Ask the Pharmacist: Are you at risk for hepatitis C?

(BPT) – What do Mickey Mantle, Evel Knievel, Naomi Judd, Pamela Anderson, Jim Nabors and Keith Richards have in common? They have all faced hepatitis C. And they are not the only ones; about 3.2 million Americans have chronic hepatitis C. It claims the lives of more people each year than HIV/AIDS and is the leading cause of liver transplants in the United States.

John Fowler is a specialty trained pharmacist and part of the Accredo Specialty Pharmacy patient counseling team, with disease-specific expertise in hepatitis C. His team flags drug interactions, provides patient support and educates patients on specialty medication therapy and ways to manage side-effects.

“Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver,” Fowler says. “For a lucky few, their body is able to clear the virus. However, in most people, the initial infection leads to long-lasting or chronic infection.”

The disease is much more common among baby boomers (those born between 1945 and 1965). Many baby boomers were infected between 1970 and 1990, before universal screenings of the blood supply were adopted. The Centers for Disease Control and Prevention recommends that all baby boomers be tested. Medicare will cover the cost of screening if you are at high risk or symptomatic.

For chronic hepatitis C patients, Fowler says, being adherent to the medication’s dosing regimen is key for the best health outcomes. “Forty percent of hepatitis C patients do not take their medication as prescribed, which can lead to therapy failure and prolonged use of medication,” says Fowler. “The challenging part is that hepatitis C medications often have significant side-effects including fatigue, mood disorders, low blood cells and flu-like symptoms, which causes nearly 40 percent of patients to become non-adherent.”

For the millions of Americans who suffer from hepatitis C, Fowler offers the following tips:

* Be adherent: Being consistent with a dosing regimen is important, especially among the hepatitis population. People with hepatitis C often must follow a medication regimen that demands multiple doses of three separate medications each day. Talk with your doctor or specialist pharmacist if you need support with your schedule or are struggling with adherence.

* Read the fine print: Many hepatitis C drugs provide specific instructions to help minimize side effects. For example, one commonly prescribed medication may cause flu-like symptoms, so some patients take the dose at night (to sleep off the side effects) or the day before a day off work. Taking an ibuprofen at the time can also lessen side effects.

* Follow specific instructions: Some of the newest medications for hepatitis C are oral medications. While oral medications are more convenient, they must be taken at precisely spaced intervals throughout the day and with food to ensure adequate absorption. In fact, some medications specify the nutritional content requirements of the food.

* Stay well hydrated: Consuming enough fluids is very important. A great rule of thumb is to determine your body weight (in pounds) and strive to drink half that number (in ounces) per day. For example, if you weigh 200 pounds, you should drink 100 ounces of fluid each day.

* Delay pregnancy: Some drugs that treat hepatitis C can harm an unborn child, so women should avoid getting pregnant while on therapy and for up to six months after completion of therapy. Men undergoing hepatitis C treatment should also practice safe sex during the same time period.

* Document the side-effects: Report all side effects and other concerns to your physician and your specialist pharmacist so they can be resolved quickly before symptoms worsen.

Express Scripts offers a sophisticated clinical patient support model through Accredo Specialty Pharmacy that promotes adherence and helps patient with hepatitis C. For more information on ways to manage hepatitis C, visit Express Scripts’ Healthcare Insights blog at

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