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 JANUARY 2010




Dealing with
drug side e ects
Dealing with drug side e ects can be challenging. Every HIV drug has its own                        Learn to recognize, monitor and
possible side e ects as well as the drugs that prevent and treat infections. ese                 manage side e ects should they arise.
e ects can vary from person to person. Some people experience few or no side                     O en, simple solutions exist to lessen
                                                                                                 many of them. In other cases, a par-
e ects at all, while some have ones that are mild and manageable. For others, they
                                                                                                 ticular side e ect may be an impor-
may be quite severe.
                                                                                                 tant signal that requires immediate
                                                                                                 medical attention.
Whenever you have symptoms, it’s                 Are women di erent?
important to talk to your doctor to
                                                 Women may experience a di erent
diagnose the cause. But regardless of                                                            Caring for your whole self
                                                 type or rate of side e ects compared
how severe or persistent the side ef-
                                                 to men, including therapies not relat-          Some conditions believed to be side
fects are, you can try some things to
                                                 ed to HIV. Why this is is not well un-          e ects may actually be due to anxiety,
manage them.
                                                 derstood. It may be due to di erences           depression or stress. Caring for your
                                                 in the way a woman’s body breaks                whole self—your emotions, thoughts
The key to coping                                down or stores drugs. Generally                 and general health—can help minimize
                                                 speaking, women have smaller body               negative feelings and their e ects.
   e key to coping with side e ects is
                                                 weight/sizes than men. It may be that,                ere are some things you can do
knowing what to watch out for and
                                                 for their weight, some women take               that may make the adjustment period
having a plan in place to respond if
                                                 too high a dose of drug. is could               easier. If possible, take some time o
they occur. If a drug you’re taking or
                                                 also be an issue for men with small             work or lighten your schedule to give
are planning to take has a side ef-
                                                 frames. Women’s hormones may also               you time to adjust to the change. If
fect that may be life-threatening, it’s
                                                 a ect drugs. Or it may be due to other          things get hard, see if someone can
important to know what these early
                                                 unknown di erences.                             help out around the house or with
symptoms are and to monitor for
                                                                                                 children or other obligations.
them. It’s also possible to prevent or
                                                                                                    Take time to re-prioritize your
reduce some side e ects by taking                What to look for?                               health needs, and make sure you eat
certain preventive therapies a few
                                                 Many people experience an adjust-               well and get plenty of sleep and rest.
days before or at the same time as
                                                 ment period when starting a new                 Try to get a little exercise during the
starting a new regimen.
                                                 therapy. is usually lasts about 4–6             day—even if just taking a walk.
   Before starting any therapy, talk to
                                                 weeks as your body adapts to the                   Most importantly, reach out for
your doctor or pharmacist about the
                                                 new drug. During this time, you may             support—be it your family, friends or
risk of side e ects. is information
                                                 experience headache, nausea, muscle             support group. If you can, let them
usually comes from studies conducted
                                                 pain and occasional dizziness. ese              know what’s going on. Sometimes just
on the drug. Ask how o en side ef-
                                                 kinds of side e ects typically lessen or        talking helps, but they may also have
fects were reported.
                                                 disappear as your body adjusts.                 ideas to help ease your side e ects.



                © PROJECT INFORM   1375 MISSION STREET   SAN FRANCISCO, CA 94103 2621   415 558 8669   WWW.PROJECTINFORM.ORG
EMAIL YOUR QUESTIONS TO
2                                                                                        www.projectinform.org/questions
                                                                                                                                     JANUARY 2010




Dealing with drug side e ects


A word about switching                              fatigued, ask yourself: how long?
                                                    Are there activities that are di cult
Sometimes people facing serious side
                                                    today that weren’t a problem a few                  as they may make it worse.
e ects will switch drugs simply to im-
                                                    months ago? Are you having trouble
prove their quality of life, even though
                                                    sleeping or sleeping more than nor-
they were controlling HIV well. is                                                                    Peripheral
                                                    mal? Provide your doctor with this
is one way to deal with side e ects.                                                                  Neuropathy
                                                    information.
   Switching a drug solely because of
                                                                                                      Peripheral neuropathy
side e ects may also save that drug                 TIPS FOR FATIGUE
                                                                                                      is caused by damage to
as a future treatment option. In fact,
                                                                                                      nerves, symptoms of
side e ects that you have with a drug                 the same time every day. Changes in
                                                                                                      which include burning, stinging, sti -
at one time may not occur again if or                 your sleep schedule can actually make
                                                                                                      ness, tickling or numbness in the feet,
when you try that drug again.                         you feel tired.
                                                                                                      toes or hands. ese can be mild or
   However, it’s dangerous to simply
                                                                                                      severe enough to prevent walking. Pe-
stop taking one drug in your regi-                    eases stress and makes you feel stron-
                                                                                                      ripheral neuropathy can be caused by
men, reduce its dose without talking                  ger and alive.
                                                                                                      HIV itself or as a side e ect of some
to your doctor or pharmacist, or only
                                                                                                      HIV-related drugs.
take it every now and then. is can                    for times you’re too tired to cook.
                                                                                                          Treatment usually involves stop-
lead to drug resistance, making that
                                                                                                      ping or decreasing the o ending
drug—and perhaps others—less use-
                                                    Rash                                              drug(s). However, no drug can reverse
ful for you now or in the future.
                                                                                                      nerve damage. If neuropathy is severe,
                                                    Rash seems to occur
                                                                                                      it’s a good idea to consult a doctor
                                                    slightly more o en
Fatigue                                             among women taking
                                                                                                      that specializes in pain management.
It’s not unusual to feel                            certain HIV drugs than                            TIPS FOR PERIPHERAL NEUROPATHY
tired, especially when                              men, like Viramune (nevirapine) and
life is hectic. A sense of                          Viracept (nel navir). Of note, women                cotton socks, and padded slippers
tiredness that doesn’t go                           appear more prone to severe rash as                 around the house. Good air circula-
away with rest is a problem. If ignored,            well. It’s important to check your skin             tion around the feet helps.
fatigue can worsen.                                 for discoloration and changes in its
    Symptoms can be physical—like it’s              surface, especially a er starting a new
di cult to getting out of bed or walk               medicine.                                           feet (a good thing), but too much can
up stairs. ey can also be psycholog-                                                                    make the problem worse.
                                                    TIPS FOR RASH
ical—like having a hard time concen-
trating. Fatigue is also a symptom of                                                                   pain.
                                                      hand to soothe and comfort skin.
another drug side e ect—anemia.
    Getting a handle on it begins with
                                                      cleansers or oatmeal soaps.
acknowledging it. If you’re feeling
                                                                                                        peripheral neuropathy.

    TOLL FREE NATIONAL HIV/AIDS TREATMENT HOTLINE    1 800 822 7422   LOCAL & INTERNATIONAL   415 558 9051   MONDAY FRIDAY 10 4   PACIFIC TIME
EMAIL YOUR QUESTIONS TO
                      www.projectinform.org/questions                                                                                           3
 JANUARY 2010




                                                                             Dealing with drug side e ects


Diarrhea                                         Dry Mouth                                              cloths over your eyes; massage the
                                                                                                        base of your skull with your thumbs
   e biggest concern is                          Dry mouth is an un-
                                                                                                        and massage both temples gently;
that diarrhea can cause                          comfortable condi-
                                                                                                        take hot baths.
dehydration. So the rst                          tion, making chewing,
course of action is to replenish lost            swallowing and talking di cult. It can
                                                                                                        Avoid or limit foods known to trigger
liquids by drinking plenty of uids,              a ect your sense of taste and can pro-
                                                                                                        them, especially ca eine (co ee, tea,
like Gatorade, ginger ale, chicken               mote mouth problems.
                                                                                                        so drinks, some meds), chocolate, red
or beef broth, herb tea or just plain
                                                 TIPS FOR DRY MOUTH                                     wine, citrus fruit (more than 1/2 cup a
water. Chronic diarrhea may lead to
                                                                                                        day), food additives (like MSG), nuts,
weight loss. Foods that provide nutri-
                                                    with salted warm water.                             onions, hard cheese and vinegar.
ents, calories, and absorb liquid (like
the BRAT diet) are good ways to deal
                                                    food stores) to moisten the mouth.
with diarrhea.                                                                                    Hair Loss
TIPS FOR DIARRHEA                                   or crushed ice to cool the mouth.             Most people experience hair loss as they
                                                                                                  get older, though it can hurt one’s self-
  slows diarrhea by absorbing liquid,               between meals.                                con dence. Sudden or abnormal hair
  like oatmeal, cream of wheat, grits                                                       -     loss can result from taking certain drugs.
  and so bread (not whole grain).                   feinated drinks.
                                                                                                  TIPS FOR HAIR LOSS
  food stores). One study showed that
                                                                                                        practices, such as dyeing, perming,
  two bars eaten one hour before bed-               treating dry mouth.
                                                                                                        straightening, braiding, corn-rowing,
  time with water can help diarrhea.
                                                                                                        using hair dryers, etc.
                                      -
  ber, like the skins of vegetables and          Headache
                                                                                                        for some, but not all, cases of baldness.
  fruits.                                           e most common
                                                 cause of headache is
                                                                                                        reduce stress and anxiety.
  high- ber or very sweet foods.                 tension. Di erent med-
                                                 icines can also cause them. Headaches
                                                 are mostly just a pain and can be eased          Anemia
                                                 by over-the-counter meds like aspirin,
                                                                                                  Anemia is low red blood cells. ese
  Pepto-Bismol.                                  acetaminophen, ibuprofen or naproxen
                                                                                                  cells deliver oxygen throughout your
                                                 sodium. ey can also be helped, and
                                                                                                  body. When your body is short on ox-
                                                 prevented, by reducing stress.
                                                                                                  ygen, you feel fatigued. Long-term or
                                                 TIPS FOR HEADACHE                                severe anemia can damage your body.
                                                                                                  Most people with HIV have anemia
                                                    your eyes closed; place cold wash-            at some point. HIV can cause it, as do



                © PROJECT INFORM   1375 MISSION STREET   SAN FRANCISCO, CA 94103 2621    415 558 8669      WWW.PROJECTINFORM.ORG
EMAIL YOUR QUESTIONS TO
4                                                                                        www.projectinform.org/questions
                                                                                                                                     JANUARY 2010




Dealing with drug side e ects


many HIV drugs , like Retrovir (zido-               TIPS FOR NAUSEA AND VOMITING                      TIPS FOR WEIGHT LOSS
vudine, AZT). For women, problems
with periods can also be a cause or                   Applesauce, and Toast) helps.                     weight, work with your doctor to de-
symptom of anemia. Severe anemia                                                           -
requires a blood transfusion.                         ing, eat a few dry crackers and sit in            vomiting? Started a new medicine?
                                                      bed for a few minutes.
TIPS FOR ANEMIA
                                                                                                        Med-Rx. Look for products high in
                                                      can help calm the stomach.                        protein and low in sugar.
  iron and vitamin B-12, both of which
  may lower risk of anemia.                                                                           Period Problems
                                                      greasy foods.                                   Period problems are common in all
  and lima beans are high in folic acid,
                                                                                                      women, but particularly in women
  another nutrient that may lower risk
                                                      with broth, carbonated beverages,               with weakened immune systems.
  of anemia.
                                                      juice, Jell-O or popsicles.                        ese include irregular, heavier,
                                                                                      -               lighter and/or painful periods or the
  can lower the risk of anemia.
                                                      e ts/risks of anti-nausea meds.                 end of them altogether. ese can be
                                                                                                      a side e ect of some meds. Excessive
  help correct moderate anemia.
                                                                                                      periods may also occur. It’s a good
                                                    Weight Loss                                       idea to track your periods, noting
  drugs that are causing the anemia.
                                                    Weight loss can be a                              changes if they occur.
                                                    serious problem in HIV
                                                                                                      TIPS FOR PERIOD PROBLEMS
Nausea and                                          disease. It can result
Vomiting                                            from vomiting, nausea, dry mouth,
                                                                                                        life. Losing weight? Stressed out?
                                                    anemia or fatigue.
Feelings of nausea and                                                                                  Addressing these and other factors
                                                           e signs can be obvious but are
the urge to vomit vary                                                                                  might help in more ways than one!
                                                    not always seen as a problem. In
greatly among people. e two symp-
                                                    fact, many positive women who lose
toms o en occur together. Certain                                                                       water bottle or a heating pad over
                                                    weight due to HIV are praised and
medications used to treat HIV or its                                                                    your lower stomach or back. Or take
                                                    told they “look good”.
related conditions can cause nausea.                                                                    a hot bath.
                                                       If you lose weight and it’s not be-
Persistent vomiting can lead to serious
                                                    cause you changed your diet or exer-
medical problems, like dehydration,                                                                     stretching. Exercise may increase
                                                    cise, it’s never a good thing. Talking to
chemical imbalances and even tearing                                                                    blood ow and decrease pain.
                                                    a doctor to identify its cause is critical
of the windpipe. Call your doctor or if
                                                    to treating unwanted weight loss.
nausea or vomiting persists.                                                                            sometimes used to regulate abnormal
                                                                                                        periods. Some HIV drugs interact
                                                                                                        with the pill.



    TOLL FREE NATIONAL HIV/AIDS TREATMENT HOTLINE    1 800 822 7422   LOCAL & INTERNATIONAL   415 558 9051   MONDAY FRIDAY 10 4   PACIFIC TIME

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Dealing With Side Effects (Additional PLUS Reading Materials)

  • 1. EMAIL YOUR QUESTIONS TO www.projectinform.org/questions JANUARY 2010 Dealing with drug side e ects Dealing with drug side e ects can be challenging. Every HIV drug has its own Learn to recognize, monitor and possible side e ects as well as the drugs that prevent and treat infections. ese manage side e ects should they arise. e ects can vary from person to person. Some people experience few or no side O en, simple solutions exist to lessen many of them. In other cases, a par- e ects at all, while some have ones that are mild and manageable. For others, they ticular side e ect may be an impor- may be quite severe. tant signal that requires immediate medical attention. Whenever you have symptoms, it’s Are women di erent? important to talk to your doctor to Women may experience a di erent diagnose the cause. But regardless of Caring for your whole self type or rate of side e ects compared how severe or persistent the side ef- to men, including therapies not relat- Some conditions believed to be side fects are, you can try some things to ed to HIV. Why this is is not well un- e ects may actually be due to anxiety, manage them. derstood. It may be due to di erences depression or stress. Caring for your in the way a woman’s body breaks whole self—your emotions, thoughts The key to coping down or stores drugs. Generally and general health—can help minimize speaking, women have smaller body negative feelings and their e ects. e key to coping with side e ects is weight/sizes than men. It may be that, ere are some things you can do knowing what to watch out for and for their weight, some women take that may make the adjustment period having a plan in place to respond if too high a dose of drug. is could easier. If possible, take some time o they occur. If a drug you’re taking or also be an issue for men with small work or lighten your schedule to give are planning to take has a side ef- frames. Women’s hormones may also you time to adjust to the change. If fect that may be life-threatening, it’s a ect drugs. Or it may be due to other things get hard, see if someone can important to know what these early unknown di erences. help out around the house or with symptoms are and to monitor for children or other obligations. them. It’s also possible to prevent or Take time to re-prioritize your reduce some side e ects by taking What to look for? health needs, and make sure you eat certain preventive therapies a few Many people experience an adjust- well and get plenty of sleep and rest. days before or at the same time as ment period when starting a new Try to get a little exercise during the starting a new regimen. therapy. is usually lasts about 4–6 day—even if just taking a walk. Before starting any therapy, talk to weeks as your body adapts to the Most importantly, reach out for your doctor or pharmacist about the new drug. During this time, you may support—be it your family, friends or risk of side e ects. is information experience headache, nausea, muscle support group. If you can, let them usually comes from studies conducted pain and occasional dizziness. ese know what’s going on. Sometimes just on the drug. Ask how o en side ef- kinds of side e ects typically lessen or talking helps, but they may also have fects were reported. disappear as your body adjusts. ideas to help ease your side e ects. © PROJECT INFORM 1375 MISSION STREET SAN FRANCISCO, CA 94103 2621 415 558 8669 WWW.PROJECTINFORM.ORG
  • 2. EMAIL YOUR QUESTIONS TO 2 www.projectinform.org/questions JANUARY 2010 Dealing with drug side e ects A word about switching fatigued, ask yourself: how long? Are there activities that are di cult Sometimes people facing serious side today that weren’t a problem a few as they may make it worse. e ects will switch drugs simply to im- months ago? Are you having trouble prove their quality of life, even though sleeping or sleeping more than nor- they were controlling HIV well. is Peripheral mal? Provide your doctor with this is one way to deal with side e ects. Neuropathy information. Switching a drug solely because of Peripheral neuropathy side e ects may also save that drug TIPS FOR FATIGUE is caused by damage to as a future treatment option. In fact, nerves, symptoms of side e ects that you have with a drug the same time every day. Changes in which include burning, stinging, sti - at one time may not occur again if or your sleep schedule can actually make ness, tickling or numbness in the feet, when you try that drug again. you feel tired. toes or hands. ese can be mild or However, it’s dangerous to simply severe enough to prevent walking. Pe- stop taking one drug in your regi- eases stress and makes you feel stron- ripheral neuropathy can be caused by men, reduce its dose without talking ger and alive. HIV itself or as a side e ect of some to your doctor or pharmacist, or only HIV-related drugs. take it every now and then. is can for times you’re too tired to cook. Treatment usually involves stop- lead to drug resistance, making that ping or decreasing the o ending drug—and perhaps others—less use- Rash drug(s). However, no drug can reverse ful for you now or in the future. nerve damage. If neuropathy is severe, Rash seems to occur it’s a good idea to consult a doctor slightly more o en Fatigue among women taking that specializes in pain management. It’s not unusual to feel certain HIV drugs than TIPS FOR PERIPHERAL NEUROPATHY tired, especially when men, like Viramune (nevirapine) and life is hectic. A sense of Viracept (nel navir). Of note, women cotton socks, and padded slippers tiredness that doesn’t go appear more prone to severe rash as around the house. Good air circula- away with rest is a problem. If ignored, well. It’s important to check your skin tion around the feet helps. fatigue can worsen. for discoloration and changes in its Symptoms can be physical—like it’s surface, especially a er starting a new di cult to getting out of bed or walk medicine. feet (a good thing), but too much can up stairs. ey can also be psycholog- make the problem worse. TIPS FOR RASH ical—like having a hard time concen- trating. Fatigue is also a symptom of pain. hand to soothe and comfort skin. another drug side e ect—anemia. Getting a handle on it begins with cleansers or oatmeal soaps. acknowledging it. If you’re feeling peripheral neuropathy. TOLL FREE NATIONAL HIV/AIDS TREATMENT HOTLINE 1 800 822 7422 LOCAL & INTERNATIONAL 415 558 9051 MONDAY FRIDAY 10 4 PACIFIC TIME
  • 3. EMAIL YOUR QUESTIONS TO www.projectinform.org/questions 3 JANUARY 2010 Dealing with drug side e ects Diarrhea Dry Mouth cloths over your eyes; massage the base of your skull with your thumbs e biggest concern is Dry mouth is an un- and massage both temples gently; that diarrhea can cause comfortable condi- take hot baths. dehydration. So the rst tion, making chewing, course of action is to replenish lost swallowing and talking di cult. It can Avoid or limit foods known to trigger liquids by drinking plenty of uids, a ect your sense of taste and can pro- them, especially ca eine (co ee, tea, like Gatorade, ginger ale, chicken mote mouth problems. so drinks, some meds), chocolate, red or beef broth, herb tea or just plain TIPS FOR DRY MOUTH wine, citrus fruit (more than 1/2 cup a water. Chronic diarrhea may lead to day), food additives (like MSG), nuts, weight loss. Foods that provide nutri- with salted warm water. onions, hard cheese and vinegar. ents, calories, and absorb liquid (like the BRAT diet) are good ways to deal food stores) to moisten the mouth. with diarrhea. Hair Loss TIPS FOR DIARRHEA or crushed ice to cool the mouth. Most people experience hair loss as they get older, though it can hurt one’s self- slows diarrhea by absorbing liquid, between meals. con dence. Sudden or abnormal hair like oatmeal, cream of wheat, grits - loss can result from taking certain drugs. and so bread (not whole grain). feinated drinks. TIPS FOR HAIR LOSS food stores). One study showed that practices, such as dyeing, perming, two bars eaten one hour before bed- treating dry mouth. straightening, braiding, corn-rowing, time with water can help diarrhea. using hair dryers, etc. - ber, like the skins of vegetables and Headache for some, but not all, cases of baldness. fruits. e most common cause of headache is reduce stress and anxiety. high- ber or very sweet foods. tension. Di erent med- icines can also cause them. Headaches are mostly just a pain and can be eased Anemia by over-the-counter meds like aspirin, Anemia is low red blood cells. ese Pepto-Bismol. acetaminophen, ibuprofen or naproxen cells deliver oxygen throughout your sodium. ey can also be helped, and body. When your body is short on ox- prevented, by reducing stress. ygen, you feel fatigued. Long-term or TIPS FOR HEADACHE severe anemia can damage your body. Most people with HIV have anemia your eyes closed; place cold wash- at some point. HIV can cause it, as do © PROJECT INFORM 1375 MISSION STREET SAN FRANCISCO, CA 94103 2621 415 558 8669 WWW.PROJECTINFORM.ORG
  • 4. EMAIL YOUR QUESTIONS TO 4 www.projectinform.org/questions JANUARY 2010 Dealing with drug side e ects many HIV drugs , like Retrovir (zido- TIPS FOR NAUSEA AND VOMITING TIPS FOR WEIGHT LOSS vudine, AZT). For women, problems with periods can also be a cause or Applesauce, and Toast) helps. weight, work with your doctor to de- symptom of anemia. Severe anemia - requires a blood transfusion. ing, eat a few dry crackers and sit in vomiting? Started a new medicine? bed for a few minutes. TIPS FOR ANEMIA Med-Rx. Look for products high in can help calm the stomach. protein and low in sugar. iron and vitamin B-12, both of which may lower risk of anemia. Period Problems greasy foods. Period problems are common in all and lima beans are high in folic acid, women, but particularly in women another nutrient that may lower risk with broth, carbonated beverages, with weakened immune systems. of anemia. juice, Jell-O or popsicles. ese include irregular, heavier, - lighter and/or painful periods or the can lower the risk of anemia. e ts/risks of anti-nausea meds. end of them altogether. ese can be a side e ect of some meds. Excessive help correct moderate anemia. periods may also occur. It’s a good Weight Loss idea to track your periods, noting drugs that are causing the anemia. Weight loss can be a changes if they occur. serious problem in HIV TIPS FOR PERIOD PROBLEMS Nausea and disease. It can result Vomiting from vomiting, nausea, dry mouth, life. Losing weight? Stressed out? anemia or fatigue. Feelings of nausea and Addressing these and other factors e signs can be obvious but are the urge to vomit vary might help in more ways than one! not always seen as a problem. In greatly among people. e two symp- fact, many positive women who lose toms o en occur together. Certain water bottle or a heating pad over weight due to HIV are praised and medications used to treat HIV or its your lower stomach or back. Or take told they “look good”. related conditions can cause nausea. a hot bath. If you lose weight and it’s not be- Persistent vomiting can lead to serious cause you changed your diet or exer- medical problems, like dehydration, stretching. Exercise may increase cise, it’s never a good thing. Talking to chemical imbalances and even tearing blood ow and decrease pain. a doctor to identify its cause is critical of the windpipe. Call your doctor or if to treating unwanted weight loss. nausea or vomiting persists. sometimes used to regulate abnormal periods. Some HIV drugs interact with the pill. TOLL FREE NATIONAL HIV/AIDS TREATMENT HOTLINE 1 800 822 7422 LOCAL & INTERNATIONAL 415 558 9051 MONDAY FRIDAY 10 4 PACIFIC TIME