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Ribavirin

Oral
Inhalation
Class
Antiviral agents
Subclass
Nucleoside analogs
Generic name
Ribavirin
Brand names
Virazole®
Common formulations
Capsule
Indications for use
Labeled indications
Adults
•
Treatment of chronic hepatitis C infection
Off-label indications
Adults
•
Treatment of HSV encephalitis
Safety risks
Boxed warnings
Hemolytic anemia
•
Use extreme caution with underlying cardiac disease or a history of hemoglobinopathy.
Contraindications
Pre-existing AIH
Warnings and precautions
Dysglycemia
•
Use caution with pre-existing diabetes mellitus.
Dyspnea
•
Use caution with a history of respiratory disorders or compromised pulmonary function.
Inadequate cardiac output
•
Use caution with a history of heart disease, arrhythmias, or ischemic events.
Major depression
•
Use caution with a history of psychiatric disorders.
Specific populations
Renal impairment
eGFR 30-50 mL/min/1.73 m²
•
Start at dose of 200 mg. Maximal dose of 400 mg. Do not exceed frequency of q48h. Monitor for anemia.
eGFR 10-30 mL/min/1.73 m²
•
Maximal dose of 200 mg. Do not exceed frequency of once daily. Monitor for anemia.
eGFR < 10 mL/min/1.73 m²
•
Maximal dose of 200 mg. Do not exceed frequency of once daily. Monitor for anemia.
Renal replacement therapy
Continuous renal replacement
•
Dose as in eGFR 10-30 mL/min/1.73 m². Maximal dose of 200 mg. Maximal frequency of daily. Monitor for anemia.
Intermittent hemodialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Maximal dose of 200 mg. Maximal frequency of daily. Monitor for anemia.
Peritoneal dialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Maximal dose of 200 mg. Maximal frequency of daily. Monitor for anemia.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: X
•
Avoid use. Evidence of fetal harm in humans. Females of childbearing potential must undergo pregnancy testing immediately before starting ribavirin therapy and periodically while being treated and for 9 months after treatment is discontinued.
•
Due to the reproductive risk, contraception requirements exist for males and females of childbearing potential in whom ribavirin is prescribed.
•
For females of reproductive potential, effective contraception is required during treatment and for 9 months post-therapy. For male patients and their female partners, effective contraception is required during treatment and for 6 months post-therapy.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia, ↓ blood lymphocyte count, ↓ blood neutrophil count, gastrointestinal disorders, hemolytic anemia, abdominal pain, asthenia, diarrhea, dizziness, dry mouth, dyspnea, fatigue, headache, indigestion, insomnia, irritability, loss of appetite, musculoskeletal pain, nausea, skin rash, vomiting, weight loss
Common 1-10%
•
↓ WBC count, ↓ platelet count, cough, exertional dyspnea, memory impairment
Uncommon < 1%
•
Bacterial infections, depression, suicide attempt, thrombotic thrombocytopenic purpura
Unknown frequency
•
Acute liver failure, acute interstitial pneumonia, bipolar disorder, conjunctivitis, drug-induced liver injury, encephalopathy, growth restriction, heart failure, ↑ blood ammonia, ↑ serum TBIL, ↑ serum uric acid, myasthenia gravis, myocardial infarction, nephrolithiasis, occupational disorders, psoriasis, pure red cell aplasia, hearing loss, systemic lupus erythematosus
Interactions
Drug(s)
Check Interactions
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