Ribavirin (Oral)

Ribavirin is used in the treatment of hepatitis C to fight the viral infection, along with other medications.

Overview

Ribavirin is an antiviral medication used in combination with other treatments to fight an infection of hepatitis C.

Hepatitis C is a virus that targets the liver in the infected individual. If this condition is not treated, it will cause serious and life-threatening liver damage over the course of a few years. In most cases, those suffering from hepatitis C will experience no symptoms until the liver has been significantly damaged.

Ribavirin works by interfering with the RNA of viruses and, in doing so, is able to fight an infection of hepatitis C. The treatment is usually administered alongside an injection of another medication. Commonly, ribavirin is used in conjunction with one of the following:

  • Interferon alfa-2b
  • Peginterferon alfa-2a
  • Peginterferon alfa-2b

This combination treatment is used in the treatment of hepatitis C in children aged three years and older and in adults.

Ribavirin is available under a range of brand names that may be prescribed, including:

  • RibaTab
  • Ribasphere Ribapak
  • Ribasphere
  • RibaPak
  • Rebetol
  • Copegus

These treatments come in the form of tablets, capsules or solutions, and are available only with a prescription from a doctor.

Conditions treated

  • Hepatitis C

Type of medicine

  • Antiviral

Side effects

In addition to the required effects of fighting a viral infection of hepatitis C, treatment with ribavirin can also cause unwanted side effects in the body. While not all side effects listed herein may occur, in some cases you may need to seek medical attention when they do occur.

You should consult your doctor immediately if you experience any of these side effects from the use of ribavirin:

Occurring more commonly:

  • Abdominal or stomach pains
  • Anxiousness
  • Black stools with a tar-like appearance
  • Body aching
  • Body pain
  • Chest pains
  • Congestion
  • Coughing
  • Crying
  • Depersonalization
  • Development of sores or ulcers
  • Diarrhea
  • Difficult breathing
  • Discouragement or lack of usual confidence
  • Dryness of the mouth
  • Dryness of the throat
  • Dysphoria
  • Euphoria
  • Feeling cold when it is warm
  • Feeling unusually sad or empty
  • Feverishness or chills
  • General feeling of discomfort
  • General feeling of illness
  • Headaches
  • Hoarseness
  • Hyperventilation
  • Inability to sleep
  • Irregularity of heartbeats
  • Irritability
  • Joint pains
  • Labored breathing
  • Lack of hunger
  • Loss of interest
  • Loss of pleasure
  • Lower back pain
  • Mental depression
  • Muscle aches
  • Muscle pains
  • Nausea
  • Nervousness
  • Pain or difficulty experienced during urination
  • Paleness of the skin
  • Paranoia
  • Poor concentration
  • Quickness emotional overreaction
  • Rapid changing of moods
  • Restlessness
  • Runny nose
  • Shaking or trembling
  • Shivering when warm
  • Shortness of breath
  • Side pain
  • Sleeplessness
  • Soreness of the throat
  • Sweating when cool
  • Swelling of glands in the neck
  • Tightness in the chest
  • Trouble in concentrating
  • Trouble with sleeping
  • Trouble with swallowing
  • Troubled breathing when exerting oneself
  • Unusual bleeding
  • Unusual bruising
  • Unusual tiredness
  • Unusual weakness
  • Voice changes or loss of voice
  • Vomiting
  • Wheezing
  • White spots appearing on the lips or mouth

Occurring less commonly:

  • Bleeding from the gums
  • Blood appearing in the urine or stools
  • Constipation
  • Decreased speed of heartbeat
  • Depressed feeling or mood
  • Drying of skin and hair
  • Feeling cold when it is warm
  • Hair thinning or loss
  • Huskiness of voice
  • Muscle cramping
  • Muscle stiffness
  • Red spots appearing on the skin
  • Swelling or bloating of abdomen or stomach
  • Weight gain

Frequency of occurrence unknown:

  • Blistering of the skin
  • Flaking of the skin
  • Peeling of the skin

Other side effects may also occur that would not normally require the patient to seek medical attention. These conditions often abate over time and are not normal symptoms of wider developing problems. If these symptoms do, however, become bothersome, then you could contact your healthcare professional for advice on how to alleviate the side effects.

The following side effects would not normally require you to seek medical attention:

Occurring more commonly:

  • Acid stomach
  • Becoming more forgetful
  • Belching or burping
  • Blocked nose
  • Blurring of vision
  • Bone pains
  • Changed taste of unpleasant aftertaste
  • Cracking or scaly skin
  • Crusting of the skin
  • Difficulty in moving
  • Dizziness
  • Feeling that oneself or surroundings are constantly moving
  • Hair loss or hair thinning
  • Heartburn
  • Indigestion
  • Irritation of the skin
  • Itching
  • Lack of strength
  • Lightheadedness
  • Loss of strength
  • Menstrual changes
  • Rash
  • Reddening of the skin
  • Sensation of constant spinning
  • Sneezing
  • Sour stomach
  • Stomach discomfort
  • Swelling
  • Swollen joints
  • Tenderness around the eye and cheekbone
  • Weight loss

Occurring less commonly:

  • Back pains
  • Burning or dryness of the eyes
  • Encrusted or oozing skin rash
  • Excessive tearing
  • Eye discharge
  • Feeling of warmth when it is cool
  • Itching of the eyes
  • Reddening of the skin on the upper body and face
  • Reddening or swelling around the eye or eyelid

Frequency of incidence unknown:

  • Changed hearing
  • Loss of hearing

Other side effects from the use of this medication can also occur that may not have been listed herein. If you believe you are experiencing other side effects, then you should contact your doctor. If you believe that your health is at immediate risk, however, then you should always contact the emergency services.

Dosage

Ribavirin should be given on a regular schedule to keep the level of medication in your body constant. Ensure that you follow the dosing schedule provided to maintain a constant level of the drug in your system.

This treatment should be used for the full course, even if you believe that you are better after a few days. This will ensure that the virus is completely destroyed and will prevent it from returning.

This medication should always be taken with food. If you are taking the capsules, then these should be swallowed whole, and should not be broken or crushed. Do not chew capsules. If you are taking the oral liquid, you should measure this with a marked measuring device. Household spoons may not be accurate measurements of volume.

This medication will be provided with a medication guide. You should ensure that you read the information in this medication guide carefully and you should consult your doctor before use if you do not understand any of the information within.

The dose of this medication will differ for each patient. You should follow the instructions given to you by the doctor. The following dosing information is a guideline only and you should not use it to make changes to the dose or frequency of use that has been prescribed to you:

For the use in the treatment of an infection of hepatitis C when used in conjunction with interferon alfa-2b:

When taking capsules:

  • Adults - The prescribing doctor calculates the dose for each patient individually and this will be based on body weight. The usual dose is 1000-1200 mg daily taken as two to three doses early in the day and three doses before bed.
  • Children three years old or more - Dose and use must be decided by the doctor and are calculated based on body weight. Usual dose is 15 mg/kg daily taken as one dose early in the day and one dose before bed.
  • Children under the age of three - The use of this treatment and the dose given must be decided individually by the doctor.

When taking solution:

  • Adults - The dose is based on body weight and will be decided by the doctor. The oral liquid form is not normally given to adults.
  • Children three years old or more - The dose is to be decided by the doctor in relation to the patient's body weight. The usual dose is 15 mg/kg of body weight, daily taken as one dose taken early and one dose taken late in the day.
  • Children under the age of three - The doctor will decide on the appropriate use and dose of this treatment.

For the use in the treatment of an infection of hepatitis C when used in conjunction with peginterferon alfa-2b:

When taking capsules:

  • Adults - The dose is to be determined by the doctor, based on how heavy the patient is. The usual dose is 800-1400 mg daily taken as two to three doses early in the day and two to four doses at night.
  • Children three years old or more - The dose is to be decided by the doctor, depending on the weight of the patient. The usual dose is 15 mg/kg of body weight daily taken as one dose early in the day and one dose before bed.
  • Children below the age of 3 - The use of this treatment and the dose given is to be decided by the doctor.

When taking solution:

  • Adults - The dose will be calculated by the doctor based on the weight of the patient. The oral liquid form is not normally given to adults.
  • Children three years old or more - Dose will be dependant on the weight of the child. Usual dose is 15 mg/kg of body weight daily taken as one dose early in the day and one dose before bed.
  • Children aged below three - The use of this treatment will be calculated in each case by the doctor.

For the use in the treatment of an infection of hepatitis C when used in conjunction with peginterferon alfa-2a:

When taking tablets:

  • Adults - The dose is to be decided by the doctor, based on the how heavy the patient is. The usual dose is 800-1200 mg daily taken as one dose early in the day and one dose in the evening.
  • Children five years old or more - The dose is to be set by the doctor in relation to the body weight of the patient. Usual dose is 400-1200 mg daily taken as one dose in the morning and one dose before going to bed.
  • Children aged below five - The use of this treatment and the dose given should be decided by the doctor.

For the use in the treatment of an infection of hepatitis C in patients also infected with HIV, when used in conjunction with peginterferon alfa-2a:

When taking tablets:

  • Adults - 800mg daily
  • Children - The use of this treatment and the dose given is for the doctor to decide.

If a dose of this treatment is missed then you should take it as soon as possible. If you are close to your next dose being due, however, then you should skip the dose and go back to following your usual dosing schedule. Do not ever take a double dose of this treatment to catch up.

Interactions

Ribavirin can interact with a wide range of medications. In some cases, it should not be used at all with certain medications, and, in other cases, your doctor may wish to amend the dose or frequency of use of one or other medications to prevent them from interacting severely with one another in your body.

It is very important that you inform you doctor about any and all medications that you are currently using or may use in the future before you begin use of this treatment. This includes the use of over the counter medications, herbal remedies and other prescribed medications that you use.

It is especially important that you inform your doctor if you are taking any of the following treatments before you begin use of ribavirin, as the use of ribavirin in conjunction with the following medication is not recommended. If you are taking this medication your doctor may choose not to prescribe ribavirin or may need to change your other prescription:

  • Didanosine

The use of the following medications in conjunction with ribavirin is not normally recommended. In some cases, however, both medications may be required and your doctor can prescribe both. To limit the side effects and limit the interaction between these medications your doctor may change the dose or frequency of one or both treatments:

  • Zidovudine
  • Zalcitabine
  • Stavudine
  • Mercaptopurine
  • Azathioprine
  • Abacavir

The use of the following medication in conjunction with ribavirin can increase the side effects that the patient may experience from the use of one or other of the treatments. The use of both may still be the best treatment for you, but your doctor may wish to make adjustments to the dose administered or to the frequency with which you use the treatments:

  • Interferon Alfa-2b

Interactions that have not been listed herein can also occur from the use of ribavirin in conjunction with other medications. To avoid any unwanted side effects it is very important that you tell your doctor of all other treatments you are taking.

Medical problems from which the patient suffers can also have an impact on the use of any given medication. This is because medical conditions can be affected by treatments for other conditions and can also impact the treatments penetration through the body. It is important that you tell your doctor of all medical conditions from which you suffer or from which you have suffered in the past. This is especially important if you suffer from any of the following:

  • Autoimmune hepatitis
  • History of heart disease
  • Severe liver disease
  • Sickle cell anemia
  • Thalassemia major

The following conditions may be worsened by use of ribavirin:

  • Blood problems
  • Bone marrow problems
  • Breathing problems
  • Lung disease
  • Colitis
  • Depression
  • Diabetes
  • History of drug abuse
  • Eye problems
  • Vision problems
  • History of heart attack
  • Heart disease
  • Blood vessel disease
  • Hypertension
  • Pancreatitis
  • Saracoidosis
  • Thyroid disease
  • Weakened immune system

Risk of the development of severe anemia is increased in patients with the following conditions:

  • Blood problems
  • Stomach problems

Patients suffering from the following should not use Copegus treatment. You may be prescribed inhaled ribavirin instead:

  • Infection
  • Influenza
  • Parainfluenza

Patients with the following conditions may have higher levels of ribavirin in their blood during treatment, which can cause serious side effects:

  • Kidney disease

Ribavirin should not be used in conjunction with peginerferon alfa-2a in patients suffering from the following:

  • Decompensated liver disease
  • Previous organ transplant of liver or kidney

Other medical conditions that have not been listed here may also impact the use of this treatment. You should inform your doctor of your full medical history before receiving this treatment.

Warnings

Before beginning use of any medications you should consider the benefits of use in relation to the risks of using the treatment. This should be considered with your doctor and should take into account your personal medical history, your current use of medications and the side effects of the treatment listed herein. You should also be sure that you have considered all of the following:

Allergies

Inform your doctor of any unusual or bad reaction you have ever had to any medications in the past. This can prohibit the use of certain medications or require that you be more closely monitored during use. You should also inform your doctor of any other allergies you have to foods, dyes, preservatives, animals or other substances.

Pediatric

The safe and efficient use of ribavirin has only been established in some pediatric age groups. The safety of use of tablets below the age of five is unknown and the safety of use of solution and capsule treatment below the age of three is unknown. Discuss the specific requirements for and risks of use in children with your doctor before you begin treatment.

Geriatric

Studies performed have not demonstrated any limitations on the use of this treatment in the elderly. Age-related problems with the kidney, heart or liver, may, however, make this treatment unsuitable for some elderly patients.

Pregnancy

Pregnant women should not use this drug. Studies have shown positive evidence of fetal abnormalities and the risks of use clearly outweigh the benefit of use in pregnant women. Alternative treatments should be found.

When taking this treatment, you should also use contraceptive methods to prevent yourself from becoming pregnant. If you believe that you have become pregnant during use, then you should inform your doctor immediately. This medication may also cause birth defects if the father impregnates a women during his use of the treatment. Men should take appropriate steps to prevent pregnancy when they are using this treatment, too.

Your doctor may want you to join a pregnancy registry for patients who are taking this treatment. Before administration to women of childbearing age, the doctor will require that you provide a negative pregnancy test. You will be required to use two forms of pregnancy control both during treatment and for six months following the cessation of treatment. While you are on this medication and following treatment, you will need to carry out regular pregnancy tests to ensure that you are not pregnant.

Breastfeeding

The risk posed to a child from nursing when the mother is taking ribavirin is unknown. You should discuss the potential for risk with your doctor and weigh these risks against the benefits of continuing breastfeeding.

Your doctor will need to check up on the patient regularly during the use of this treatment. This will allow them to ascertain whether the medication is working properly and whether any unwanted side effects may be occurring.

This medication should not be used in conjunction with didanosine under any circumstances. Use of these two medications together will cause serious problems in the patient.

Ribavirin can cause agitation in some patients and they may display abnormal behavioral patterns. Patients can also have suicidal thoughts during treatment and will have a tendency to become more depressed. If you experience these side effects or notice them in someone, then you should contact your doctor.

The blood disorder anemia can develop during the use of this treatment. You should be alert for the following symptoms and contact your doctor immediately if you notice them:

  • Back pains
  • Leg pains
  • Stomach pains
  • Bleeding of the gums
  • Swelling of the body
  • Headaches
  • Paleness of the skin
  • Soreness of the throat
  • Unusual tiredness
  • Unusual weakness
  • Yellowing of the eyes
  • Yellowing of the skin

Anaphylaxis can occur from the use of this treatment. This serious allergic reaction can be a threat to life and should be treated immediately. You should be alert for these symptoms and call the emergency services if they occur:

  • Itching
  • Hives
  • Hoarseness of voice
  • Troubled breathing
  • Trouble swallowing
  • Swelling of the hands
  • Swelling of the face
  • Swelling of the throat or mouth

This medication can cause serious skin conditions to develop in the patient. If you notice any changes to your skin then you should report these to your doctor as soon as you can.

Pancreatitis can occur during use. You will experience sudden stomach pains, nausea, fever and lightheadedness if pancreatitis occurs. If you experience these symptoms, then you should visit emergency healthcare services.

This medication should not be taken in conjunction with alcohol. Doing so will put you at serious risk of developing other conditions that can have life-long effects.

This medication can cause dizziness and drowsiness. Ensure that you are completely safe to drive and operate machinery before doing so.

You will need to visit an eye doctor if your vision begins to change during your use of this medication.

Use of this treatment can temporarily expose you to a greater risk of infection. This is because there will be a short-term drop in the count of white blood cells in your body. As such, you should take steps to avoid infection. These include:

  • Avoiding infected individuals
  • Reporting suspected infections to your doctor immediately
  • Reporting blood in excretion right away
  • Taking extra care when cleaning the teeth and mouth. You may wish to use alternatives to a toothbrush, floss and pick
  • Taking extra care with sharp items
  • Avoiding contact sports or activities with risks of bruising and injury
  • Not touching your eyes or nose unless you have washed your hands and face immediately previous to this

This medication can cause problems for the teeth and gums. You should consult a dentist if these conditions occur.

This medication can affect growth in a child. Your doctor may need to regularly check height and weight of the treated child to ensure no stunting of growth is occurring.

Storage

All medications should be stored out of the reach of children at all times.

You should not keep outdated or unwanted medication for any longer than necessary and you should dispose of them properly as directed by your doctor.

Tablets and capsules should be stored at room temperature away from direct light, moisture and heat.

The oral liquid should be kept in the refrigerator but caution should be taken to prevent it from freezing. Keep it away from the sides of the fridge to help prevent this from occurring.

Summary

Ribavirin is a medication that is used in conjunction with other treatments to combat an infection of hepatitis C. It can also be used for the treatment of hepatitis C in patients who suffer from a HIV infection, as well.

Ribavirin is an antiviral treatment that works by attacking the RNA of the virus to help in its destruction. This medication can cure an infection of hepatitis C when used correctly.

Hepatitis C is a very serious medical condition that will gradually destroy the liver of the patient over many years. Treating it swiftly can prevent damage and allow the patient to return to health.

Patients should not drink alcohol while receiving this treatment, as it can further damage the liver and have a life-changing impact on the patient.

When using this treatment both male and female patients should take steps to avoid pregnancy. The medication is known to cause fetal abnormalities when used in both pregnant women and in fathers who impregnate a woman whilst he is being treated. Two forms of birth control should be used to prevent pregnancy both during use of the treatment and for six months after cessation of treatment. Women of childbearing age will be required to provide a negative pregnancy test before they begin treatment with this medication.

This medication can have a wide range of side effects and can expose the patient to the risk of developing a range of other medical conditions. Before beginning use of this treatment, the patient should take the time to understand the risks of use and ensure that they know what symptoms to look out for that may indicate the development of other serious conditions.

This treatment can be used in children of a certain age and in adults. Side effects experienced may be different, depending on the age of the patient.

 

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Last Reviewed:
February 01, 2018
Last Updated:
April 03, 2018