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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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Copegus, Rebetol, Ribasphere, Virazole

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.


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


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


• 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


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.


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


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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


A synthetic antiviral ribonucleoside that inhibits DNA and RNA replication.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Rebetol® Virology An oral ribavirin, a synthetic nucleoside analogue and broad-spectrum antiviral. See Rebetron.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


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.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


A drug that is used to combat viral infections.
Mentioned in: Hemorrhagic Fevers
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
References in periodicals archive ?
The study aims to further improve treatment outcomes by examining whether genotype 2 and 3 patients who do not have a rapid virological response at 4 weeks should have treatment with Pegasys and Copegus extended to 48 weeks.(6) This global study will enrol approximately 400 patients at 90 centres in seven countries.
Copegus can increase the toxicity of certain drugs used to treat HIV.
The cost-effectiveness of peginterferon alfa-2a (40KD) (Pegasys) plus ribavirin (Copegus) versus interferon alfa-2b plus ribavirin for chronic hepatitis C (CHC) [abstract].
Albuterol * Airet, Proventil, Ventolin, Volmax Ipratropium * Apo-Ipravent, Atrovent, Kendral-Ipratropium Racemic epinephrine * micoNephrine,Vaponefrin Ribavirin * Copegus, Rebetol, Virazole
The patients, who had normal ALT" levels on at least three occasions at 6-18 months alter a normal baseline test, were assigned to placebo or to 2.4 or 48 weeks of treatment with peginterferon alfa-2a (Pegasys 180 [micro]g weekly) or ribavirin (Copegus 800 mg/day).
Hoffmann-La Roche for its own version of ribavirin, Copegus, globally.
The programme is said to be tailored for those patients taking Janssen's hep C pill Incivo (telaprevir) with Roche's injectable interferon treatments Pegasys and Copegus.
In addition, the partnership will initially focus on seven medications dispensed through CVS Caremark's specialty pharmacy business, including Pegasys and Copegus, for the treatment of hepatitis C, as well as the oncology drugs Gleevec, Tasigna, Sprycel, Tarceva and Tykerb.
The median ALT activity declined up to 10 U/L in treated patients and remained low in sustained responders in the trial, which was funded by Roche, the marketer of peginterferon alfa-2a (Pegasys) and ribavirin (Copegus).
Recommended Dosage: 180 [micro]g of Pegasys administered subcutaneously once a week, and (depending on HCV genotype) 800-1,200 mg of Copegus by mouth daily, for 24 or 48 weeks.
Copegus has not been directly compared with Schering-Plough's combination of Peg-Intron (pegintefferon alfa-2b) and Rebetol, approved in 2001 to treat HCV in interferon-a-naive adults with compensated liver disease.