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
- 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
- Oral is almost exclusively used for treatment of hepatitis C virus (HCV)
- 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
RESOURCES
- Ribavirin Package Insert (Copegus)
- Ribavirin Package Insert (Rebetol)
- Ribavirin Package Insert (Ribasphere)
- Ribavirin Inhalation Solution Package Insert (Virazole)
- American Association For The Study Of Liver Diseases (AASLD) Hepatitis C Treatment Guidelines (Updated Regularly)
- Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014; 134: e1474–e1502.
- Dawson-Caswell M and Muncie HL. Respiratory Syncytial Virus Infection in Children. American Family Physician. 2011;83 (2): 141-146.
- Turner TL et al. Respiratory syncytial virus: current and emerging treatment options. ClinicoEconomics and Outcomes Research. 2014; 6: 217–225.