Ribavirin: uses, side effects, administration & cost

Ribavirin is broad-spectrum antiviral, used in the treatment of Respiratory Syncytial Virus, hepatitis C, influenza, and Lassa fever. Studies assessing its role in the treatment of Respiratory Syncytial Virus infection in children have been small, and, although they show no reduction in hospital stay, there is a beneficial effect on pulmonary function at 1 (one) year.
Currently used in the treatment of RSV bronchiolitis and pneumonia in hospitalized children—especially those with complicated or severe disease.

• Mode of action
guanosine analogue interferes with nucleic acid synthesis and may also block production of viral messenger RNA(mRNA).

• Resistance
Not demonstrated in Respiratory Syncytial Virus.

• Pharmacology
Excreted renally (around 40%) and in faeces (15%),and metabolized by the liver. Some is retained in tissues (especially red blood cells (RBCs).

Route of Administration
Given by nebulizer in bronchiolitis, per oral or intravenously in other conditions.

Dosage
The dosage and length of treatment is based on the age, weight, medical condition and response to treatment.

• Toxicity and side effects
Dose-related anaemia (extravascular
haemolysis) and marrow suppression at high doses. Itch, nausea,depression,and cough. With aerosolized preparations—conjunctivitis,
rash, bronchospasm.
Drink plenty of water while being treated with this medication. Doing so will decrease the risk of serious side effects and toxicity.

• Contraindications
Pregnancy (teratogenic risk—contraception for
6 months after therapy in both men and women, and condoms must be used if the partner of the male patient is pregnant,as ribavirin is present in semen) and breastfeeding. Avoid oral therapy in severe cardiac disease,haemoglobinopathies, severe hepatic dysfunction, autoimmune disease.

• Monitoring
Full Blood Count(FBC) and biochemistry on initiation of therapy, and at weeks 2 and 4. Electrocardiogram (ECG) if there is history of cardiac disease.

Cost

Ribavirin is free in all federal and some state teaching hospitals in Nigeria. In pharmacies, it is sold for #5,000 per ampoule.

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This article was adapted from the Oxford Handbook on Infectious Diseases and Treatment.

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