Home Drug Guide Ribavirin

Drug Guide

Generic Name

Ribavirin

Brand Names Virazole, Rebetol, Copegus, Ribasphere

Classification

Therapeutic: Antiviral, used for viral infections including hepatitis C and respiratory syncytial virus (RSV)

Pharmacological: Nucleoside analog, inhibits viral RNA synthesis

FDA Approved Indications

  • Treatment of chronic hepatitis C in combination with peginterferon alfa
  • Treatment of RSV infection in hospitalized infants and young children

Mechanism of Action

Ribavirin is a nucleoside analog that mimics guanosine, leading to inhibition of viral RNA synthesis and viral replication; it also induces lethal mutagenesis of viral genomes.

Dosage and Administration

Adult: Variable depending on indication; for hepatitis C, 400 mg twice daily with peginterferon, duration varies by treatment response.

Pediatric: Dosing based on body weight and indication; specific protocols depend on age and severity.

Geriatric: No specific adjustments; caution in renal impairment.

Renal Impairment: Dose adjustments required; contraindicated in severe renal impairment.

Hepatic Impairment: Use with caution; no specific dosage adjustment provided.

Pharmacokinetics

Absorption: Well absorbed orally with high bioavailability.

Distribution: Widely distributed including lungs, kidney, liver, and other tissues.

Metabolism: Primarily metabolized in tissues; enterohepatic recirculation occurs.

Excretion: Renal excretion predominantly; renal function affects clearance.

Half Life: Approximately 2 hours for circulating drug, but active intracellular metabolites may persist longer.

Contraindications

  • Pregnancy (Category X) due to teratogenicity
  • Known hypersensitivity to ribavirin

Precautions

  • Use with caution in patients with anemia, cardiovascular disease, or renal impairment; monitor hemoglobin closely.
  • Pregnancy prevention measures mandatory for women of childbearing age and men whose partners are pregnant.

Adverse Reactions - Common

  • Anemia (Very common)
  • Fatigue (Common)
  • Headache (Common)

Adverse Reactions - Serious

  • Cardiac arrhythmias (Uncommon)
  • Birth defects, fetal death (if used during pregnancy) (Serious and classified as contraindication)

Drug-Drug Interactions

  • Didanosine, zidovudine (increased risk of anemia)
  • Certain antiretrovirals

Drug-Food Interactions

  • Potential for altered absorption if taken with food high in fat

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Baseline hemoglobin, pregnancy status, renal function.

Diagnoses:

  • Risk for decreased cardiac output (due to anemia)
  • Risk for fetal injury during pregnancy

Implementation: Monitor hematologic parameters regularly, especially hemoglobin; enforce pregnancy prevention protocols.

Evaluation: Assess for anemia, adverse effects, and therapeutic response.

Patient/Family Teaching

  • Avoid pregnancy during and for 6 months after treatment.
  • Report signs of anemia (fatigue, pallor) or adverse effects.
  • Use effective contraception.
  • Take medication with food if tolerated.

Special Considerations

Black Box Warnings:

  • Carcinogenic, teratogenic, and radiation warnings. Pregnant women must not handle crushed or broken tablets or capsules.

Genetic Factors: Genetic factors influencing enzyme activity may affect metabolism.

Lab Test Interference: May interfere with pregnancy tests and other laboratory results.

Overdose Management

Signs/Symptoms: Severe anemia, hypotension, cardiac events.

Treatment: Supportive care, transfusions if necessary; no specific antidote.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended conditions until expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.