Ribavirin (Inhalation)

As an antiviral, Ribavirin interferes with RNA metabolism required for viral replication - it is a nucleoside inhibitor.

Overview

Ribavirin for inhalation is only available on prescription and will be given by trained health professionals while a child is in hospital for treatment of RSV infection. In order to clear the infection totally, Ribavirin must be given for the full time of treatment, even if the patient starts to feel better. It must be administered on a regular schedule to ensure that there is a constant amount of the drug in the lungs. For viral hemorrhagic fever, Ribavirin is only used for Hantavirus infection, Lassa Fever and Congo hemorrhagic fever, not Marburg or Ebola. For treatment of hepatitis C, Ribavirin capsules or tablets are used in conjunction with other drugs.

Ribavirin helps to alleviate the symptoms of RSV infection which can include a cough, sneezing, mild to moderate fever, a runny nose, appetite reduction, a headache and a sore throat. RSV can be life-threatening to young children and infants affected may experience symptoms such as trouble nursing, a lack of appetite and even rapid breathing/wheezing.

For viral hemorrhagic fever, Ribavirin can be given orally to help alleviate symptoms such as fatigue, dizziness, weakness, fever and muscle aches and pains. More severe symptoms such as bleeding under the skin or from bodily orifices can also be alleviated, although research has shown that the drug is most effective when given in the early stages of infection.

For hepatitis C, Ribavirin is usually given in conjunction with other medication.

Conditions Treated

  • Respiratory syncytial virus (RSV) infection
  • Hepatitis C
  • Viral hemorrhagic fever

Type of Medicine

  • Antiviral

Side Effects

Some of the side effects reported by patients taking Ribavirin include blurred vision, confusion and fatigue, as well as dark urine and coughing which produces pink, frothy sputum along with chest pain. Back, stomach and leg pain along with general body swelling have also been reported. Some patients have reported a loss of appetite, nausea or vomiting and general lack of energy. Allergic reactions have been reported as well as liver problems and red blood cell breakdown.

Patients taking Ribavirin should be wary of experiencing noisy breathing or wheezing, or a fast, slow or irregular heartbeat. If the patient experiences any of these aforementioned conditions, they should seek urgent medical attention.

While most patients taking Ribavirin only experience minimal side effects, if side effects persist over time or worsen, the patient should follow up with their doctor without delay. The drug is generally given because the benefit is greater than the risk of side effects.

Other less serious side effects worth mentioning include eye discharge or tearing, itching, burning or red eyes, and redness and swelling of the eyelid or inner eyelid lining.

Taking Ribavirin has been reported to lead to excessive dryness of the mouth and throat, which could lead to problems with your teeth and gums. Be sure to drink plenty of fluids. A dry mouth can be treated by chewing sugar-free gum, sucking on sugar-free hard candy or ice chips or drinking plenty of cold water.

Dosage

The manufacturers of Ribavirin have provided general dosage instructions, but as the drug is generally administered in hospital by a nurse or trained health professional for treatment of RSV infection, the dose given may be altered by the patient's doctor.

For treating Bronchiolitis in children aged 1-23 months, the recommended dosage is 20mg/mL of solution which is inhaled via a small particle aerosol generator. This dosage must be given for 12-18 hours for at least three days and a maximum of seven days.

For treatment of viral hemorrhagic fever, the following are the recommended dosages:

For treatment of suspected or confirmed cases of VHF in adults an oral regimen is recommended of 2g orally followed by 4g/day in four divided doses for four days followed by 2g/day for six days.

In case of suspected or confirmed exposure to the pathogen, a dosage of 2g/day orally in four divided doses is recommended.

Ribavirin capsules should be swallowed whole - do not split, chew or crush them. This medication should be taken exactly as prescribed and it is important not to take more or less of it than your doctor has prescribed. You can ask your doctor or pharmacist to explain any part of your prescription label that you do not understand. If you experience side effects of this medication or if your condition does not improve, your doctor may decrease your dose or tell you to stop taking Ribavirin altogether. It is important that you do not decrease your dose or stop taking this medication unless your doctor tells you to.

Interactions

Drugs can interact with other drugs in the body, causing side effects or changing the effects each medication has on the body. This could lead to a dangerous reaction for the patient or could cause one drug to be ineffective in treating a condition. It is important to be aware of any other medication being taken, including the frequency and dosage. Below is a list of the drugs known to have interacted with Ribavirin. Using this medicine with the following medicines is not recommended and the patient should notify their doctor before taking their first dose of Ribavirin as interactions have been reported:

  • Didanosine
  • Bexarotene
  • Azathioprine
  • Imuran (Azathioprine)
  • Azasan (Azathioprine)
  • Mercaptopurine
  • Purinethol (Mercaptopurine)
  • Purixan (Mercaptopurine)
  • Targretin (Bexarotene)
  • Videx (didanosine)
  • Videx EC (didanosine)

Ribavirin should not be used with zidovudine due to an increased risk of anemia. Use of the drug with didanosine can increase the risk of mitochondrial toxicity.

Warnings

Patients should always advise their doctor of any allergies as well as discussing their medical history and any current health problems. You should tell your doctor and pharmacist if you are allergic to Ribavirin or any of its ingredients. Patients taking Ribavirin should tell their doctor if they have any of the following medical problems:

  • Heart disease
  • Anemia
  • Lung disease – this may make side effects worse
  • Kidney disease
  • Liver failure
  • Autoimmune hepatitis

Patients should tell their doctor and pharmacist about any other prescription and non-prescription medication, nutritional supplements, herbal products and vitamins they are taking.

Care should be taken to maintain standard supportive respiratory and fluid management therapy. Ribavirin should never be given to pregnant women as taking it can result in birth defects for the baby. It is recommended that birth control be used for 7 months after taking Ribavirin. Women must not breastfeed while taking Ribavirin.

Patients should also avoid drinking alcohol while taking Ribavirin. Taking this drug can make you feel dizzy, drowsy or confused. You should avoid operating heavy machinery or driving a car until you know how this medicine affects you. In fact, patients should not engage in any activity requiring clear vision or an alert mind until they feel certain they can do so safely.

Storage

Ribavirin should be kept in the container it came in and this should be kept tightly closed at all times and well out of reach of children. Capsules and tablets should not be stored in the bathroom as they need to be stored at room temperature. Care should be taken to keep them away from excess moisture and heat. Oral solution should be stored at room temperature or in the fridge.

It is important to dispose of unused medication properly to ensure that children and pets cannot consume them. Ribavirin should not be flushed down the toilet. The best way to dispose of any unneeded medication is to use a medicine take-back program. Details of local schemes available in your area can be obtained from your community recycling department or pharmacist. If you cannot access a medicine take-back program then you should visit the FDA’s Safe Disposal of Medicine website for further information on how to safely dispose of your unwanted medicine.

It is important that all medicine is kept out of sight and reach of children at all times. Many containers are not child resistant and can be easily opened.

Summary

Ribavirin is a beneficial antiviral but it can pose a risk if patients fail to communicate properly with their doctor or pharmacist. As a treatment for RSV infection, viral hemorrhagic fever and hepatitis C, Ribavirin acts as an antiviral and is in a class of medications known as nucleoside analogues. It works by interfering with RNA metabolism needed for viral replication and stops viral RNA synthesis.

As Ribavirin can produce side effects such as dizziness and drowsiness, the use of this drug can impair the patient's ability to drive and operate machinery, so proper precautions must be taken. It is vital the patient inform their doctor of their own and family medical history as there are a number of medical conditions that could be worsened by taking the drug as well as a number of known drug interactions.

Taken correctly, Ribavirin can successfully treat RSV infection, hepatitis C and viral hemorrhagic fever, although research has shown that for VHF the drug is most effective when taken in the early stages.

 

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Last Reviewed:
January 30, 2018
Last Updated:
January 27, 2018
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