warnings). COPEGUS (ribavirin) can cause birth defects and/or death to an unborn baby. Female patients and the female partners of male patients should avoid getting pregnant. Ribavirin is known to cause anemia (low red blood cells), which can make heart disease worse (see the COPEGUS Medication Guide for more information and Warnings). Your healthcare provider should examine you during regular office visits. If you have signs of these problems, your healthcare provider may stop your medicine. In many patients, but not all, these conditions get better after they stop taking PEGASYS. 9

10 Treating Chronic Hepatitis C (continued) How do I take PEGASYS and ribavirin? PEGASYS is a medicine that you inject once a week under your skin. You will be able to give yourself the injections at home after your healthcare provider teaches you how. You can also ask for a brochure or video to take home to help with the self-injection instructions. PEGASYS comes in 2 delivery devices the PEGASYS ProClick (autoinjector) and a prefilled syringe (see below). There is no mixing or measuring with either device. Speak with your healthcare provider about which one is right for you. Ribavirin pills need to be taken by mouth twice a day in addition to PEGASYS. You should take ribavirin with food. PEGASYS ProClick TM Autoinjector (not actual size) PEGASYS Prefilled Syringe (not actual size) For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 10

11 How long will I have to take PEGASYS and ribavirin? Treatment with PEGASYS and ribavirin usually lasts either 24 weeks or 48 weeks. Speak with your healthcare provider about whether PEGASYS is right for you and the length of treatment you can expect. How will I know if treatment is working for me? Your healthcare provider will learn if treatment is working for you by doing simple blood tests. These blood tests will measure the level of virus (called viral load) in your body. They also help your healthcare provider check your overall health. During treatment, you will have these blood tests on a regular schedule. The goal of treatment is achieving SVR. An SVR means that the hepatitis C virus can no longer be found in the body 6 months after you have finished treatment. 11

12 Treating Chronic Hepatitis C (continued) What is the most important information I should know about PEGASYS alone or in combination with COPEGUS (ribavirin)? 1. COPEGUS (ribavirin) in combination with PEGASYS may cause birth defects or death of your unborn baby. Females must have pregnancy tests before, during, and for 6 months after PEGASYS/ COPEGUS combination therapy. During treatment and for 6 months after treatment, female and male patients must: use 2 forms of birth control, one being a condom with spermicide. inform their healthcare provider if pregnancy occurs while taking PEGASYS/COPEGUS or within 6 months after stopping PEGASYS/COPEGUS therapy. Patients or their healthcare provider should contact the Ribavirin Pregnancy Registry by calling Mental health problems and suicide. PEGASYS therapy may cause you to develop mood or behavioral problems, including: irritability (getting upset easily) depression (feeling low, feeling bad about yourself or feeling hopeless), and anxiety aggressive behavior former drug addicts may fall back into drug addiction or overdose thoughts of hurting yourself or others, or suicide 3. Heart problems. Some people who take PEGASYS alone or in combination with COPEGUS may get heart problems, including: high blood pressure fast heart rate or abnormal heart beat chest pain heart attacks For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 12

13 4. Stroke or symptoms of a stroke. Symptoms may include weakness, loss of coordination, and numbness. 5. New or worsening autoimmune problems. Some people taking PEGASYS develop autoimmune problems (a condition where the body s immune cells attack other cells or organs in the body), such as rheumatoid arthritis, lupus, and psoriasis. 6. Infections. Some people who take PEGASYS may get an infection. Symptoms may include: fever chills burning and painful urination urinating often coughing up yellow or pink mucus (phlegm) PEGASYS alone or in combination with COPEGUS (ribavirin) can cause serious side effects. Some of these side effects may cause death. Tell your healthcare provider right away if you have any of these symptoms while taking PEGASYS. 13

14 Questions or concerns? If you have any questions about side effects or anything else related to hepatitis C, write them down in the space below. Bring this booklet with you to your next healthcare appointment so you won t forget them. Notes: For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 14

15 Will treatment with PEGASYS and ribavirin work for me? Everyone is different, so that is why the way you respond to treatment can be different from the way someone else does. Some factors that affect how you respond to dual therapy include: The exact type of chronic hepatitis C virus you have Healthcare providers refer to this as the genotype. There are 6 genotypes of chronic hepatitis C. Some genotypes do not respond to treatment as well as others. For example, genotypes 2 and 3 generally respond to dual therapy better than genotype 1. Genotype 1 is the most common type of chronic hepatitis C in the United States. How much virus you have (known as viral load) The lower the amount of virus you have in your body before treatment means the greater your chances are of responding to treatment. Your race and ethnic group African American and Latino patients may not respond to treatment as well as Caucasian patients. Whether or not you have cirrhosis (severe liver damage) People living with the chronic hepatitis C virus who also have cirrhosis have a lower chance of responding to treatment than those without cirrhosis. For this reason, it is important to be treated early before cirrhosis occurs. Speak with your healthcare provider about factors that can affect your response to treatment. Other factors may include your age; whether or not you are also infected with HIV or hepatitis B; and whether you are taking your medicine exactly as prescribed. 15

16 Starting treatment early helped my response to treatment.

17 Before Treatment What tests will I need before I start treatment? Your healthcare provider will probably want you to have some medical tests before you start treatment with PEGASYS. The tests you will have are based on your health history. Some of the tests you may have are shown in the following tables. Your healthcare provider may want you to have other tests. Type of test Complete blood count (CBC) Blood test for liver function Hepatitis C blood tests Eye exam What the test shows A small amount of blood is taken from a vein in your arm. Then, the number of white blood cells, red blood cells, hemoglobin, and platelets in your blood is measured. Hemoglobin is a protein in blood that carries oxygen. Platelets help your blood form clots when you are bleeding. A small amount of blood is taken from a vein in your arm. Then it is tested to see how well your liver is working. Some of these blood tests measure enzymes or proteins in the liver. Another blood test can also measure how long it takes your blood to clot. Your clotting time could be affected if your liver is not working the way it should. A small amount of blood is taken from a vein in your arm. Then it is tested to see how much hepatitis C virus is in your blood. This is also called viral load. It also shows the exact type (genotype) of hepatitis C you have. A complete eye exam shows the health of your eyes and how well you can see. People who already have eye problems should have eye exams during treatment. If you develop a change in vision during treatment, speak with your healthcare provider. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 17

18 Before Treatment (continued) Type of test Pregnancy test EKG or ECG Psychological history Blood sugar and thyroid tests What the test shows You should not be pregnant or get pregnant immediately before, during, and for 6 months after treatment Treatment can cause birth defects in babies Women of childbearing age must have a negative pregnancy test before starting treatment, each month during treatment, and monthly for 6 months after finishing treatment Any positive pregnancy test must be reported to your healthcare provider right away Small patches, called electrodes, are placed on your chest. The electrodes are connected to a machine. The machine shows how well your heart is working. If you already have a heart condition, you must have this test before starting treatment. Your healthcare provider will want to know if you have mood problems, such as depression or anxiety. If you have a history of mood problems, you may need to have these tests before starting treatment. They include speaking with your healthcare provider and filling out some forms that have questions about your thoughts and feelings. A small amount of blood is taken from a vein in your arm. Then your blood sugar and thyroid hormone levels are measured. PEGASYS treatment can cause problems with your blood sugar or thyroid hormone levels. Your hepatitis C treatments may interfere with other medicines. Be sure your healthcare provider is aware of any prescription or over-the-counter medicine or herbal remedies you are taking. Speak with your healthcare provider about any health conditions you have. If you have health conditions such as diabetes, prediabetes (insulin resistance), thyroid disease, a heart problem, or mood problems such as depression or bipolar disorder, it is important that you get them under control before starting treatment for chronic hepatitis C. 18

19 Make healthy lifestyle choices Before starting treatment, it is important to think about your lifestyle choices. If you don t already, avoid smoking, drinking alcohol, and using drugs. If you need help to do this, speak with your healthcare provider or with a counselor who helps people who have alcohol and/or drug problems. He or she can help you find the support you need. You should also eat a healthy diet. Your healthcare provider can give you more information about making healthy choices. See pages for other helpful resources. Consider joining a support group Support groups can help you learn more about how people live with chronic hepatitis C. They can also give you tips to help you stay on treatment. Over time, you may find that you can help other people with chronic hepatitis C. Ask your healthcare provider if there is a local hepatitis support group that you can join. He or she can also help you find support groups if you need help to stop drinking or using drugs. These support groups include Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 19

20 Before Treatment (continued) Avoid spreading hepatitis C to other people Hepatitis C can spread from contact with infected blood. By taking these simple steps, you can help prevent spreading hepatitis C to others: Tell anyone who may come into contact with your blood that you have chronic hepatitis C. This includes your healthcare provider, sex partner, or dentist Do not share items that may have blood on them. These include toothbrushes, nail clippers, and razors Be careful when you throw away things that may have your blood on them. These include tissues, tampons, bandages, and swabs. Wrap them up before putting them in the garbage, then wash your hands Wash your hands after touching anything with your blood on them Clean any cuts and scratches, and use bandages to cover them Use condoms and avoid sexual activities that could cause bleeding Do not donate blood Do not share needles or other drug-injecting equipment; they could have a small amount of blood on them that you cannot see I learned as much as I could about hepatitis C before I started treatment. That way, I knew what to expect. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 20

21 During Treatment What other steps can I take during my treatment? The following information does not replace the advice and guidance of your healthcare provider. Always talk with him or her about any questions or concerns you have. It is important that you follow your treatment program. This may not always be easy, but you can do it. In fact, 9 out of 10 people in clinical studies were able to finish their treatment. People who maintain a healthy lifestyle and take their medicine as directed improve their chance of having the best results. You can make the most of your treatment by following these steps: Take your medicine exactly as prescribed If you miss a dose of any of your hepatitis C medicines, contact your healthcare provider Keep all your appointments with your healthcare provider Getting blood tests during treatment is very important. These tests will help your healthcare provider decide how long to treat you. Tests also help address any serious side effects in a timely manner Do not drink alcohol Alcohol may make your liver disease worse Do not use street drugs If you use intravenous drugs, you could catch another type of hepatitis or HIV/AIDS; you can also get reinfected with hepatitis C Do not take PEGASYS in combination with ribavirin if you: are pregnant, or planning to get pregnant during treatment or during the 6 months after treatment are a male patient with a female sexual partner who is pregnant or plans to become pregnant at any time while you are being treated with ribavirin or during the 6 months after your treatment has ended have certain blood disorders such as thalassemia major or sickle-cell anemia take didanosine (Videx or Videx EC) 21

22 During Treatment (continued) Make healthy lifestyle changes Eat well A healthy diet includes fruits and vegetables, lean proteins, and multi or whole grains Drink plenty of water (this can help reduce the effects of treatment) Avoid all uncooked seafood and shellfish (oysters, clams, and mussels) because raw or undercooked shellfish can give you a different form of hepatitis or a bacterial infection that could make you very sick Speak with your healthcare provider before taking any medicines, vitamins, supplements, or herbal remedies. Some of these may be harmful to your liver or make treatment less effective Get some exercise Any type of exercise, including walking, can help you by: Making your body stronger to fight disease Helping you feel less tired and depressed Reducing stress Helping your heart Improving blood circulation Possibly making your treatment work better by providing good blood supply to your liver Speak with your healthcare provider about what activities are right for you. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 22

23 Keep a positive attitude Focus on how healthy you want to be Work with your healthcare provider. He or she knows how to help you Get support from PEGASSIST (Genentech s patient support program) Support from nurses 24 hours a day, 7 days a week Monthly personal support User-friendly online support at The information obtained through this program is not intended to replace the advice and guidance of your healthcare provider. Use the space below to write any questions you want to ask your healthcare provider about other things you can do during treatment. Bring this booklet with you to your office visits so that you can take notes while speaking with him or her. Notes: For more information about steps you can take during treatment, call PEGASYS ( ) and press prompt #2 to speak with a nurse, or visit 23

24 Even though I am finished with my treatment, I know it is important to eat right and get plenty of exercise.

25 After Treatment What can I expect after treatment? You may still have side effects The medicine that treats hepatitis C can stay in your body after you stop taking it. This means that you may still feel some side effects. These may continue for a few months. This is normal. If you feel any side effects that are unusual or are worse than they were during treatment, speak with your healthcare provider. Maintain a healthy lifestyle The information on the following pages will help you maintain your health after treatment. Do not get pregnant for at least 6 months after completion of therapy Female patients and the female partners of male patients have to avoid getting pregnant for at least 6 months after stopping PEGASYS and ribavirin. You and your partner should continue to use 2 forms of birth control during this time. If pregnancy does occur during this time, tell your healthcare provider right away. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 25

26 After Treatment (continued) Maintain your healthy lifestyle Now that your treatment is over, it is important that you maintain your healthy lifestyle. Here are some steps you can take: Eat a healthy diet Keep eating fruits and vegetables, lean proteins, and whole grains Avoid alcohol and street drugs You must avoid alcohol and street drugs. They can damage your liver Using street drugs can cause serious health risks. Unsafe behavior can result in your liver becoming infected again Maintain a healthy weight Continue getting exercise Continue to seek support Even though your treatment is over, continue to get support. This can help you stay focused and positive. If you have been attending a support group, continue to do so. You may even find yourself offering support to those who are just starting their treatment. Also continue to speak with your healthcare provider For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 26

27 Speak with your healthcare provider before taking any medicines, vitamins, supplements, or herbal remedies These may affect your liver Keep your follow-up visits with your healthcare provider Six months after treatment, it is important to have the follow-up blood tests your healthcare provider recommends. These tests will show whether you ve achieved a sustained virologic response, or SVR. This means that the hepatitis C virus can no longer be measured in your blood. Achieving SVR is the goal of hepatitis C treatment. If you achieve SVR, it means the virus has stopped damaging your liver Use this space to write down the date and time of your follow-up visits with your healthcare provider. Date: time: 27

28 Resources The resources listed below can help you learn more about hepatitis C, eating well, sleeping better, or dealing with depression. Genentech is neither affiliated with nor endorses any of the following organizations. The information provided by Genentech is for informational purposes only and is not meant to replace your healthcare provider s medical advice. American Dietetic Association (ADA) 120 South Riverside Plaza, Suite 2000 Chicago, IL Connecticut Avenue NW, Suite 480 Washington, DC American Liver Foundation 39 Broadway, Suite 2700 New York, NY GO-LIVER ( ) Centers for Disease Control and Prevention (CDC) 1600 Clifton Road Atlanta, GA Hep C Connection 1325 South Colorado Boulevard, Building B, Suite 302 Denver, CO HEPC ( ) For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 28

29 Hepatitis C Support Project/HCV Advocate PO Box San Francisco, CA International Foundation for Research and Education on Depression (ifred) PO Box Baltimore, MD HOPE ( ) MyPyramid.gov, a service of the United States Department of Agriculture (USDA) Center for Nutrition Policy and Promotion 3101 Park Center Drive, 10th floor Alexandria, VA National Institute of Mental Health (NIMH) Science Writing, Press, and Dissemination Branch 6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD National Sleep Foundation (NSF) 1010 N. Glebe Road, Suite 310 Arlington, VA United States Department of Veterans Affairs VA Hepatitis C Resource Centers Minneapolis, MN San Francisco, CA West Haven, CT , ext 2206 Seattle, WA

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31 Section 2: Side Effect Management Possible side effects of therapy Flu-like symptoms Fatigue Depression Skin problems Injection-site reactions Hair changes Insomnia (trouble sleeping) Nausea Changes in appetite Important Safety Information You are encouraged to report negative side effects of prescription drugs to the FDA. Visit or call FDA Side Effect Management For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a).

32 Some Common Side Effects of Therapy What are some of the most common side effects of treatment with PEGASYS and ribavirin? Flu-like symptoms (muscle aches, joint pain, fever, headaches, chills) Fatigue (tiredness and weakness) Depression Irritability and anxiety Skin reactions: redness, swelling, dry or itchy skin at the site of injection Hair thinning Insomnia (trouble sleeping) Stomach problems: nausea and vomitting may happen with PEGASYS Loss of appetite (not feeling hungry) These are not all the side effects of PEGASYS. For more information, ask your healthcare provider or pharmacist. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 32

33 How can I manage side effects? If you experience side effects during treatment, your healthcare provider may be able to help you manage them. The information in this section can help you recognize and manage some common side effects. These and other side effects can become serious. Always speak with your healthcare provider about any side effects you have. He or she may be able to help you manage them. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. 33

34 Flu-like Symptoms What are flu-like symptoms? Most patients have flu-like symptoms during treatment. Flu-like symptoms include muscle aches, joint pain, headaches, chills, and fever. These usually start within 24 hours of the injection. The symptoms usually go away over time. While these symptoms can be unpleasant, there are many things you can do to manage them. Tips for managing flu-like symptoms Speak with your healthcare provider about any flu-like symptoms you have and ways to help manage them. Write them down in the notes section on the next page. Plan ahead for your injections Choose the day you will take PEGASYS and stick with that day throughout your treatment Take PEGASYS the evening before a day when you won t be busy with work or other activities. For example, if Wednesday is not a busy day for you, take your injection Tuesday night Choose the time you will take PEGASYS Inject your medicine in the early evening. That way, any flu-like symptoms will usually happen at night, and you may be able to sleep through them Plan to take an over-the-counter pain medicine Speak with your healthcare provider about taking an over-the-counter pain-relief medicine. Taking one of these medicines 30 minutes before injecting PEGASYS may help with headaches, joint pain, and muscle aches For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 34

35 Take steps to feel better Drink plenty of water. Try to drink about eight 8-ounce glasses of water a day Use extra blankets and clothes when you have the chills Use ice or gel packs for fevers, headaches, and other aches and pains To help with headaches: Avoid loud noises, bright lights, alcohol, and foods and beverages that have caffeine (such as colas, coffee, and chocolate) Avoid foods and drinks that contain artificial sweeteners Avoid foods and drinks that have given you headaches in the past Speak with your healthcare provider about other foods and drinks you should avoid Notes: Remember to use the convenient dosing chart in your Keeping Pace journal to help plan the best time to inject PEGASYS. If you have a fever that doesn t go away or gets worse, call your healthcare provider right away. Fever may be a sign of serious infection. 35

36 Fatigue What is fatigue? Fatigue is a feeling of being more tired than usual. Even when you do rest, you may still feel tired. Fatigue can sometimes make it hard for you to do the things you want to do. It is the most common side effect in patients who take PEGASYS. Most often, patients feel fatigue when they start treatment, but it can last the entire time they take PEGASYS. Tips for managing fatigue Here are some ways to manage fatigue. Try to find a balance between getting rest and being active. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Stay active Keep moving; speak with your healthcare provider about the kinds of activities or exercises that would be good for you Try to do activities during the times of day when you usually have the most energy Relax and get plenty of rest Rest often; take short naps of 30 minutes or less Do things that are relaxing, such as watching movies or reading Plan to do your most important tasks first; let less important tasks wait If possible, ask your job manager if you can work shorter hours or work from home Let friends and family help you do things, such as housework, shopping, and taking care of your children Try stress reduction and relaxation techniques, such as deep breathing exercises or walking 36

37 Other tips you can try Eat healthy foods; your healthcare provider can help you choose foods that are right for you Speak with your healthcare provider about taking vitamins or supplements Drink plenty of fluids during the day, but stop 2 to 3 hours before bedtime so you don t have to get up to use the bathroom Take PEGASYS close to your bedtime Notes: If you are severely fatigued, notify your healthcare provider. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 37

38 When I stopped caring about activities I usually enjoy, I decided to talk with my healthcare provider.

39 Depression What is depression? Depression is more than feeling sad once in a while. Depression interferes with your ability to lead your normal daily life and to do your usual activities. Many patients feel depressed when they find out they have hepatitis C. They can also feel depressed as a result of the treatment for hepatitis C. Below are some of the symptoms of depression. Speak with your healthcare provider if you have any of these symptoms. He or she may be able to help you find a way to treat depression. Symptoms of depression... Major mood swings... Anger... Panic attacks... Loss of energy, feeling tired... Lack of interest in your usual activities... No longer enjoying things that used to make you happy... Trouble focusing... Changes in sleep patterns, such as difficulty sleeping Noticeable changes in weight in a short period of time... Loss of appetite or eating too much... Crying for no reason... Feelings of hopelessness or intense sadness... Thoughts of suicide or killing the people around you For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 39

40 Depression (continued) Tips for managing depression Tell your healthcare provider if you ve ever been treated for depression or if any of your relatives have depression. If you start feeling depressed, or if your mood causes problems at work or in your daily life, speak with your healthcare provider right away. Here are some ways to manage the symptoms of depression. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Take care of your body Some people with depression sleep too much or too little. It may help to set up and follow regular routines, such as eating meals at the same time every day and going to sleep at the same time every night Do things that relieve stress, such as getting regular exercise or meditating Avoid drinking too much coffee or soda or eating too much sugar Eat healthy meals, fruits, and salads; drink plenty of water Get enough sleep If you are taking medicine for depression, make sure to take it exactly as prescribed by your healthcare provider For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 40

41 Talk about your feelings Keep track of any negative thoughts or feelings that are affecting your moods in the space provided in your Keeping Pace journal or your own diary. Then show the diary to your healthcare provider Join a local hepatitis C support group, if one is available Share your feelings with a family member or close friend Listen to those around you for clues that you may need to get help (moods of crankiness, grouchiness, anger, nervousness, or nastiness) Share your feelings with your healthcare provider Ask your healthcare provider if you should speak with a therapist; if you are already seeing one, ask if you should see him or her more often Notes: If you have thoughts of suicide, hurting yourself, or hurting others during treatment, speak with your healthcare provider right away. 41

42 Skin Problems What are skin problems? Some patients develop skin problems during treatment with PEGASYS. These include rash, itchiness, redness, dryness, sores, or skin infections. In patients who already have eczema (a medical condition that causes the skin to be inflamed or irritated), the symptoms might become worse. These skin problems are usually not serious and often go away on their own. Most cases of rash are mild to moderate and go away over time. However, some people have experienced severe rash that required them to stop taking one or more of their medications. If you develop a severe rash, contact your healthcare provider immediately. A rash on more than half of your body area is considered severe. When in doubt, contact your healthcare provider. Tips for managing skin problems Here are some ways to prevent or manage skin problems. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Moisturize your skin Apply a thin layer of petroleum jelly or a moisturizer to dry, itchy areas right after you shower. Make sure the moisturizer is for sensitive skin Take lukewarm baths. Add oil to the water at the end of the bath Use mild soaps (and mild laundry detergents) For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 42

43 Relieve the itch Press on the itchy areas, or rub them with your fingers or an ice cube. Do not scratch the area with your fingernails Add oatmeal to the water at the end of a bath to relieve itching Eat well Drink plenty of noncaffeinated beverages, especially water, to keep your skin hydrated Eat healthy foods; speak with your healthcare provider about taking vitamins or supplements Speak with your healthcare provider Ask him or her about medicines that can relieve pain or prevent allergic reactions that may be causing your skin problems Notes: Call your healthcare provider right away if you develop a rash with fever, blisters, or sores. Also call if you develop psoriasis or have psoriasis that gets worse. 43

44 Injection-site Reactions What are injection-site reactions? Some patients have skin reactions at the sites of their injection. These include redness, swelling, or pain. Tips for managing injection-site reactions Here are some ways to prevent injection-site reactions. Speak with your healthcare provider about other things you can do. Write them down in the blank spaces on the next page. Plan your injections Always follow your healthcare provider s instructions for injecting PEGASYS After taking the autoinjector or syringe out of the refrigerator, lay it on a flat, clean surface. Wait a few minutes until it reaches room temperature this is because injecting the cold medicine can cause pain. If you notice that the outside of the autoinjector or syringe is wet, wait another few minutes until it dries Pick a different injection site each time you give yourself an injection Check your injection sites for signs of redness, swelling, or pain Apply cool or warm compresses to the area before or after injecting Speak with your healthcare provider if you have any questions about injection sites. Write them down in the notes section on the next page For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 44

45 Take care of your skin Avoid spending a lot of time in the sun. Always use sunscreen when you are outside Apply moisturizing creams to injection sites, but avoid alcohol-based products See the PEGASYS Medication Guide and the DVD in your starter kit for more information about injecting PEGASYS. Notes: Speak with your healthcare provider before using hydrocortisone cream or anti-itch medicines, and use only as directed. 45

46 Hair Thinning Many patients treated for hepatitis C experience changes in their hair. These changes can include hair loss, thinning hair, and changes in hair texture. Hair loss can be a scary side effect for some patients, but most cases of hair loss are mild. Also, hair that is lost during treatment usually grows back after treatment ends. Tips for managing hair loss Here are some ways to manage hair changes. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Be gentle Do not comb or brush your hair too frequently. When you do, use a wide-toothed comb or soft brush Limit blow-drying or using curling/straightening irons Avoid using hair accessories that pull hair, such as clips, bands, and hair extensions Buy satin pillowcases to reduce friction on your hair while you sleep For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 46

47 Wash with care Wash your hair less often; use warm (not hot) water when you do Use a mild shampoo. Ask your hair stylist or barber for a recommendation Use a conditioner or detangler Try a different hairstyle Consider a short haircut Use less hair gel, spray, and mousse (especially alcohol-based products, which can be drying) During treatment, do not perm or color your hair Notes: Speak to your healthcare provider if you have any questions regarding your hair loss. 47

48 Insomnia What is insomnia? Insomnia means that you are having trouble falling asleep or staying asleep, even when you feel tired. It is important that you get enough sleep during your treatment. If you feel you re not getting the rest you need, or have feelings of depression, mood swings, stress, or panic attacks, speak with your healthcare provider right away. Tips for managing insomnia Here are some ways to manage insomnia. Speak with your healthcare provider about other things you can do. Write them down in the notes section below. Watch what you eat and drink Limit caffeine from soda, tea, and coffee, especially later in the day Don t drink a lot of fluids or eat heavy meals close to bedtime Have foods and beverages that contain tryptophan, such as turkey or milk (tryptophan is a natural sleep agent) Notes: For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 48

49 Take time to relax Take warm baths, read, or listen to soothing music before bedtime Try relaxation techniques such as massage or aromatherapy, or listen to relaxation tapes Reduce household noise at bedtime Set a routine Limit daytime naps; set your alarm clock or timer to go off in 20 to 30 minutes Try to wake up and go to sleep at the same time each day and night Exercise during the day; don t exercise for at least 4 hours before bedtime Time your dose Take your second dose of ribavirin before 5 PM Always speak with your healthcare provider before taking any medicines to help you sleep. 49

50 Nausea What is nausea? Nausea is the feeling that you are going to throw up. Many people treated for hepatitis C have nausea. Nausea usually occurs during the first month of treatment, but decreases over time. It is important that you do not let this side effect get in the way of your treatment. If your nausea is severe, speak with your healthcare provider right away. Tips for managing nausea Here are some ways to manage nausea. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Watch what you eat and drink Eat smaller, more frequent meals throughout the day Avoid foods and drinks that are very hot or very cold let them come to room temperature before eating Avoid greasy or spicy foods, or foods that have strong odors Snack on low-salt pretzels or crackers Have foods and drinks that have natural ginger in them, including gingersnap cookies and ginger ale Take ribavirin after a big meal; it will be less likely to cause nausea For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 50

51 Watch what you drink Drink plenty of water Drink flat soda Other tips you can try If you usually feel nauseated in the morning, keep crackers by your bed. Before you get out of bed, sit up slowly and eat just a few crackers After eating, do not lie down. Sit up or put pillows under your head and upper body to keep them elevated Ask your healthcare provider about activities that you can do that might help Notes: Speak with your healthcare provider about which over-the-counter antacid medicines you could try. In some cases, healthcare providers prescribe a medicine that can prevent nausea and/or heartburn. 51

52 Changes in Appetite What is a change in appetite? During treatment for hepatitis C, some people feel less hungry than usual, so they may eat less food. This can lead to weight loss. It is important to be on the lookout for any weight loss. If you do lose weight, speak with your healthcare provider about it. Tips for managing a change in appetite Here are some ways to manage a change in appetite. Speak with your healthcare provider about other things you can do. Write them down in the notes section on the next page. Eat healthy foods Make sure you eat enough protein each day. Protein is found in meat, poultry (chicken and turkey), fish, beans or peas, eggs, nuts, seeds, and in soy products such as tofu Eat a wide variety of foods from all food groups; these include fruits and vegetables, whole grains, lean meats, cooked cereal, and crunchy nuts Eat nutritious foods that are high in calories, such as peanut butter and cheese If you are on a special diet because of a medical condition, speak with your healthcare provider about what you should eat and drink Talk with your HCP* about taking supplements Ask your healthcare provider about meal-replacement products and protein powders that you can add to foods and beverages *Healthcare provider. For Important Safety Information for the Patient, please see section 2, pages Please see accompanying complete Prescribing Information and patient Medication Guide for PEGASYS (peginterferon alfa-2a). 52

53 Make a point to eat When you are hungry, eat whatever appeals to you When you re not hungry, it is still important to eat. Try to eat small, frequent meals that are healthy Other tips you can try Try to prepare and eat meals with family and/or friends As long as you are not feeling nauseated, add flavor to food by using small amounts of spices and herbs Avoid eating hot food. Instead, eat food that is chilled or at room temperature Take care of your teeth and gums by brushing and flossing every day Stay active; speak with your healthcare provider about the kinds of activities that would be good for you Notes: If you lose more than 2 pounds in a week, speak with your healthcare provider. He or she may prescribe a medicine to increase your appetite. 53