From the Guidelines
Ribavirin is an antiviral medication used to treat various viral infections, primarily hepatitis C and respiratory syncytial virus (RSV), with dosages and administration routes varying depending on the specific infection and patient population, as outlined in recent guidelines 1.
Key Points
- For hepatitis C, ribavirin is typically prescribed in combination with other antiviral drugs like interferon or direct-acting antivirals, with dosages ranging from 800-1200 mg daily divided into two doses for 12-48 weeks, depending on the specific treatment regimen 1.
- For RSV infections, ribavirin is often administered as an aerosol at 6 grams via small particle aerosol generator over 12-18 hours daily for 3-7 days 1.
- Ribavirin works by interfering with viral RNA synthesis and viral protein production, preventing viruses from replicating effectively.
- Common side effects include anemia, fatigue, headache, and irritability.
- It's contraindicated during pregnancy due to potential teratogenic effects, and patients should use effective contraception during treatment and for six months afterward.
- Regular blood tests are necessary during treatment to monitor for anemia and other potential complications.
Administration and Dosage
- The ribavirin dose should be 1000 or 1200 mg/day, based on body weight (<75 kg or ≥75 kg, respectively), split in two administrations 1.
- For patients with severe renal impairment or end-stage renal disease, ribavirin should be used with caution and dose adjustments may be necessary 1.
Special Considerations
- Patients with renal disease, particularly those on hemodialysis, should be treated with caution due to the risk of hemolytic anemia associated with ribavirin accumulation 1.
- Relative contraindications to ribavirin include severe anemia or hemoglobinopathy, pregnancy and breast-feeding, coronary artery disease, renal insufficiency, decompensated liver disease, and known hypersensitivity 1.
From the FDA Drug Label
VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is a brand name for ribavirin, a synthetic nucleoside with antiviral activity. Ribavirin is 1-beta-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide, with the following structural formula:
Ribavirin is a synthetic nucleoside with antiviral activity. It is used for the treatment of severe lower respiratory tract infections due to RSV in hospitalized infants and young children 2. The drug is administered via inhalation solution, and its chemical name is 1-beta-D-ribofuranosyl-1H-1,2,4-triazole-3-carboxamide 2.
From the Research
Definition and Mechanism of Action
- Ribavirin is a broad-spectrum antiviral agent that has been used to treat various viral infections, including respiratory syncytial virus, Lassa fever virus, and hepatitis C virus 3, 4.
- It has multiple mechanisms of action, including direct inhibition of viral RNA-dependent RNA polymerases, inhibition of the host inosine monophosphate dehydrogenase, modulation of the host immune response, and inhibition of viral capping enzymes 5, 6.
- Ribavirin can also act as an RNA virus mutagen, increasing mutations in the RNA virus genome and reducing their infectivity 5, 6.
Clinical Uses
- Ribavirin has been used to treat respiratory tract infections, including those caused by respiratory syncytial virus and influenza 3, 4.
- It has also been used to treat Lassa fever, haemorrhagic fever with renal syndrome, and chronic hepatitis C infection, often in combination with interferon-alpha 3, 4, 5.
- Ribavirin may also be effective against other emerging exotic infections, such as West Nile virus and Nipah virus 3.
Side Effects
- One of the major side effects of ribavirin is a reversible hemolytic anemia, which can be caused by membrane oxidative damage 7.
- Ribavirin can also cause a decrease in erythrocyte adenosine triphosphate content and an increase in hexosemonophosphate shunt, leading to red cell susceptibility to oxidation 7.