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  • Hepatitis C: Should I Take Antiviral Medicine?
 

Hepatitis C: Should I Take Antiviral Medicine?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Hepatitis C: Should I Take Antiviral Medicine?

Get the facts

Your options

  • Take antiviral medicine for hepatitis C.
  • Don't take antiviral medicine. Have regular blood tests and maybe a liver biopsy to check for liver problems.

Key points to remember

  • Chronic hepatitis C can be treated and sometimes cured with medicines. But treatment is expensive and does not work for everyone.
  • Treating a chronic hepatitis C infection can help prevent serious problems like liver failure or liver cancer.
  • People with chronic hepatitis C may not need to decide about treatment right away. Your doctor can monitor the infection to see if it is causing liver damage or other problems.
  • The medicines used to treat hepatitis C can have serious side effects that make people feel so sick that they stop taking them. Some medicines are more likely than others to cause problems. The kind of medicines you take to treat hepatitis C depend on the genotype of the virus you are infected with and how serious the infection is.
FAQs

What is hepatitis C?

Hepatitis C is a virus that infects the liver. You can get hepatitis C when you share needles to inject illegal drugs with someone who has the virus. You can also get it by having a shot, tattoo, or piercing with a needle that has infected blood on it.

When most people get hepatitis C, they don't even know they have it. Early symptoms are mild and don't last long.

Some people who get the virus have it for a short time and then get better. This is called acute hepatitis C. But up to 85 people out of 100 who are infected with the virus get long-term (chronic) hepatitis C.1 "Chronic" means that the virus is active in your body for more than 6 months.

Chronic hepatitis C can cause swelling and tiny scars to form in your liver. When this happens, your liver doesn't work well. About 25 out of 100 people who have chronic hepatitis C get more serious liver problems such as cirrhosis, liver cancer, or liver failure. This most often happens over a period of 20 years or more.2 If the damage is severe, you may need a liver transplant.

What medicines are used to treat hepatitis C?

A combination of antiviral medicines is the main treatment for hepatitis C. When used together, peginterferon and ribavirin can stop or slow the growth of the virus. A protease inhibitor (such as boceprevir, simeprevir, or telaprevir) or a nucleotide analog inhibitor (such as sofosbuvir) also may be used to increase effectiveness.

Treatment usually is needed for at least 12 weeks. But it may continue for up to a year depending on the genotype of the virus and how serious the infection is.

Who should take antiviral medicines for hepatitis C?

Results from your blood tests can help you and your doctor decide if you should start treatment. Your doctor may also take a tiny piece of your liver, called a biopsy, to see if it has been affected by the virus.

The medicines used in the past to treat hepatitis C did not always work well, especially for infection with genotype 1. But new medicines are available, and they work much better and have fewer side effects. So people who may not have been helped by medicines in the past are being treated successfully now.

Even though hepatitis C is serious, most people can manage the infection and lead active lives. Two key steps are to take good care of yourself and get regular checkups to watch for liver problems.

How well do antiviral medicines work?

Antiviral medicines can cure hepatitis C or slow the growth of the virus and help prevent serious liver problems. There are several types of the hepatitis C virus that cause infection. Six different strains (genotypes) of hepatitis C have been found. Most people in the United States have genotype 1.

Studies have shown that:

  • A combination of peginterferon and ribavirin works for as many as 50 out of 100 people with genotype 1 or 4.3 This means that it doesn't work for the other 50 people.
  • Adding a protease inhibitor (such as boceprevir, simeprevir, or telaprevir) to peginterferon/ribavirin therapy controls hepatitis C in up to 88 out of 100 people who have genotype 1.4, 5
  • The peginterferon and ribavirin combination also works for as many as 80 out of 100 people who have genotype 2 or 3.3 This means that combination therapy doesn't work for 20 out of 100 people who have these genotypes.
  • Adding sofosbuvir to peginterferon and ribavirin significantly improved hepatitis C treatment in people who had genotype 1.6 Using sofosbuvir with only ribavirin was effective for people with genotype 2.6

Antiviral medicines may not decrease the amount of the virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver. This can lower your chance of getting cirrhosis and liver cancer.7

A combination of medicines is more likely to work if you have:

  • Low levels of the hepatitis C virus in your blood when you start treatment.
  • Small amounts of liver damage when you start treatment.

Treatment may not be an option for everyone who has hepatitis C. These medicines don't work for everyone, and they cost a lot. Some insurance companies may cover all or part of the cost of these medicines. If you don't have health insurance, drug companies may be able to help cover the cost of your treatment.

What are the side effects of antiviral medicines?

About half of the people who take both peginterferon and ribavirin have serious side effects during their treatment. Some people may need to stop taking their medicines because the medicines make them feel very sick. Talk to your doctor if your hepatitis C medicines are causing serious side effects.

Side effects of combination therapy can include:

  • Fatigue, headache, fever, chills, and muscle and joint aches.
  • Nausea, loss of appetite, and weight loss.
  • Irritability, insomnia, and confusion.
  • Depression.
  • Thyroid problems.
  • Hair loss or skin rash.
  • Low levels of red cells, white cells, and platelets in your blood.

Why might your doctor recommend antiviral medicines?

Your doctor might advise you to take antiviral medicines if:

  • You have active infection. This means that you have high levels of the virus in your blood.
  • Your liver enzyme levels are more than twice the normal amount.
  • You are likely to develop serious liver disease such as cirrhosis or liver cancer.
  • You have mild to severe liver damage.
  • You have another serious health problem, such as HIV infection.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take antiviral medicine Take antiviral medicine
  • You take medicine for 12 weeks to a year.
  • You have regular exams and blood tests to check for liver problems.
  • Antiviral medicines can cure hepatitis C or slow the growth of the hepatitis C virus.
  • They can help prevent serious liver problems.
  • Possible side effects may include:
    • Fever and muscle aches.
    • Headaches.
    • Nausea and diarrhea.
    • Depression.
    • Hair loss or skin rash.
    • Trouble sleeping.
    • Low blood cell counts, including anemia.
Don't take antiviral medicine Don't take antiviral medicine
  • You have regular exams and blood tests to check for liver problems.
  • You take steps to prevent further liver damage by not drinking alcohol or using illegal drugs.
  • You can avoid the side effects and cost of antiviral medicines.
  • If the hepatitis C virus is active in your body, you may:
    • Get severe liver disease.
    • Get liver cancer.
    • Spread the infection to others.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about antiviral treatment for hepatitis C

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I would like to try combination treatment with peginterferon and ribavirin to try to keep my liver healthy. I realize that I may never have liver failure, even if I don't have treatment, but I want to feel like I've done everything possible to prevent it.

Frank, age 29

I was shocked when I tried to donate blood and found out that I had hepatitis C. My liver enzymes have been up, but my liver doesn't show any signs of damage yet. I'm glad. I hate the thought of having a treatment that might make me sick, and I really don't believe that my liver will be damaged. I am just going to keep visiting my doctor to keep an eye on my condition.

Rick, age 50

I have two teenagers, and I really want to stay as healthy as I can for as long as I can while they grow up and have their own families. My doctor says antiviral treatment is the best chance I have of staying healthy and active, so I am going to take my doctor's advice and have treatment.

Nina, age 45

The side effects of treatment worry me. It also costs a lot of money, and it doesn't help everyone. I don't feel sick, even though my doctor says that my liver enzymes have been a little high for about the past 8 months and my liver biopsy showed some mild damage. Because of my concerns, my doctor and I decided to keep checking my liver enzymes and repeat the liver biopsy in a few years.

Karen, age 53

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiviral medicine for hepatitis C

Reasons not to take antiviral medicine for hepatitis C

I'm willing to take medicine regularly for at least 12 weeks to help get rid of the virus in my body.

I don't like taking medicine for a long period of time.

More important
Equally important
More important

I'll do whatever I can to avoid getting liver disease or liver cancer.

I'm not worried about getting liver disease or liver cancer.

More important
Equally important
More important

I'm worried that I might spread the virus to others if I don't treat the infection.

I'm not worried about spreading the virus to others.

More important
Equally important
More important

I'm not worried about missing work to go to the doctor for the examinations and tests that I need.

I can't afford to take time off from work to go to the doctor.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiviral medicine

NOT taking antiviral medicine

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Medicines used to treat hepatitis C infection can prevent liver disease.

  • TrueThat's right. Treating a chronic hepatitis C infection with antiviral medicines can prevent serious problems like liver failure or liver cancer.
  • FalseSorry, that's not right. Treating a chronic hepatitis C infection with antiviral medicines can prevent serious problems like liver failure or liver cancer.
  • I'm not sureYou may want to go back and read "Get the Facts." Treating a chronic hepatitis C infection with antiviral medicines can prevent serious problems like liver failure or liver cancer.
2.

The same antiviral medicines are used to treat everyone who has hepatitis C.

  • TrueSorry, that's not right. The medicines chosen to treat hepatitis C depend on the genotype of the virus you have and how serious the infection is.
  • FalseThat's right. The medicines chosen to treat hepatitis C depend on the genotype of the virus you have and how serious the infection is.
  • I'm not sureIt may help to go back and read "Get the Facts." The medicines chosen to treat hepatitis C depend on the genotype of the virus you have and how serious the infection is.
3.

Antiviral medicines can help everyone who has hepatitis C.

  • TrueSorry, that's not right. Treatment does not work for everyone and may not be a good choice for people with some health conditions.
  • FalseThat's right. Treatment does not work for everyone and may not be a good choice for people with some health conditions.
  • I'm not sureYou may want to go back and read "Get the Facts." Treatment does not work for everyone and may not be a good choice for people with some health conditions.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer W. Thomas London, MD - Hepatology

References
Citations
  1. Dienstag JL (2010). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1593–1670. Philadelphia: Churchill Livingstone Elsevier.
  2. Flamm SL (2003). Chronic hepatitis C virus infection. JAMA, 289(18): 2413–2417.
  3. Pawlotsky JM, McHutchinson J (2012). Chronic viral and autoimmune hepatitis. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 973–979. Philadelphia: Saunders.
  4. Bacon BR, et al. (2011). Boceprevir for previously treated chronic HCV genotype 1 infection. New England Journal of Medicine, 364(13): 1207–1217.
  5. Simeprevir (Olysio) for Chronic Hepatitis C (2014). The Medical Letter On Drugs and Therapeutics, 56(1433): 1–2.
  6. Koff RS (2014). Review article: The efficacy and safety of sofosbuvir, a novel, oral nucleotide NS5B polymerase inhibitor, in the treatment of chronic hepatitis C virus infection. Alimentary Pharmacology and Therapeutics, published online January 6, 2014. DOI: 10.1111/apt.12601. Accessed February 12, 2014.
  7. Morgan RL, et al. (2013). Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: A meta-analysis of observational studies. Annals of Internal Medicine, 158(5, Part 1): 329–337.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Hepatitis C: Should I Take Antiviral Medicine?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Take antiviral medicine for hepatitis C.
  • Don't take antiviral medicine. Have regular blood tests and maybe a liver biopsy to check for liver problems.

Key points to remember

  • Chronic hepatitis C can be treated and sometimes cured with medicines. But treatment is expensive and does not work for everyone.
  • Treating a chronic hepatitis C infection can help prevent serious problems like liver failure or liver cancer.
  • People with chronic hepatitis C may not need to decide about treatment right away. Your doctor can monitor the infection to see if it is causing liver damage or other problems.
  • The medicines used to treat hepatitis C can have serious side effects that make people feel so sick that they stop taking them. Some medicines are more likely than others to cause problems. The kind of medicines you take to treat hepatitis C depend on the genotype of the virus you are infected with and how serious the infection is.
FAQs

What is hepatitis C?

Hepatitis C is a virus that infects the liver. You can get hepatitis C when you share needles to inject illegal drugs with someone who has the virus. You can also get it by having a shot, tattoo, or piercing with a needle that has infected blood on it.

When most people get hepatitis C, they don't even know they have it. Early symptoms are mild and don't last long.

Some people who get the virus have it for a short time and then get better. This is called acute hepatitis C. But up to 85 people out of 100 who are infected with the virus get long-term (chronic) hepatitis C.1 "Chronic" means that the virus is active in your body for more than 6 months.

Chronic hepatitis C can cause swelling and tiny scars to form in your liver. When this happens, your liver doesn't work well. About 25 out of 100 people who have chronic hepatitis C get more serious liver problems such as cirrhosis , liver cancer, or liver failure. This most often happens over a period of 20 years or more.2 If the damage is severe, you may need a liver transplant.

What medicines are used to treat hepatitis C?

A combination of antiviral medicines is the main treatment for hepatitis C. When used together, peginterferon and ribavirin can stop or slow the growth of the virus. A protease inhibitor (such as boceprevir, simeprevir, or telaprevir) or a nucleotide analog inhibitor (such as sofosbuvir) also may be used to increase effectiveness.

Treatment usually is needed for at least 12 weeks. But it may continue for up to a year depending on the genotype of the virus and how serious the infection is.

Who should take antiviral medicines for hepatitis C?

Results from your blood tests can help you and your doctor decide if you should start treatment. Your doctor may also take a tiny piece of your liver, called a biopsy, to see if it has been affected by the virus.

The medicines used in the past to treat hepatitis C did not always work well, especially for infection with genotype 1. But new medicines are available, and they work much better and have fewer side effects. So people who may not have been helped by medicines in the past are being treated successfully now.

Even though hepatitis C is serious, most people can manage the infection and lead active lives. Two key steps are to take good care of yourself and get regular checkups to watch for liver problems.

How well do antiviral medicines work?

Antiviral medicines can cure hepatitis C or slow the growth of the virus and help prevent serious liver problems. There are several types of the hepatitis C virus that cause infection. Six different strains (genotypes) of hepatitis C have been found. Most people in the United States have genotype 1.

Studies have shown that:

  • A combination of peginterferon and ribavirin works for as many as 50 out of 100 people with genotype 1 or 4.3 This means that it doesn't work for the other 50 people.
  • Adding a protease inhibitor (such as boceprevir, simeprevir, or telaprevir) to peginterferon/ribavirin therapy controls hepatitis C in up to 88 out of 100 people who have genotype 1.4, 5
  • The peginterferon and ribavirin combination also works for as many as 80 out of 100 people who have genotype 2 or 3.3 This means that combination therapy doesn't work for 20 out of 100 people who have these genotypes.
  • Adding sofosbuvir to peginterferon and ribavirin significantly improved hepatitis C treatment in people who had genotype 1.6 Using sofosbuvir with only ribavirin was effective for people with genotype 2.6

Antiviral medicines may not decrease the amount of the virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver. This can lower your chance of getting cirrhosis and liver cancer.7

A combination of medicines is more likely to work if you have:

  • Low levels of the hepatitis C virus in your blood when you start treatment.
  • Small amounts of liver damage when you start treatment.

Treatment may not be an option for everyone who has hepatitis C. These medicines don't work for everyone, and they cost a lot. Some insurance companies may cover all or part of the cost of these medicines. If you don't have health insurance, drug companies may be able to help cover the cost of your treatment.

What are the side effects of antiviral medicines?

About half of the people who take both peginterferon and ribavirin have serious side effects during their treatment. Some people may need to stop taking their medicines because the medicines make them feel very sick. Talk to your doctor if your hepatitis C medicines are causing serious side effects.

Side effects of combination therapy can include:

  • Fatigue, headache, fever, chills, and muscle and joint aches.
  • Nausea, loss of appetite, and weight loss.
  • Irritability, insomnia, and confusion.
  • Depression.
  • Thyroid problems.
  • Hair loss or skin rash.
  • Low levels of red cells, white cells, and platelets in your blood.

Why might your doctor recommend antiviral medicines?

Your doctor might advise you to take antiviral medicines if:

  • You have active infection. This means that you have high levels of the virus in your blood.
  • Your liver enzyme levels are more than twice the normal amount.
  • You are likely to develop serious liver disease such as cirrhosis or liver cancer.
  • You have mild to severe liver damage.
  • You have another serious health problem, such as HIV infection.

2. Compare your options

  Take antiviral medicine Don't take antiviral medicine
What is usually involved?
  • You take medicine for 12 weeks to a year.
  • You have regular exams and blood tests to check for liver problems.
  • You have regular exams and blood tests to check for liver problems.
  • You take steps to prevent further liver damage by not drinking alcohol or using illegal drugs.
What are the benefits?
  • Antiviral medicines can cure hepatitis C or slow the growth of the hepatitis C virus.
  • They can help prevent serious liver problems.
  • You can avoid the side effects and cost of antiviral medicines.
What are the risks and side effects?
  • Possible side effects may include:
    • Fever and muscle aches.
    • Headaches.
    • Nausea and diarrhea.
    • Depression.
    • Hair loss or skin rash.
    • Trouble sleeping.
    • Low blood cell counts, including anemia.
  • If the hepatitis C virus is active in your body, you may:
    • Get severe liver disease.
    • Get liver cancer.
    • Spread the infection to others.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about antiviral treatment for hepatitis C

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I would like to try combination treatment with peginterferon and ribavirin to try to keep my liver healthy. I realize that I may never have liver failure, even if I don't have treatment, but I want to feel like I've done everything possible to prevent it."

— Frank, age 29

"I was shocked when I tried to donate blood and found out that I had hepatitis C. My liver enzymes have been up, but my liver doesn't show any signs of damage yet. I'm glad. I hate the thought of having a treatment that might make me sick, and I really don't believe that my liver will be damaged. I am just going to keep visiting my doctor to keep an eye on my condition."

— Rick, age 50

"I have two teenagers, and I really want to stay as healthy as I can for as long as I can while they grow up and have their own families. My doctor says antiviral treatment is the best chance I have of staying healthy and active, so I am going to take my doctor's advice and have treatment."

— Nina, age 45

"The side effects of treatment worry me. It also costs a lot of money, and it doesn't help everyone. I don't feel sick, even though my doctor says that my liver enzymes have been a little high for about the past 8 months and my liver biopsy showed some mild damage. Because of my concerns, my doctor and I decided to keep checking my liver enzymes and repeat the liver biopsy in a few years."

— Karen, age 53

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take antiviral medicine for hepatitis C

Reasons not to take antiviral medicine for hepatitis C

I'm willing to take medicine regularly for at least 12 weeks to help get rid of the virus in my body.

I don't like taking medicine for a long period of time.

             
More important
Equally important
More important

I'll do whatever I can to avoid getting liver disease or liver cancer.

I'm not worried about getting liver disease or liver cancer.

             
More important
Equally important
More important

I'm worried that I might spread the virus to others if I don't treat the infection.

I'm not worried about spreading the virus to others.

             
More important
Equally important
More important

I'm not worried about missing work to go to the doctor for the examinations and tests that I need.

I can't afford to take time off from work to go to the doctor.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking antiviral medicine

NOT taking antiviral medicine

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Medicines used to treat hepatitis C infection can prevent liver disease.

  • True
  • False
  • I'm not sure
That's right. Treating a chronic hepatitis C infection with antiviral medicines can prevent serious problems like liver failure or liver cancer.

2. The same antiviral medicines are used to treat everyone who has hepatitis C.

  • True
  • False
  • I'm not sure
Sorry, that's not right. The medicines chosen to treat hepatitis C depend on the genotype of the virus you have and how serious the infection is.

3. Antiviral medicines can help everyone who has hepatitis C.

  • True
  • False
  • I'm not sure
Sorry, that's not right. Treatment does not work for everyone and may not be a good choice for people with some health conditions.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer W. Thomas London, MD - Hepatology

References
Citations
  1. Dienstag JL (2010). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1593–1670. Philadelphia: Churchill Livingstone Elsevier.
  2. Flamm SL (2003). Chronic hepatitis C virus infection. JAMA, 289(18): 2413–2417.
  3. Pawlotsky JM, McHutchinson J (2012). Chronic viral and autoimmune hepatitis. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 973–979. Philadelphia: Saunders.
  4. Bacon BR, et al. (2011). Boceprevir for previously treated chronic HCV genotype 1 infection. New England Journal of Medicine, 364(13): 1207–1217.
  5. Simeprevir (Olysio) for Chronic Hepatitis C (2014). The Medical Letter On Drugs and Therapeutics, 56(1433): 1–2.
  6. Koff RS (2014). Review article: The efficacy and safety of sofosbuvir, a novel, oral nucleotide NS5B polymerase inhibitor, in the treatment of chronic hepatitis C virus infection. Alimentary Pharmacology and Therapeutics, published online January 6, 2014. DOI: 10.1111/apt.12601. Accessed February 12, 2014.
  7. Morgan RL, et al. (2013). Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: A meta-analysis of observational studies. Annals of Internal Medicine, 158(5, Part 1): 329–337.

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