Virazole, Rebetol, Copegus, Ribasphere
Classifications: antiviral agent; Therapeutic: antiviral
Pregnancy Category: X
6 g/100 mL vial; 200 mg tablets; 200 mg capsules; 40 mg/mL oral solution
Synthetic nucleoside with broad-spectrum antiviral activity against DNA and RNA viruses. Mode is believed to involve multiple
mechanisms including selective interference with viral ribonucleic protein synthesis.
Active against many RNA and DNA viruses, including respiratory syncytial virus (RSV), influenza A and B, parainfluenza,
measles, mumps, Lassa fever, enterovirus 72 (formerly called hepatitis A), yellow fever, HIV, herpes simplex virus (HSV-1
and HSV-2), and vaccinia.
Aerosol treatment of carefully selected hospitalized infants and young children with severe lower respiratory tract infection
caused by respiratory syncytial virus (RSV). Oral used in combination with interferon-alfa to treat hepatitis C and in combination
with peginterferon alpha for treatment of hepatitis C in patients coinfected with HIV.
Prophylaxis and treatment of influenza A and B, pneumonia caused by adenovirus; Lassa fever, measles, HSV-1, HSV-2, hepatitis
A, herpes zoster, and for carefully selected patients with AIDS and AIDS-related complex (ARC).
Mild RSV infections of lower respiratory tract; infants requiring simultaneous assisted ventilation; severe cardiovascular
disease, congestive heart failure, angina, unstable cardiac disease; pancreatitis, prolonged or multiple courses of ribavirin
inhalation therapy; autoimmune hepatitis; renal failure, or Clcr <50 mL/min; hemoglobinopathy, thalassemia major, sickle cell disease; pregnancy (category X), lactation; tablet form for
children <18 y.
COPD, asthma; anemia; history of MI, cardiac arrhythmias; older adults, decreased renal, hepatic, or cardiac function; respiratory
depression; history of depression or suicidal tendencies.
Route & Dosage
Child: Inhalation 20 mg via SPAG nebulizer administered over 1218 h/d for a minimum of 3 d (max: 7 d)
(in combination with interferon-alfa)Adult: PO >75 kg, 600 mg b.i.d. for 2448 wk; <75 kg, 400 mg in a.m., 600 mg in p.m. for 2448 wk
Child: PO >3 y, >75 kg, 600 mg b.i.d.; 6275 kg, 400 mg in a.m., 600 mg in p.m.; 5061 kg, 400 mg b.i.d.; 3749 kg, 200 mg in a.m. and 400 mg in p.m.; 2536 kg, 200 mg b.i.d. for 2448 wk
Clcr <50 mL/min: oral ribavirin should not be used
Note: Aerosol solution is prepared with either sterile water for injection or sterile water for inhalation, without preservatives
or any other added substance. See manufacturer's package insert for preparation directions. Inspect solution for discoloration
or presence of particulate matter. Discard discolored or cloudy solutions.
- Administer only by SPAG-2 aerosol generator, following manufacturer's directions.
- Caution: Ribavirin has demonstrated teratogenicity in animals. Advise pregnant health care personnel of the potential teratogenic
risks associated with exposure during ribavirin administration to patients.
- Do not give other aerosol medication concomitantly with ribavirin.
- Discard solution in the SPAG-2 reservoir at least q24h and whenever liquid level is low before fresh reconstituted solution
- Store unopened vial in a dry place at 15°25° C (59°78° F) unless otherwise directed.
- Following reconstitution, store solution at 20°30° C (68°86° F) for 24 h.
Adverse Effects (≥1%)CV:
Hypotension (faintness, light-headedness, unusual fatigue), MI, cardiac arrest. Special Senses: Conjunctivitis
, erythema of eyelids. Hematologic:
Reticulocytosis, hemolytic anemia
(especially in combination with interferon alpha). Respiratory:
Deterioration of respiratory function, dyspnea, apnea,
chest soreness, bacterial pneumonia
, ventilator dependence. GI:
Transient increases in AST, ALT, bilirubin; abdominal cramps, jaundice
Ribavirin may antagonize the antiviral
effects of zidovudine
against HIV; increased risk of fetal defects with peginterferon.
Rapidly absorbed orally (44%) and systemically from lungs. Peak:
Inhaled 6090 min. PO 1.73 h. Distribution:
Crosses placenta; distributed into breast milk. Metabolism:
In cells to an active metabolite. Elimination:
85% in urine, 15% in feces. Half-Life:
24 h in plasma, 1640 d in RBCs.
Assessment & Drug Effects
- Obtain specimens for rapid diagnosis of RSV infection before therapy is initiated or at least during the first 24 h of ribavirin
therapy. Do not continue therapy without laboratory confirmation of RSV infection.
- Treatment efficacy in RSV infections appears greatest if initiated within the first 3 d.
- Monitor respiratory function and fluid status closely during therapy. Note baseline rate and character of respirations and
pulse. Observe for signs of labored breathing: dyspnea, apnea; rapid, shallow respirations, intercostal and substernal retraction,
nasal flaring, limited excursion of lungs, cyanosis. Auscultate lungs for abnormal breath sounds.
- Observe patients requiring simultaneous assisted ventilation closely for S&S of worsening pulmonary function. Check equipment
carefully every 2 h, including endotracheal tube, for malfunction. Precipitation of ribavirin and accumulation of fluid
in tubing can obstruct the apparatus and cause inadequate ventilation and gas exchange.
- Consult physician about management of fluid and food intake and keep an accurate record of I&O.