Table 3.

Adverse effects

Adverse effects of peginterferon	Comments
Influenza like symptoms: Fever	Typically after the first injection.
Gastrointestinal symptoms: Nausea
Hair loss:	20–25% of patients, usually temporary.
Bone marrow suppression: Leucopenia, thrombocytopenia	Typically 30–50% reduction in counts, may treat with G-CSF.
CNS toxicity: headache, depression, irritability, psychological changes	10% of patients, use of anti-depressants, dose reduction if severe.
Seizures	1–2% of patients, dose discontinuation.
Autoimmune thyroid disease: Hypothyroidism, hyperthyroidism	1–2% of patients, treat if symptomatic.
Others: cardiac side effects, interstitial nephritis, vision and hearing disturbances, elevation in serum aminotransferases

Adverse effects of Ribavirin	Comments
Hemolytic anemia	Dose reduction if symptomatic or Hct <30%, dose discontinuation if Hct drops further, may use erythropoietin.
Lymphopenia	Lymphocyte counts may decrease by 10–15%.
Gout: Increase in uric acid	Discontinue if attack severe/prolonged.
Pruritis	20% of patients, discontinue if severe.
Nasal stuffiness, sinusitis	20% of patients, treat if symptomatic.
Teratogenicity	Discontinue if pregnancy test positive.
Others: Hepatic iron accumulation, cholelithiasis, retinal changes

Hct, hematocrit; G-CSF, granulocyte-colony stimulating factor.