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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

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.

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