Ribavirin

What is Ribavirin

Ribavirin (1-beta-D-ribofuranosyl-1,2,4-triazole-3-carboxamide) is a synthetic guanosine analog with antiviral activity.

It was originally synthesized in the 1970s and has been shown to be active against many DNA and RNA viruses. Oral ribavirin monotherapy is not effective in the treatment of chronic hepatitis C; however, in combination with interferon alfa, peginterferon alfa, or a nucleotide analog NS5B polymerase inhibitor (i.e., sofosbuvir) or NS3/4A protease inhibitor (i.e., simeprevir), it has activity against this disease.

Indications & Dosage

  • adenovirus
  • adenovirus infection
  • Colorado tick fever virus
  • Crimean-Congo hemorrhagic fever virus
  • Crimean-Congo virus hemorrhagic fever (CCVHF)
  • Crimean-Congo virus hemorrhagic fever (CCVHF) prophylaxis
  • cytomegalovirus (CMV)
  • encephalitis
  • Hantaan virus
  • Hantaan virus infection
  • hemorrhagic fever with renal syndrome (HFRS)
  • hepatitis A virus
  • hepatitis C infection
  • hepatitis C virus
  • herpes simplex virus type 1
  • herpes simplex virus type 2
  • human immunodeficiency virus (HIV)
  • influenza A virus
  • influenza B virus
  • Junin virus
  • Lassa fever infection
  • Lassa fever prophylaxis
  • Lassa fever virus
  • measles virus
  • Muerto Canyon virus
  • mumps virus
  • parainfluenza virus
  • reovirus
  • respiratory syncytial virus (RSV)
  • respiratory syncytial virus (RSV) infection
  • rhinovirus
  • Rift Valley fever virus
  • rotavirus
  • severe acute respiratory syndrome (SARS)
  • subacute sclerosing panencephalitis virus
  • variola virus (smallpox)
  • viral hemorrhagic fever (VHF)
  • West Nile virus
  • West Nile virus infection
  • yellow fever virus

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. anemia
  5. angina
  6. anorexia
  7. anxiety
  8. aplastic anemia
  9. apnea
  10. arthralgia
  11. asthenia
  12. back pain
  13. blurred vision
  14. bradycardia
  15. bronchospasm
  16. cardiac arrest
  17. chest pain (unspecified)
  18. chills
  19. cholangitis
  20. clastogenesis
  21. coma
  22. conjunctivitis
  23. constipation
  24. cough
  25. cyanosis
  26. dehydration
  27. depression
  28. diabetes mellitus
  29. diarrhea
  30. dizziness
  31. dysgeusia
  32. dyspepsia
  33. dyspnea
  34. eczema vaccinatum
  35. emotional lability
  36. fatigue
  37. fever
  38. flushing
  39. growth inhibition
  40. hallucinations
  41. headache
  42. hearing loss
  43. hemolytic anemia
  44. hepatic failure
  45. hepatomegaly
  46. hyperthyroidism
  47. hypotension
  48. hypothyroidism
  49. hypoventilation
  50. infection
  51. injection site reaction
  52. insomnia
  53. irritability
  54. lacrimation
  55. leukopenia
  56. lymphopenia
  57. malaise
  58. menstrual irregularity
  59. musculoskeletal pain
  60. myalgia
  61. nausea
  62. neutropenia
  63. ocular inflammation
  64. ocular irritation
  65. pancreatitis
  66. peptic ulcer
  67. peripheral neuropathy
  68. pharyngitis
  69. pneumothorax
  70. pruritus
  71. psychosis
  72. pulmonary edema
  73. pulmonary embolism
  74. pulmonary hypertension
  75. rash
  76. red cell aplasia
  77. respiratory depression
  78. retinal detachment
  79. rhinitis
  80. sinus tachycardia
  81. sinusitis
  82. Stevens-Johnson syndrome
  83. suicidal ideation
  84. teratogenesis
  85. thrombocytopenia
  86. thrombotic thrombocytopenic purpura (TTP)
  87. tinnitus
  88. toxic epidermal necrolysis
  89. vertigo
  90. vomiting
  91. weight loss
  92. xerostomia

Monitoring Parameters

  • CBC with differential
  • echocardiogram
  • hemoglobin/hematocrit
  • LFTs
  • plasma hepatitis C RNA
  • pregnancy testing
  • serum uric acid
  • thyroid function tests (TFTs)

Contraindications

  • anemia
  • angina
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cerebrovascular disease
  • children
  • contact lenses
  • contraception requirements
  • coronary artery disease
  • dialysis
  • geriatric
  • growth inhibition
  • heart failure
  • hemoglobinopathy
  • hemolytic anemia
  • hepatic disease
  • hepatitis
  • hepatitis C and HIV coinfection
  • infants
  • infection
  • infertility
  • influenza
  • male-mediated teratogenicity
  • myocardial infarction
  • neonates
  • ocular exposure
  • organ transplant
  • pancreatitis
  • pregnancy
  • pregnancy testing
  • renal failure
  • renal impairment
  • reproductive risk
  • requires an experienced clinician
  • respiratory depression
  • respiratory insufficiency
  • ribavirin monotherapy
  • sickle cell disease
  • thalassemia
  • thyroid disease
  • viral infection

Interactions

  • Abacavir
  • Abacavir; Dolutegravir; Lamivudine
  • Abacavir; Lamivudine, 3TC
  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Amprenavir
  • Atazanavir
  • Atazanavir; Cobicistat
  • Azathioprine
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Didanosine, ddI
  • Dolutegravir; Lamivudine
  • Dolutegravir; Rilpivirine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Etravirine
  • Fosamprenavir
  • Indinavir
  • Lamivudine, 3TC
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lopinavir; Ritonavir
  • Nelfinavir
  • Nevirapine
  • Non-nucleoside reverse transcriptase inhibitors
  • Ombitasvir; Paritaprevir; Ritonavir
  • Protease inhibitors
  • Rilpivirine
  • Ritonavir
  • Saquinavir
  • Stavudine, d4T
  • Talimogene Laherparepvec
  • Telbivudine
  • Tipranavir
  • Zalcitabine, ddC
  • Zidovudine, ZDV