Ribavirin is a drug used to treat hepatitis C. It’s typically prescribed in combination with other medications for up to 24 weeks. When used long-term, ribavirin can cause serious side effects.

If your doctor has prescribed ribavirin to help treat your hepatitis C, you likely want to know more about the long-term side effects. With this article, we’ll describe these side effects, including symptoms to watch for. We’ll also tell you about hepatitis C and how ribavirin works to treat this condition.

Ribavirin can cause many serious long-term side effects. These effects may not occur right away because ribavirin can take up to four weeks to build to its full level in your body. When ribavirin’s side effects do appear, though, they can last longer or be worse than side effects from other drugs. One reason for this is that ribavirin takes a long time to leave your body. In fact, ribavirin can stay in your body’s tissues for up to six months after you stop taking it.

Some of ribavirin’s side effects are serious enough to be included in a boxed warning. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). The side effects of ribavirin described in the boxed warning include:

Hemolytic anemia

This is the most serious side effect of ribavirin. Hemolytic anemia is a very low level of red blood cells. Red blood cells carry oxygen to cells throughout your body. With hemolytic anemia, your red blood cells don’t last as long as they usually do. This leaves you with fewer of these critical cells. As a result, your body can’t move as much oxygen from your lungs to the rest of your body.

Symptoms of hemolytic anemia can include:

  • increased tiredness
  • an irregular heart rhythm
  • heart failure, with symptoms such as tiredness, shortness of breath, and minor swelling of your hands, legs, and feet

If you have any of these symptoms, call your doctor right away. If you develop hemolytic anemia, you could need a blood transfusion. This is when you receive donated human blood intravenously (through your vein).

Worsened heart disease

If you already have heart disease, ribavirin could make your heart disease worse. This could lead to a heart attack. If you have a history of serious heart disease, you should not use ribavirin.

Ribavirin can cause anemia (very low levels of red blood cells). Anemia makes it harder for your heart to pump enough blood throughout your body. When you have heart disease, your heart is already working harder than normal. Together, these effects cause even more stress on your heart.

Symptoms of heart disease can include:

  • rapid heart rate or changes in heart rhythm
  • chest pain
  • nausea or severe indigestion
  • shortness of breath
  • feeling lightheaded

Call your doctor if any of these symptoms occur suddenly or seem to get worse.

Pregnancy effects

Ribavirin is a category X pregnancy drug. This is the most serious pregnancy category from the FDA. Studies have shown that drugs in this category can cause birth defects or end a pregnancy. Do not take ribavirin if you or your partner is pregnant or planning to become pregnant. The risk of harm to a pregnancy is the same whether it is the mother or father taking the drug.

If you’re a woman who could become pregnant, a pregnancy test must prove you’re not pregnant before you can start treatment. Your doctor may test you for pregnancy in their office, or they may ask you to take a pregnancy test at home. You may also need monthly pregnancy tests during your treatment and for six months after you stop taking this drug. During this time, you must use two forms of birth control. If you think you may be pregnant at any time while taking this drug, call your doctor right away.

If you’re a man who has sex with a woman, you also must use two forms of birth control. You’ll need to do this throughout your treatment with this drug and for at least six months after your treatment ends. If you’re taking this drug and your partner thinks she may be pregnant, call your doctor right away.

Most other side effects from ribavirin occur in the first few days or weeks of treatment, but they can also develop over time. Call your doctor right away if you have other serious side effects from ribavirin. These can include:

Eye problems

Ribavirin can cause eye problems such as trouble seeing, loss of vision, and macular edema (swelling in the eye). It can also cause bleeding in the retina and a very serious condition called detached retina.

Symptoms of eye problems can include:

  • blurry or wavy vision
  • floating specks that suddenly appear in your line of vision
  • flashes of light that appear in one or both eyes
  • seeing colors as pale or washed out

Call your doctor if any of these symptoms occur suddenly or seem to get worse.

Lung problems

Ribavirin can cause lung problems such as trouble breathing and pneumonia (infection of the lungs). It can also cause pulmonary hypertension (high blood pressure in the lungs).

Symptoms of lung problems can include:

  • shortness of breath
  • fever
  • cough
  • chest pain

Call your doctor if any of these symptoms occur suddenly or seem to get worse. If you develop lung problems, your doctor may stop your treatment with this drug.


Ribavirin can cause pancreatitis, which is inflammation of the pancreas. The pancreas is an organ that makes substances that help with digestion.

Symptoms of pancreatitis can include:

  • chills
  • constipation
  • sudden and severe pain in your abdomen

Call your doctor right away if you have any of these symptoms. If you develop pancreatitis, your doctor will likely stop your treatment with this drug.

Mood changes

Ribavirin can cause mood changes, including depression. This can be a short-term or long-term side effect.

Symptoms can include feeling:

  • agitated
  • irritable
  • depressed

Call your doctor if you have these symptoms and they bother you or don’t go away.

Increased infections

Ribavirin raises your risk of infection from bacteria and viruses. Ribavirin can lower your body’s level of white blood cells. These cells fight infection. With fewer white blood cells, you may get infections more easily.

Symptoms of an infection can include:

  • fever
  • body aches
  • tiredness

Call your doctor if any of these symptoms occur suddenly or seem to get worse.

Decreased growth in children

Ribavirin can cause decreased growth in children who take it. This means they may grow less and gain less weight than their peers. This effect can occur when your child uses ribavirin with the drug interferon.

Symptoms can include:

  • a slower rate of growth compared to what is expected for the child’s age
  • a slower rate of weight increase compared to what is expected for the child’s age

Your child’s doctor should monitor your child’s growth during their treatment and until the end of certain growth phases. Your child’s doctor can tell you more.

Breastfeeding effects

It’s not known if ribavirin passes into breast milk to a child who is breastfed. If you breastfeed your child, talk with your doctor. You’ll likely need to stop breastfeeding or avoid using ribavirin.

Ribavirin has been used for many years to treat hepatitis C. It’s always used in combination with at least one other drug. Until recently, treatments for hepatitis C centered around ribavirin and another drug called interferon (Pegasys, Pegintron). Today, ribavirin may be used with newer hepatitis C drugs, such as Harvoni or Viekira Pak.


Ribavirin comes in the forms of a tablet, capsule, or liquid solution. You take these forms by mouth. All forms are available as brand-name drugs, which include Copegus, Rebetol, and Virazole. Your doctor can give you a full list of current brand-name versions. The tablet and capsule are also available in generic forms.

How ribavirin works

Ribavirin doesn’t cure hepatitis C, but it does help prevent severe effects from the disease. These effects include liver disease, liver failure, and liver cancer. Ribavirin also helps reduce the symptoms of hepatitis C infection.

Ribavirin may work by:

  • Reducing the number of hepatitis C virus cells in your body. This can help reduce your symptoms.
  • Increasing the number of gene mutations (changes) in the virus. These increased mutations can weaken the virus.
  • Stopping one of the processes that help the virus make copies of itself. This helps slow the spread of hepatitis C in your body.

Read more: Detailed drug information for ribavirin »

Hepatitis C is an infection of the liver. It’s caused by the hepatitis C virus (HCV), a contagious virus that’s passed through the blood. Originally diagnosed in the mid-1970s as non-type A/non-type B hepatitis, HCV was not officially named until the late 1980s. Some people with hepatitis C have an acute (short) illness. Acute HCV does not often cause symptoms. But most people with HCV develop chronic (long-lasting) hepatitis C, which typically does cause symptoms. These symptoms can include fever, tiredness, and pain in your abdomen.

Keep reading: What do you want to know about hepatitis C? »

If your doctor prescribes ribavirin to treat your hepatitis C, be sure to discuss your full health history before you start treatment. Ask your doctor how to prevent or reduce side effects from ribavirin. And during your treatment, report any side effects to your doctor right away. Avoiding or reducing any side effects from ribavirin can help you feel better during your therapy. This can help you finish your treatment and better manage your hepatitis C.