Ribavirin interactions

Food & lifestyle

• high-fat foods

  Moderate

  Absorption

  Food enhances the oral absorption and bioavailability of ribavirin. Administration of a single oral dose of ribavirin following a high-fat meal delayed absorption (Tmax was doubled) but increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by up to 70% compared to administration in the fasting state.

  What to do: To ensure maximal oral absorption, ribavirin should be administered with or immediately after a meal.

  2 sources

  1. "Product Information. Copegus (ribavirin)." Roche Laboratories (2003):
  2. "Product Information. Rebetol (ribavirin)." Schering-Plough Corporation (2004):

Conditions

Conditions in which Ribavirin needs care, as documented in this source.

• Anemia

  Major

  Oral ribavirin may cause anemia. The decrease in hemoglobin generally occurs within 1 to 2 weeks after initiation of therapy and stabilizes by week 4. Because significant anemia may adversely affect cardiac function, oral ribavirin should not be used in patients with severe anemia of any etiology or a history of serious or unstable heart disease. It should also be avoided in patients with hemoglobinopathies such as thalassemia or sickle- cell anemia. Therapy with oral ribavirin may be administered cautiously in patients with stable heart conditions. Both the hemoglobin level and cardiovascular status must be closely monitored. A permanent dosage reduction is required in these patients if the hemoglobin decreases by >= 2 g/dL during any 4- week period. If, after 4 weeks on the reduced dosage, the hemoglobin remains < 12 g/dL, therapy should be discontinued. The drug should also be withdrawn if cardiovascular status deteriorates. For all patients, a dosage reduction is recommended when hemoglobin is < 10 g/dL. If hemoglobin falls below 8.5 g/dL, oral ribavirin should be permanently discontinued. In clinical trials, hemoglobin values generally returned to baseline 4 to 8 weeks after cessation of therapy.

  2 sources

  1. "Product Information. Virazole (ribavirin)." ICN Pharmaceuticals Inc (2001):
  2. "Product Information. Rebetron (interferon alfa-2b-ribavirin)." Scherer Laboratories Inc

• Kidney Diseases

  Major

  Orally administered ribavirin is metabolized by the liver, and both parent drug and metabolites are eliminated by the kidney. In patients with creatinine clearance between 10 and 30 mL/min, the mean area under the concentration-time curve has been shown to be three times greater than that in patients with normal renal function, presumably due to decreased clearance of the drug. Therapy with oral ribavirin should be administered cautiously in patients with creatinine clearance below 50 mL/min. Dosage adjustments may be necessary. The drug is not recommended for use in patients with severe renal impairment.

  2 sources

  1. Paroni R, Del Puppo M, Borghi C, et al. "Pharmacokinetics of ribavirin and urinary excretion of the major metabolite 1,2,4-triazole-3-carboxamide in normal volunteers." Int J Clin Pharmacol Ther Toxicol 27 (1989): 302-7
  2. "Product Information. Rebetron (interferon alfa-2b-ribavirin)." Scherer Laboratories Inc

• Lung Diseases

  Major

  The use of aerosolized ribavirin has been associated with deterioration in pulmonary function, most significantly in patients with chronic obstructive pulmonary disease or asthma. Respiratory status should be monitored in all patients receiving aerosolized ribavirin, but in particular, patients with underlying respiratory disorders. Therapy should be stopped if sudden deterioration occurs, and reinstituted only with extreme caution and consideration of concomitant bronchodilator therapy.

  3 sources

  1. Hebert MF "Ribavirin." Bulletin of the Hospital Pharmacy and The Drug Information Analysis Service University of California 36 (1988): 1-4
  2. "Product Information. Virazole (ribavirin)." ICN Pharmaceuticals Inc (2001):
  3. Janai HK, Marks MI, Zaleska M, Stutman HR "Ribavirin: adverse drug reactions, 1986 to 1988." Pediatr Infect Dis J 9 (1990): 209-11