A Practical Guide to the Side Effects of Anti-HIV Drugs

A Practical Guide to the Side Effects of Anti-HIV Drugs

Determine the cause

Nausea - having a heart ache - is a problem that everyone knows from time to time, and it can lead to vomiting. Sometimes, the nausea fades in a few hours or a day. When it causes frequent and persistent vomiting, however, nausea can cause severe malnutrition, dehydration, and electrolyte imbalances, which are normal biochemicals in the blood.

The loss of appetite - we do not feel the urge to eat - often accompanies nausea, but it can also happen alone. This is difficult to see in some cases, but loss of appetite becomes serious when it prevents the affected person from consuming enough nutrients to maintain good health.

If you take note of the details of your problems, you will help your doctor to deal with them effectively. Watch out for the following trends:

How many times a day do you feel nauseated, how long does it last, and how often do you vomit in these moments? If the sensation lasts most of the day, write it down. Also note the number of days in the week that nausea occurs;

Are you aware of any trend regarding your nausea? Do they occur when you wake up, after taking your medications, when you smell food, when you start eating, after meals, in response to anything else you notice?

Does nausea change in any way, how or when you take your anti-HIV medicines? Do you ever skip doses of your antiretrovirals or other medications because the nausea is too strong? Do you have trouble keeping your medications in the stomach because of vomiting? If so, how often does it happen to you?

Write down everything you eat or drink during a few days. You and your doctor can then determine if your total calorie and nutrient intake is sufficient to support optimal health.

There is no doubt that drugs often cause nausea, vomiting or loss of appetite, but these symptoms also have other causes. Your doctor should perform blood tests and a complete medical checkup to determine if your nausea or loss of appetite is caused in part by liver problems, infections, hormonal deficiencies or other medical conditions. There are several possible causes for these symptoms, and in many cases two or more factors contribute to this.

Not all doctors are very thorough when it comes to nausea, vomiting and loss of appetite. If you think your symptoms are not being treated effectively, tell your doctor that they are seriously affecting your life and your ability to eat healthy. Emphasize the importance of continuing to research the cause (s) of your symptoms.

infections

In some cases, loss of appetite and nausea are caused by infections. Almost any infection can decrease appetite and cause fever, fatigue and general malaise. Common bacterial and viral infections are often the cause of nausea. Since organisms that cause food poisoning often cause sudden and sometimes sudden nausea, this possibility should always be considered.

Infections and cancers that may cause nausea in people with HIV include H. pylori gastritis , secondary syphilis , cryptococcal meningitis, cryptosporidiosis and other parasitic infections, viral hepatitis, Mycobacterium avium complex (MAC), severe toxoplasmosis and lymphoma. Some of these conditions are quite rare in people whose HIV is well controlled with antiretrovirals, but it is still important to consider the possibility that an infection contributes to nausea and loss of appetite and to take the necessary measures to diagnose and effectively treat the infection in question.

Antiretroviral drugs, other medicines and supplements

Nausea is a common side effect of antiretroviral drugs, pain killers, cancer chemotherapies, radiation therapy and other treatments. Almost all currently available antiretroviral drugs can cause nausea, but some of them (protease inhibitors, for example) are more likely to cause this problem than others. . Nausea is also one of the symptoms of the rare hypersensitivity reaction to abacavir. See the section Less Common Side Effects for more information.

Medications used against many infections can cause nausea. In this regard, remember that some people with low CD4 count take Bactrim / Septra , a sulfonamide antibiotic used to prevent Pneumocystis pneumonia and other microbial infections. The majority of patients tolerate this medication well, but some of them experience severe nausea and need to substitute a different preventative drug.

The painkillers cause nausea in many people. If these medications may be contributing to your nausea and loss of appetite, discuss other options with your doctor. Cancer chemotherapy and radiotherapy are also causing very severe nausea in many cases, so it is very important to address this problem so that we can continue to treat cancer.

In some people, nausea is caused by supplements , including fish oil. This problem may occur more frequently if the supplement is taken on an empty stomach. Pharmacists advise patients to watch for side effects when they start taking a supplement and do not start taking it while they are changing medications.

Liver problems, pancreatitis, testosterone deficiency, depression

The search for possible liver problems is important in determining the cause of nausea and loss of appetite. If the tests reveal the possibility of liver damage, it is essential to start therapy to strengthen the organ and treat the damage or prevent it from getting worse.

People living with HIV are at higher risk of developing pancreatitis , and the risk increases further with certain medications or high alcohol consumption. If you experience severe abdominal pain that starts suddenly and is accompanied by nausea and vomiting that lasts for several hours, especially after eating or drinking excessively, pancreatitis is a possibility. Urgent medical care is needed in these cases. To learn more about this serious condition, see the section Less Common Side Effects .

The testosterone deficiency occurs frequently in men and women living with HIV can reduce appetite. It is important to have testosterone levels measured for many reasons. If the test reveals that the rate is low, hormone replacement therapy for testosterone may improve appetite. For more information, see the section called The emotional well-being .

Some people living with HIV suffer from depression . When it is present, it often causes a loss of appetite. If depression is a problem for you, it is very important that you get the treatment you need. This topic is discussed in detail in the section entitled Emotional Well-being .

Change medications and schedule of medication

If the nausea or loss of appetite you are experiencing now has occurred shortly after the start of a new medication , it is possible that it is the cause of your symptoms. If the problem does not improve after a few weeks, talk to your doctor. In many cases, these side effects subside or disappear after a short period of time, so it may be worth persevering, rather than giving up or changing drugs immediately. Later in this section we list remedies that are often useful for nausea or short-term appetite loss, including anti-nausea medications.

Another factor to consider is the schedule of your medication intake. Consult your doctor or pharmacist to determine the potential benefit of changing the time you take your medications. Some medications cause less nausea when taken with a full meal, while others need to be taken on an empty stomach.

Modification of eating habits

To cope with persistent nausea or loss of appetite, it may be helpful to change one's eating habits . Eat on a fixed schedule and replace three hearty meals a day with frequent small meals and snacks. When the stomach is left empty for too long, the nausea tends to get worse. Even if you are not hungry when the time of your next meal or snack rings, do your best to eat. You can try anything to stimulate your appetite and relieve your nausea. Here are a few tips :

Experiment with different seasonings or sauces to find a few that enhance the flavor of the food without causing nausea;

Ginger is often very useful against nausea. Ginger powder in the form of capsules, ginger ale (made with real ginger), ginger tea or candied ginger can all be very useful;

Lemon can soothe nausea. Before meals, slice a fresh lemon and smell it for a minute or two. Or drink a glass of warm lemon water before eating;

If you have more appetite or less nausea at certain times of the day, try eating at these times, and choose nutritious foods to make the most of every bite;

Odors often trigger nausea, and cold foods usually feel less strong, so try to make a meal with cold foods;

Sip your liquids with a straw to limit odors;

If the smell of cooking triggers nausea, try to get away from the kitchen while preparing meals; open the windows and run the fans to remove the odors from cooking;

Keep tasty snacks close at hand so you can enjoy every moment you have an appetite;

Eat dry and / or salty foods to soothe the stomach, such as crackers, bread or toast;

Protein-rich foods can relieve nausea, while sugary foods can sometimes make it worse, so avoid sugary foods at lunchtime. Instead, start your day with a small portion of protein, such as a boiled hard-boiled egg or chicken from the day before;

Sip cool drinks like juice or carbonated drinks like spritzers with fruit juices. It should be noted, however, that some people find that gasification aggravates nausea and therefore prefer non-carbonated beverages; try both to find the one that suits you;

Chew your food completely so that it is easier to digest for your stomach;

Avoid spicy foods, fried foods, high-fat meats, brown sauces and sauces, sour cream, caffeinated beverages and alcohol;

Eat bland foods like broth, miso soup, mashed potatoes, rice, oatmeal, toast, naan bread or plain yogurt;

Eat in a sitting position and try to stay upright for two hours after eating; this can help reduce the tendency to vomit.

If you vomit frequently, it is very important that you restore the balance of your electrolytes. For more information, see the section called Diarrhea, gas and bloating .

Counteract nutritional deficiencies

Persistent nausea and loss of appetite creates a vicious cycle of nutrition. At first, the reduction of food intake gives rise to inadequate nutrient levels. Then, this lack of nutrients causes in turn a loss of appetite induced by malnutrition, which makes persist the inadequate absorption of nutrients. When this vicious cycle occurs, it is necessary to restore the normal nutrient levels of the body. The solution usually lies in a combination of appetite stimulants, nutrient-rich foods and nutritional supplements.

A multivitamin with mineralscan compensate for inadequate intake of micronutrients. If nausea makes taking pills difficult, multivitamins in liquid form are an option. With regard to micronutrients, the deficiency most associated with loss of appetite concerns zinc. Although zinc is present in the majority of multivitamins, you can restore your zinc levels faster by taking a separate supplement of this nutrient (75 mg per day, with a meal). Taking zinc can reduce the absorption of copper, so some people take a supplement of it (5 mg a day, at a different meal) to reduce the risk of heart problems. Note that too high levels of copper are likely to harm the liver, so talk to your doctor before you start taking this supplement.

Sometimes the idea of ??drinking a liquid meal seems easier than eating one. Try homemade mixed soup or nutritious, high-calorie smoothies . Experiment by mixing the following ingredients:

plain or coconut milk with fresh, non-acidic fruits such as bananas, apples, peaches or blueberries

coconut oil or nut butter if you need more calories

frozen fruit or fresh fruit with ice cream if you fancy a frozen smoothie

high quality protein powder

Whey products are among the best. But it's important not to overdo it because excess protein can stress the kidneys and cause diarrhea.

If you do not want to make your own supplement, look for low-sugar drinks that contain mostly medium-chain triglycerides (MCTs), a moderately high quality protein content and a high overall caloric intake.

Antinauseants and stimulants of appetite

If all the above suggestions fail to solve your problems of nausea or loss of appetite, it is very important that you talk about taking any medications to counter them with your doctor or pharmacist.

In Canada, the most commonly used nausea medication, including in hospital emergencies, is dimenhydrinate (Gravol and its generic equivalents). You may find that the dose of Gravol for children is enough for you, rather than the adult dose. The child dose also helps to prevent drowsiness. If you are taking the adult dose of Gravol without relieving your nausea, talk to your doctor or pharmacist as soon as possible.

Many prescription medications are used to treat severe nausea and loss of appetite. If one of them is not effective, another could do the trick. Sometimes you get the best results using drugs that work differently. For example, some medications cause the stomach to empty more quickly, while others block signals to and from the brain that cause nausea.

Talk to your doctor or pharmacist before you change medications. The drugs are likely to interact with each other, so they cause side effects or other problems. Before you try anything, always check with your pharmacist for any drug interactions that may occur between your antiretroviral medications and your other medications.

Some antinauseants exist in various forms. For people whose severe nausea makes it difficult or impossible to take pills, fast-acting tablets, suppositories, transdermal patches, intravenous injections and infusions are all important options.

Drug warning: megestrol acetate (Megace) used to be used to stimulate appetite, but this drug can reduce or inhibit the production of testosterone, a hormone that is already too low for many people living with HIV. Testosterone deficiency can also contribute to loss of appetite and cause breast enlargement in men. Talk to your doctor about other medication options that may be right for you.

Other antinausea agents

Studies reveal that ginger is an effective antinauseant agent, even against nausea induced by chemotherapy. Since ginger must be present in the stomach to exert its anti-nausea effect, consume it a few minutes before eating, drinking or taking medication. You can also take it as a capsule or syrup; add a little of it to water and sip it all day long.

You could also make a ginger tea by adding 30 to 45 ml (two or three tablespoons) of fresh ginger chopped or grated to 250 ml (one cup) of boiling water. Let the mixture simmer for five to 10 minutes, then drink all day. You can also add chopped ginger to many dishes to enhance the taste and combat nausea.

The medical marijuana is effective as an appetite stimulant and anti-nausea agent, then it can be a good choice for people who need both. If you prepare a healthy meal before using medicinal marijuana, you will be more likely to get the best nutritional benefits from its stimulating appetite. The cannabinoid drug nabilone (Cesamet) is sometimes used for the treatment of severe nausea and vomiting. As smoking marijuana can hurt the lungs, some people prefer to put in browniesor cookies. All cannabinoid agents may feel "frozen," and the possible connection between marijuana use and the medical condition known as psychosis is controversial. People with a predisposition to psychosis should talk to their doctor before using marijuana.

Acupuncture and acupressure

The acupuncture and acupressure may be helpful against nausea. The first involves inserting needles into the energy points of the body, while the second is based on physical pressure on the energy points. Commonly sold as a cure for seasickness, acupressure strips are a simple way to relieve nausea. They are available in many pharmacies, health food stores and some health professionals.o