II. Indications
-
Hepatitis C
- See Hepatitis C Treatment with Interferon and Ribavirin
- Largely replaced in the U.S. by other Hepatitis C Antiviral Regimens, with the exception of a few Genotypes
-
Respiratory Syncytial Virus (RSV)
- Aerosolized Ribavirin (Virazole) used in high risk infants
- Acute Hemorrhagic Fever (Intravenous or Oral Ribavirin, not FDA approved)
- Arenavirus (Lassa Fever, AHF, BHF, VHF)
- Bunyaviridae (e.g. Hantavirus, Rift Valley Fever)
- Severe Influenza infection (not FDA approved)
- Intravenous or aerosolized
III. Contraindications
- Pregnancy
- Hemoglobinopathy
- Unstable cardiovascular disease
- Autoimmune Hepatitis
-
Cirrhosis with Decompensation
- Child-Pugh Score >6 if HCV Infection only
- Child-Pugh Score >5 if HCV Infection and HIV Infection
IV. Pharmacokinetics
- Half-Life after single dose: >40 hours
- Half life after multiple doses: ~300 hours
- Extremely long half life >12 days
- Elimination over 5 half-lives is 60 days
V. Mechanism
- Synthetic antiviral Nucleoside analog of guanosine
- Ribavirin incorporates into viral RNA, substituting guanosine, and resulting in mutations and blocking viral replication
- Activity against both RNA viruses (e.g. Hepatitis CVirus) as well as DNA viruses
VI. Adverse Effects
-
Hemolytic Anemia
- Increased risk in age >50 years, Renal Insufficiency
-
Teratogenic (Pregnancy Class X)
- Women need to avoid conception for 6 months (2 forms of Contraception)
- Men should use barrier protection for 6 months
VII. Dosing: Chronic Hepatitis C
- Used in combination with Interferon
- Adult weight <75 kg
- Dose 400 mg orally each morning, and 600 mg orally each evening
- Adult weight >75 kg
- Dose 600 mg orally twice daily
-
Hemolytic Anemia
- Dose 300 mg orally twice daily
-
Renal Dosing
- eGFR 30 to 50 ml/min
- Alternate 200 mg with 400 mg every other day
- eGFR <30 ml/min
- Dose 200 mg orally daily
- eGFR 30 to 50 ml/min
VIII. Dosing: Respiratory Syncytial Virus (RSV)
- Aerosolized Ribavirin (Virazole) 12 to 18 hours per day for 3 to 7 days
- Risk of exposure to Caregivers (avoid exposing pregnant women)
IX. Safety
- Pregnancy Category X
- Avoid in Lactation
X. Monitoring
-
Complete Blood Count (CBC)
- Obtain at baseline, 2 weeks, 4 weeks and then periodically
- Other testing as indicated
- Baseline Pregnancy Test and then periodically afterward for up to 6 months after last dose
- Baseline Electrocardiogram if preexisting cardiac disorder
XI. Drug Interactions
-
Warfarin
- May decrease INR
- Increased INR monitoring for 4 weeks after starting and stopping Ribavirin
-
Nucleoside Reverse Transcriptase Inhibitor (nRTI)
- Lactic Acidosis risk
- Avoid Zidovudine and Didanosine
-
Azathioprine
- Neutropenia risk
- Monitor CBC weekly for 1 month, every other week for 2 months and then monthly
XII. Resources
- Ribavirin Tablet (DailyMed)
- Ribavirin Powder for Aerosolization Solution
XIII. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (1999) Med Lett Drugs Ther 41(1054):53-4 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A synthetic nucleoside analog of ribofuranose with activity against hepatitis C virus and other RNA viruses. Ribavirin is incorporated into viral RNA, thereby inhibiting viral RNA synthesis, inducing viral genome mutations, and inhibiting normal viral replication. |
Definition (NCI_NCI-GLOSS) | A drug used to treat respiratory syncytial virus (RSV) infection in the lungs. |
Definition (MSH) | A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. |
Definition (CSP) | 1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamid e; antiretroviral agent with potential efficacy against AIDS. |
Definition (PDQ) | A synthetic nucleoside analogue of ribofuranosyl with antiviral activity. Ribavirin incorporates into viral nucleic acid, inhibits viral ribonucleic acid (RNA) synthesis, induces viral genome mutations, and inhibits normal viral replication. Ribavirin shows activity against a variety of RNA viruses, especially hepatitis C virus. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40325&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40325&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C807" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Nucleic Acid, Nucleoside, or Nucleotide (T114) |
MSH | D012254 |
SnomedCT | 346695009, 35063004, 387188005 |
LNC | LP35809-0, MTHU018696 |
English | Ribovirin, Tribavirin, 1H-1,2,4-Triazole-3-carboxamide, 1-beta-D-ribofuranosyl-, 1-Beta-D-ribofuranosyl-1,2,4-triazolo-3-carboxamide, 1-Beta-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide, ribavirin, Ribavirin, RIBAVIRIN, RIBA, ribavirin (medication), Ribavirin [Chemical/Ingredient], ribovirin, Tribavirin (product), 1-.beta.-D-Ribofuranosyl-1H-1,2, 4-triazole-3-carboxamide, RTCA, Ribavirin (product), Ribavirin (substance) |
Swedish | Ribavirin |
Czech | ribavirin |
Finnish | Ribaviriini |
Russian | RIBOVARIN, RIBOVIRIN, RIBAVIRIN, TRIBAVIRIN, VIRAZOL, ВИРАЗОЛ, РИБАВИРИН, РИБОВАРИН, ТРИБАВИРИН, РИБОВИРИН |
Japanese | リボビリン, リバビリン, トリバビリン |
Italian | Tribavirina, Ribovirina, Ribavirina |
Polish | Rybawiryna |
Croatian | RIBAVIRIN |
Spanish | ribavirina (producto), ribavirina (sustancia), ribavirina, tribavirina, Ribavirina, Ribovirina, Tribavirina |
French | Ribavirine |
German | Ribavirin, Ribovirin, Tribavirin |
Portuguese | Ribavirina, Ribovirina, Tribavirina |
Ontology: Rebetol (C1170576)
Concepts | Pharmacologic Substance (T121) , Nucleic Acid, Nucleoside, or Nucleotide (T114) |
MSH | D012254 |
English | Ribavirin Merck Brand, Merck Brand of Ribavirin, Pfizer Brand of Ribavirin, rebetol, Rebetol, Essex Brand of Ribavirin |
Ontology: Virazole (C1622085)
Concepts | Pharmacologic Substance (T121) , Nucleic Acid, Nucleoside, or Nucleotide (T114) |
MSH | D012254 |
English | virazole, Virazole, ICN Brand of Ribavirin, Vilona |