ribavirin

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ribavirin

 [ri″bah-vi´rin]
a nucleoside analogue that acts as a broad-spectrum antiviral; used in treatment of severe viral pneumonia caused by respiratory syncytial virus, particularly in high-risk infants with underlying conditions such as cardiopulmonary disease; administered by oral inhalation. It is also used in conjunction with interferon alfa-2b in the treatment of chronic hepatitis C, administered orally.

ribavirin

Pharmacologic class: Synthetic nucleoside analog

Therapeutic class: Antiviral

Pregnancy risk category X

FDA Box Warning

• Ribavirin monotherapy isn't effective in treating chronic hepatitis C infection and shouldn't be used alone for this indication.

• Drug's main clinical toxicity is hemolytic anemia, which may worsen cardiac disease and lead to fatal and nonfatal myocardial infarctions. Don't administer to patients with history of significant or unstable cardiac disease.

• Drug is contraindicated in pregnant women and their male partners. Caution female patients and female partners of male patients receiving ribavirin to use extreme care to avoid pregnancy during therapy and for 6 months afterward.

Action

Unknown. Thought to inhibit RNA and DNA synthesis by depleting nucleotides and blocking replication and maturation of viral cells.

Availability

Capsules: 200 mg

Powder to be reconstituted for inhalation (Virazole): 6 g in 100-ml glass vial

Tablets: 200 mg

Indications and dosages

Chronic hepatitis C infection

Note: Dosage calculated solely on basis of patient's weight.

Adults and children weighing 75 kg (165 lb) or more: 600 mg P.O. q morning and evening, given with interferon alfa-2b

Adults weighing less than 75 kg (165 lb) and children weighing more than 61 kg (134 lb): 400 mg P.O. q morning and 600 mg P.O. q evening, given with interferon alfa-2b

Children weighing 50 to 61 kg (110 to 134 lb): 400 mg P.O. b.i.d., given with interferon alfa-2b

Children weighing 37 to 49 kg (81 to 108 lb): 200 mg P.O. every morning and 400 mg P.O. every evening, given with interferon alfa-2b

Children weighing 25 to 36 kg (55 to 79 lb): 200 mg P.O. b.i.d., given with interferon alfa-2b

Hospitalized children with severe lower respiratory infection caused by respiratory syncytial virus

Infants and young children: 20 mg/ml by inhalation as a starting solution in Viratek Small Particle Aerosol Generator (SPAG-2) for 12 to 18 hours daily for 3 to 7 days. Give by oxygen hood from SPAG-2 unit to infant who isn't mechanically ventilated.

Dosage adjustment

• Cardiovascular disease
• Chronic obstructive pulmonary disease (COPD)
• Renal impairment
• Hemoglobin below 10 g/dl

Off-label uses

• Influenza A or B
• Pneumonia caused by adenovirus
• Severe lower respiratory tract infection in adults
• Genital herpes
• Hemorrhagic fever

Contraindications

• Hypersensitivity to drug or its components
• Autoimmune hepatitis (oral combination therapy)
• Creatinine clearance below 50 ml/minute
• Significant or unstable cardiac disease
• Hemoglobinopathy (such as sickle cell anemia, thalassemia major)
• Females of childbearing age (inhalation form)
• Pregnancy, pregnant partner of male patient (oral drug)
• Breastfeeding

Precautions

Use cautiously in:
• decompensated hepatic disease, coinfection with hepatitis B or human immunodeficiency virus, COPD
• liver or other transplant recipients
• patients who don't respond to interferon.

Administration

Be aware that oral form must be given with interferon alfa-2b injection.
• Give aerosol by Viratek SPAG-2 only. Don't use other aerosol-generating equipment.
• Dilute powder in sterile water for injection. Don't use solutions with antimicrobial ingredients.
• Know that drug may be given by oral or nasal inhalation.
• Discard solution in SPAG-2 every 24 hours before adding new solution.

Avoid prolonged contact with aerosol, which can cause headache or eye irritation.

Adverse reactions

CNS: fatigue, headache, nervousness, depression, suicidal ideation

CV: hypotension, bradycardia (with inhalation form), cardiac arrest

EENT: conjunctivitis, eyelid erythema or rash

GI: nausea, dyspepsia, anorexia, pancreatitis

Hematologic: reticulocytosis, hemolytic anemia

Respiratory: bacterial pneumonia, pneumothorax, bronchospasm, pulmonary edema, apnea, worsening respiratory status (with inhalation form)

Skin: rash, pruritus

Interactions

Drug-drug.Abacavir, didanosine, lamivudine, stavudine, zalcitabine, zidovudine: potentially fatal lactic acidosis

Stavudine, zidovudine: decreased antiviral activity

Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin: increased levels

Hemoglobin: decreased level

Reticulocytes: increased count

Patient monitoring

Carefully monitor patient's respiratory status. Check ventilator often to ensure that drug precipitates don't impede function.

Monitor ECG and vital signs. Watch for hypotension, bradycardia, and other signs of impending cardiac arrest or worsening respiratory condition.

Assess neurologic status. Stay alert for depression and suicidal ideation.
• Monitor liver function tests and CBC with white cell differential.

Patient teaching

• Explain drug delivery system and precautions carefully to patient or to parents of children receiving inhalation form.

Tell patient or parents that drug may cause depression or suicidal thoughts, which should be reported immediately.

Instruct patient or parents to immediately report new or worsening respiratory symptoms.
• Counsel sexually active patients (both males and females) about appropriate birth control. Tell them to use extreme care to avoid pregnancy. Stress importance of using two forms of effective contraception during and for 6 months after treatment (when using oral ribavirin).
• Advise female patient not to breastfeed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

ribavirin

/ri·ba·vi·rin/ (ri″bah-vi´rin) a broad-spectrum antiviral used in the treatment of severe viral pneumonia caused by respiratory syncytial virus, particularly in high-risk infants; also used in conjunction with interferon alfa-2b in the treatment of chronic hepatitis C.

ribavirin

(rī′bə-vī′rĭn)
n.
A synthetic antiviral ribonucleoside that inhibits DNA and RNA replication.

ribavirin

[rī′bəvir′in]
an aerosol antiviral drug.
indications It is prescribed for the treatment of respiratory syncytial virus infections for the lower respiratory tract in infants and small children.
contraindications It is not recommended for infants requiring assisted ventilation.
adverse effects Reported side effects include bacterial pneumonia, pneumothorax, apnea, hypotension, and cardiac arrest, conditions that may also have resulted from the patient's underlying disease; deteriorated respiratory function; rash; conjunctivitis; and reticulocytosis.

ribavirin

Rebetol® Virology An oral ribavirin, a synthetic nucleoside analogue and broad-spectrum antiviral. See Rebetron.

ribavirin

An antiviral drug effective against a range of both DNA and RNA viruses including the herpes group and those causing hepatitis, and several strains of influenza.

Ribavirin

A drug that is used to combat viral infections.
Mentioned in: Hemorrhagic Fevers

ribavirin (rī´bəvir´in),

n an antiviral agent that acts against many ribonucleic acid and deoxyribonucleic acid viruses by inhibiting protein synthesis and replication. Used in the United States only for aerosol therapy for infants to treat acute lower respiratory infections resulting from respiratory syncitial virus.

ribavirin

a broad-spectrum, non-interferon inducing, antiviral nucleoside.
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Approval in HIV-coinfected patients was based on the APRICOT study, a trial of 868 coinfected patients, which found the SVR rate after 48 weeks was 40% in those treated with Pegasys-Copegus, versus 20% in those on Pegasys alone and 12% in those on conventional interferon and Copegus.
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The results of another study presented at AASLD show that intensifying treatment with a higher fixed dose of PEGASYSalong with a higher dose of COPEGUS may yield higher response rates in patients with several characteristics that make hepatitis C more difficult-to-treat.
Eighty-five percent (85%) of patients receiving R7128 1500mg twice-daily (BID) with Pegasys plus Copegus for 4 weeks achieved undetectable HCV RNA levels with safety and tolerability comparable to placebo with Pegasys plus Copegus.
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Results from the phase II study show that levels of the hepatitis C virus (HCV) were undetectable in 84% of patients infected with genotype 1 virus (the most difficult to treat) when patients were treated for 4 weeks with this triple combination, followed by 44 weeks of Pegasys (peginterferon alfa-2a) and Copegus (ribavirin).
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This was higher than in patients treated with Pegasys and Copegus alone for the entire 48-week treatment period (65%).