ribavirin: clinical use

Prescribing considerations

• Use only in an appropriate combination regimen under an experienced specialist.
• Assess renal function because reduced clearance increases exposure and anaemia risk.
• Review cardiac history; anaemia may worsen coronary or cardiac disease.
• Establish pregnancy-prevention measures for patients and relevant partners.
• Review accompanying antiviral products for additional contraindications, interactions and adverse effects.

Contraindications and cautions

• Hypersensitivity to ribavirin or formulation excipients
• Pregnancy
• Breastfeeding
• Severe pre-existing, unstable or uncontrolled cardiac disease within the previous six months
• Haemoglobinopathies such as thalassaemia or sickle-cell anaemia

Monitoring

• Full blood count, particularly haemoglobin, before and during treatment
• Renal and liver function
• Clinical cardiac status where relevant
• Pregnancy testing where applicable
• Uric acid or symptoms of gout in predisposed patients
• Mental health, vision and growth where interferon-containing or paediatric treatment is used

Clinical pharmacology

Ribavirin undergoes intracellular phosphorylation, distributes extensively into red blood cells and has prolonged elimination. It is mainly cleared through renal pathways and has little potential for cytochrome P450-mediated interactions.

Formulation and product differences

• The selected film-coated tablet should not be broken or crushed.
• The selected hard capsule contains lactose and gelatine.
• The selected capsule licence includes some children aged 3 years and over; the selected tablet product does not generally recommend use below 18 years.

Capsule

Route: Oral

Strengths: 200 mg

Tablet

Route: Oral

Strengths: 200 mg