Ribavirin

Question 1

Ribavirin

Answer 1

Active against many different types of viruses; mainly used for HCV and RSV- respiratory syncytial virus

Question 2

Ribavirin MOA

Answer 2

Not well characterized

Nucleoside analogue of guanosine that is phosphorylated into active form inside cells
Technically is a direct acting anti-HCV antiviral but considered separate

Has some activity against other viruses, including influenza and adenovirus

Question 3

Ribavirin Adverse Effects

Answer 3

Main AE is hemolytic anemia
Dose related, dose limiting, may be severe
Interferons given with ribavirin can exacerbate this effects (they also cause cytopenias)

Also fatigue, HA, insomnia (not sure if ribavirin itself, interferons, or the combo is responsible)

Question 4

Ribavirin Important Facts

Answer 4

For HCV, must always be used in a combo
As monotherapy, rapidly leads to resistance

Usually administered orally
Can be given as aerosolized form for pulmonary RSV (principally in young children, immunocompromised adults- notably lung or hematopoietic stem cell transplants)
This route is complex- need to reduce environmental exposure of ribavirin- known teratogen
Many centers are moving away for aerosolized in adults- studies show similar efficacy in oral form

Pregnancy category X- causes birth defects
Fertile women should use reliable contraception
Pregnant women must avoid aerosolized form
Pregnant healthcare workers should avoid caring for these patients

Primary means of managing anemia is dose reduction
If it becomes severe or persistent, erythropoietin can be given
Monitor hemoglobin closely
Expect some degree of anemia and act accordingly

Question 5

Ribavirin Good For

Answer 5

Part of combo therapy for some patients with chronic HCV

Severe RSV in both children and adults (primarily immunocompromised or those with severe comorbidities)