A high dose of interferon-alfa2b (IFN) is currently the only treatment approved for melanoma patients at high risk of recurrence after surgery. Unfortunately, many serious side effects have been reported by those taking IFN, including problems in the skin, muscles, stomach, heart, kidney, liver and blood. Some side effects, such as fatigue, can even last for the entire year that IFN is taken. Here are some simple tips that will help you cope with this challenging drug:
Flu-like symptoms (fever, chills, headache, muscle ache, nausea, vomiting) last about 1 to 12 hours after receiving a dose of IFN. Fortunately, your body will develop a tolerance over time and the symptoms will slowly subside. Taking acetaminophen (like Tylenol), anti-vomiting drugs (called "anti-emetics"), or nonsteroidal anti-inflammatory drugs (like aspirin, Advil and naproxen) before injecting the IFN can reduce the severity of these symptoms. Drinking lots of water (two liters, or a half-gallon, per day) also may help.
Fatigue is a common side effect of IFN and is reported in 70% to 100% of patients. It generally increases in intensity as therapy continues and can be very debilitating. To help manage your fatigue, you should eat a quality, balanced diet, alternate between periods of rest and activity, increase your aerobic activity with exercise, schedule more strenuous activities during times of peak energy, and make sure to drink plenty of water.
Patients who are treated with IFN often complain of a lack of appetite, weight loss, and feeling "full" soon after starting to eat. However, since proper nutrition is key to being able to complete the full course of interferon therapy, you should try eating small, frequent meals, use high-protein supplements, and take multivitamins. And don't be shy about asking family or friends to help prepare your meals!
The most frequently reported IFN-related psychiatric side effects are depression and irritability, but also common are apathy, sleep disturbances, tremor, sexual dysfunction, memory loss, manic symptoms, cognitive dysfunction, and suicidal thoughts. Tell your doctor or nurse if you are feeling especially depressed so that antidepressant drugs (such as citalopram, escitalopram, fluoxetine, paroxetine, or sertraline) can be considered. On the other hand, if you experience mania, bipolar symptoms, or severe mood changes, you may need emergency consultation with a psychiatrist.
Your doctor will be monitoring the function of your liver during IFN administration. Refrain from drinking alcohol or taking any anesthetics or statin medications (like Lipitor, Zocor). If you're taking acetaminophen, be sure to stick to the recommended dose.
Working During Therapy
The flu-like symptoms and fatigue associated with IFN make it very difficult for people who have demanding jobs that require sustained attention, particularly for transportation and heavy machinery workers, pilots, and bus and truck drivers. Those with such responsibilities should be cautioned against accepting the full demands of their occupation while undergoing IFN therapy. For most others, it generally is possible to resume your regular activities of daily life while continuing treatment.
For IFN to be as effective as possible, taking the full year-long dose is important. Side effects need to be identified and treated quickly before they become more severe, so be sure to stay in close communication with your doctor or nurse.
Hauschild A, Gogas H, Tarhini A, Middleton MR, Testori A, Dréno B, Kirkwood JM. "Interdisciplinary management recommendations for toxicity associated with interferon-alfa therapy." Cancer. 2008 Mar 1;112(5):982-94.