Drug reference

Ribavirin

Antiviral · Antiviral for Chronic Hepatitis C and Lassa Fever

Also known as REBETRON

AntiviralAntiviral for Chronic Hepatitis C and Lassa Fever

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

5 major

SEVERE in our sources

PREGNANCY

(see Useful

FDA category + note

Top interactionssee all 6 →

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Mechanism

Ribavirin inhibits a wide range of DNA and RNA viruses.

Indications

Chronic hepatitis C (in combination with peginterferon alfa)Chronic hepatitis C (in combination with interferon alfa)Chronic hepatitis C (in combination with sofosbuvir)Chronic hepatitis C (in triple therapy with peginterferon alfa and one protease inhibitor or sofosbuvir)Chronic hepatitis C genotype 1 or 4 with advanced liver disease or other negative prognostic factors (e.g., prior treatment experience) when used in combination with daclatasvir and sofosbuvirChronic hepatitis C genotype 3 in treatment-experienced patients, with or without compensated cirrhosis (in combination with daclatasvir and sofosbuvir)Chronic hepatitis C genotype 4 (in combination with daclatasvir and peginterferon alfa)Chronic hepatitis C genotype 1 with or without compensated cirrhosis (in combination with ombitasvir, paritaprevir, ritonavir, and possibly dasabuvir)Chronic hepatitis C genotype 4 with or without compensated cirrhosis (in combination with ombitasvir, paritaprevir, and ritonavir)Chronic hepatitis C genotypes 1, 2, 3, 4, 5, or 6 in patients with compensated liver disease (in combination with sofosbuvir, with or without peginterferon alfa)Chronic hepatitis C in patients with compensated liver function not previously treated with IFN-α-2b or who have relapsed after IFN-α-2b therapy (in combination with IFN-α-2b)Lassa fever (unlicensed indication)Chronic HCV infection in combination with DAAs (e.g., with sofosbuvir and ledipasvir or velpatasvir in decompensated cirrhosis; with grazoprevir/elbasvir in genotype 1a HCV with preexisting NS5A RASs)Respiratory syncytial virus (aerosolized form)Hemorrhagic fever (intravenous form)Severe influenza (intravenous form)chronic hepatitis C (first line, combined with peginterferon)respiratory syncytial virus bronchiolitis in infants and children (nebulized)severe influenza A/B and measles in immunosuppressed patients (not first line)herpes virus infections (not first line)acute hepatitis (not first line)Severe encephalitis due to California encephalitis (La Crosse) virus (isolated cases reported)Severe adenovirus or rotavirus encephalitis (in rare patients, typically infants or young children)Encephalitis due to LCMV or other arenavirusessevere RSV-induced lower respiratory tract infection (in children, aerosol formula)adenovirus infections (intravenous)hantavirus infections (intravenous)measles virus infections (intravenous)PIV infections (intravenous)influenza virus infections (intravenous)Lassa FeverHemorrhagic Fever with Renal Syndrome (HFRS)Hantavirus Pulmonary Syndrome (HPS) (efficacy not shown in trial)

Dosing

Adult: is given by mouth for the treatment of chronic hepatitis C infection, in double therapy with peginterferon alfa, interferon alfa, or sofosbuvir, or in triple therapy with peginterferon alfa and one protease inhibitor or sofosbuvir. Ribavirin is also effective in Lassa fever [unlicensed indication].…
Pediatric: 400 to 1200 mg daily depending on body weight, administered in two divided doses, for children 5 years or older
Renal adjustment: Reduced for renal impairment (eGFR ≤50 mL/min/1.73 m2)

Pharmacokinetics

Half-life

7–10 days (plasma and intracellular derivatives)

Bioavailability

Approximately 50% (oral); increased by food

Protein binding

Widely distributed into tissues

Metabolism

Hepatic metabolism (deribosylation and hydrolysis to a triazole carboxamide)

Excretion

35 ± 8%

Contraindications

Men and women attempting conception (and for 6 months following treatment cessation)

Side effects

Common

Conjunctival irritation (aerosolized)RashTransient wheezing (aerosolized)Rigors (bolus intravenous infusion)Dose-related reversible hemolytic anemiaFatigueCoughPruritusReversible anemia

Serious