Nurses Compass
Drug Guide
Ribavirin
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/ANursing 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.