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IDStewardship

Ribavirin

Ribavirin Photo:

KEY POINTS

  • Ribavirin (Copegus, Rebetol, Ribasphere, Virazole) is a nucleoside antihepaciviral medication that inhibits replication of DNA and RNA viruses
  • Is teratogenic, requiring special handling and should not expose pregnant individuals to ribavirin
    • Pregnancy category X
  • Available as oral capsule or tablet (Copegus, Rebetol, Ribasphere)
    • Oral is almost exclusively used for treatment of hepatitis C virus (HCV)
      • Treatment of hepatitis C is complex and selection of therapy depends on factors such as genotype, previous HCV medication exposure, HCV viral load quantity, and cirrhosis status
        • Always used with at least one other medication versus HCV
      • Dosing is usually weight-based and may be adjusted downward on therapy to help minimize toxicity while continuing treatment
        • Use with caution in renal impairment
      • Has a black box warning for hemolytic anemia
      • Common side effect of concern with oral ribavirin is anemia / fatigue, so monitoring of hemoglobin and fatigue during therapy is warranted
      • Other side effects of oral to beware include: rash, headache, fever, insomnia, irritability, hair loss, dry skin, nausea, diarrhea, weight loss, leukopenia, thrombocytopenia, increased bilirubin, and more
      • Oral should be given with food
  • Available as inhalation (Virazole)
    • Inhalation is almost exclusively used for treatment of respiratory syncytial virus (RSV), which is something more common to see in either pediatric patients or post-transplantation
    • Inhaled is commonly given over continuous aerosolization (over 12-18 hours per day)
    • The drug delivery equipment may be problematic when giving the inhaled product to ventilated patients
    • Has a black box warning for respiratory deterioration
    • Common adverse effects are fatigue, headache, insomnia, nausea, anorexia and anemia

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