Ribavirin, Oral Tablet

Important warnings

Other warnings

• Suicidal thoughts warning: Ribavirin may cause you to have suicidal thoughts or try to hurt yourself. Call your doctor right away or go to the emergency room if you have new or worsening symptoms of depression or thoughts about suicide.
• Serious breathing problems: This drug may raise your risk of pneumonia, which can be fatal. If you have trouble breathing, tell your doctor right away.
• Growth problems in children: The combination of this drug with peginterferon alfa or interferon may cause weight loss or slowed growth in children. Most children will go through a growth spurt and gain weight after treatment stops. However, some children may never reach the height that they were expected to reach before treatment. Talk to your child’s doctor if you’re concerned about your child’s growth during treatment.

What is ribavirin?

Ribavirin is a prescription drug. It comes as an oral tablet, oral capsule, oral liquid solution, and inhalant solution.

Ribavirin oral tablet is available in a generic form. Generic drugs usually cost less than brand-name versions.

This drug must be used as part of a combination therapy. That means you need to take it with other drugs.

Why it’s used

Ribavirin is used to treat chronic hepatitis C virus (HCV) infection. It’s used for people who have HCV alone, and who have both HCV and HIV.

The ribavirin tablet is used with another drug called peginterferon alfa to treat chronic HCV infection.

How it works

It isn’t known exactly how ribavirin works to treat hepatitis C.

Ribavirin side effects

Ribavirin oral tablet may cause drowsiness. It can also cause other side effects.

More common side effects

Ribavirin is used with peginterferon alfa. Common side effects of taking the drugs together can include:

• flu-like symptoms, such as:
  • tiredness
  • headache
  • shaking along with having a fever
  • muscle or joint aches
• mood changes, such as feeling irritable or anxious
• trouble sleeping
• loss of appetite
• nausea
• vomiting
• diarrhea
• dry mouth
• eye problems

The more common side effects of ribavirin in children include:

• infections
• a decrease in appetite
• stomach pain and vomiting

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Anemia (low red blood cell count). Symptoms may include:
  • a general feeling of weakness
  • tiredness
  • dizziness
  • fast heart rate
  • trouble sleeping
  • pale skin
• Pancreatitis (swelling and irritation of your pancreas). Symptoms may include:
  • stomach pain
  • nausea
  • vomiting
  • diarrhea
• Pneumonia. Symptoms may include:
  • trouble breathing
• Severe depression
• Liver problems. Symptoms may include:
  • stomach bloating
  • confusion
  • brown-colored urine
  • yellowing of your skin or the whites of your eyes
• Heart attack. Symptoms may include:
  • pain in your chest, left arm, jaw, or between your shoulders
  • shortness of breath

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Ribavirin may interact with other medications

Ribavirin oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with ribavirin are listed below.

Immunosuppressant drug

Taking azathioprine with ribavirin can increase the amount of azathioprine in your body. This may increase your risk of infection.

Interferons (alfa)

Taking ribavirin with interferons (alfa) might increase the risk for side effects, including low red blood cells (anemia), due to ribavirin treatment.

HIV medications

• Taking reverse transcriptase inhibitors with ribavirin may increase the risk of dangerous effects on your liver. Taking these medications together should be avoided if possible.
• Taking zidovudine with ribavirin may increase your risk of negative effects, including low red blood cells (anemia) and low neutrophils (neutropenia). Taking these two medications together should be avoided if possible.
• Taking didanosine with ribavirin may increase your risk of negative effects such as nerve pain and pancreatitis. Didanosine should not be taken with ribavirin.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Ribavirin warnings

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Food interaction warning

Don’t take ribavirin with a high-fat meal. This can increase the amount of the drug in your blood. Take your medication with a low-fat meal.

Warnings for certain groups

For pregnant women: Ribavirin is a category X pregnancy drug. Category X drugs should never be used during pregnancy.

Ribavirin can cause birth defects or it can end a pregnancy. This can happen if either the mother or father uses ribavirin during conception, or if the mother takes the drug during pregnancy.

• Pregnancy warnings for women:
  • Don’t use ribavirin if you’re pregnant.
  • Don’t use ribavirin if you plan to become pregnant.
  • Don’t become pregnant while taking ribavirin and for 6 months after your treatment ends.
  • You must have a negative pregnancy test before starting treatment, every month while being treated, and for 6 months after treatment ends.
• Pregnancy warnings for men:
  • Don’t use ribavirin if your female partner plans to become pregnant.
  • Your female partner should not become pregnant while you’re taking ribavirin and for 6 months after your treatment ends.
• Pregnancy warnings for women and men:
  • You must use two effective forms of birth control during and for 6 months after treatment if you’re being treated with ribavirin. Talk to your doctor about forms of birth control you can use.
  • If you, or your female partner, becomes pregnant during or within 6 months after treatment with ribavirin, tell your doctor right away. You or your doctor should contact the Ribavirin Pregnancy Registry by calling 800-593-2214. The Ribavirin Pregnancy Registry collects information about what happens to mothers and their babies if the mother takes ribavirin while pregnant.

For women who are breastfeeding: It isn’t known if ribavirin passes through breastmilk. If it does, it could cause serious effects in a breastfeeding child.

You and your doctor may need to decide if you’ll take ribavirin or breastfeed.

For children: The safety and effectiveness of the ribavirin tablet haven’t been established in children under the age of 5 years.

How to take ribavirin

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Ribavirin

• Form: oral tablet
• Strength: 200 mg, 400 mg, 600 mg

Dosage for chronic hepatitis C infection alone

Adult dosage (ages 18 years and older)

Used with peginterferon alfa:

• Typical dosage for HCV genotypes 1 and 4: If you weigh:
  • less than 75 kg: 400 mg taken every morning and 600 mg taken each evening for 48 weeks.
  • more than or equal to 75 kg: 600 mg taken each morning and 600 mg taken each evening for 48 weeks.
• Typical dosage for HCV genotypes 2 and 3: 400 mg taken each morning and 400 mg taken each evening for 24 weeks.

Child dosage (ages 5–17 years)

Dosage is based on your child’s weight.

• 23–33 kg: 200 mg taken each morning and 200 mg taken each evening
• 34–46 kg: 200 mg taken each morning and 400 mg taken each evening
• 47–59 kg: 400 mg taken each morning and 400 mg taken each evening
• 60–74 kg: 400 mg taken each morning and 600 mg taken each evening
• More than or equal to 75 kg: 600 mg taken each morning and 600 mg taken each evening

Children who reach their 18th birthday during treatment should stay on the child dosage until the end of treatment. The recommended length of therapy for children with genotype 2 or 3 is 24 weeks. For other genotypes, it’s 48 weeks.

Child dosage (ages 0–4 years)

A safe and effective dose hasn’t been determined for this age group.

Senior dosage (ages 65 years and older)

Seniors may have decreased kidney function and may not be able to process the drug well. This increases risk of side effects.

Dosage for chronic hepatitis C with HIV coinfection

Adult dosage (ages 18 years and older)

Used with peginterferon alfa:

• Typical dosage for all HCV genotypes: 400 mg taken each morning and 400 mg taken each evening for 48 weeks.

Child dosage (ages 0–17 years)

A safe and effective dose hasn’t been determined for this age group.

Senior dosage (ages 65 years and older)

Seniors may have decreased kidney function and may not be able to process the drug well. This increases risk of side effects.

Special considerations

• For people with kidney disease: Your dosage should be reduced if you have a creatinine clearance less than or equal to 50 mL/min.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Ribavirin is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Ribavirin won’t work to treat your hepatitis C virus infection. The infection will continue to progress and cause more damage to your liver. This infection may be deadly if not treated properly.

If you don’t take it on schedule: You may become resistant to this drug and it will no longer work for you. The infection will continue to progress and cause more damage to your liver. Be sure to take your medication every day as directed.

If you take too much: You could have dangerous levels of the drug in your body. You could be at increased risk of kidney problems, bleeding inside your body, or heart attack.

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

If you miss a dose: If you miss a dose of ribavirin, take the missed dose as soon as possible during the same day. Don’t double the next dose to try to catch up. If you have questions about what to do, call your doctor.

How to tell if the drug is working: Your doctor will do blood tests to check the amount of the virus in your body. If ribavirin is working, this amount should decrease. These blood tests may be done before you start treatment, at weeks 2 and 4 of treatment, and at other times to see how well the medications are working.

Important considerations for taking ribavirin

Keep these considerations in mind if your doctor prescribes ribavirin for you.

General

• Take this medication with food.
• Don’t cut or crush this medication.

Storage

• Store in temperatures from 59°F to 86°F (15°C to 30°C).

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

During treatment with ribavirin, your doctor may do blood tests to check your:

• levels of hepatitis C virus infection in your body. Blood tests may be done before, during, and after treatment to make sure that the virus is no longer causing infection or inflammation.
• liver function
• levels of red and white blood cells and platelets
• thyroid function

You may also need these tests:

• Pregnancy test: Ribavirin may cause birth defects or it may end a pregnancy. Your doctor will do pregnancy tests each month during treatment and for 6 months after stopping treatment.
• Dental exam: This drug can cause dental issues because of dry mouth caused by the medication.
• Eye exam: Ribavirin can cause serious eye issues. Your doctor will do a baseline eye exam and possibly more if you have eye problems.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies will require a prior authorization before they approve the prescription and pay for ribavirin.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.