Ribavirin, Oral Tablet

Medically reviewed by University of Illinois-Chicago, Drug Information Group on February 28, 2017Written by University of Illinois-Chicago, Drug Information Group

Important warnings

FDA warnings

  • This drug has black box warnings. A black box warning is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Ribavirin usage warning: Ribavirin shouldn’t be used alone to treat your hepatitis C virus infection. You’ll need to take it with other drugs.
  • Heart disease warning: This drug can cause your red blood cells to die early, which can lead to heart attack. Don’t use ribavirin if you have a history of heart disease.
  • Pregnancy warning: Ribavirin may cause birth defects or end a pregnancy. Don’t take ribavirin if you’re pregnant or plan to become pregnant. Men shouldn’t take the drug if their partner is pregnant or plans to become pregnant.

Other warnings

  • Suicidal thoughts warning: Ribavirin may cause you to have suicidal thoughts or try to hurt yourself. The risk may be higher in adolescents. 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 and PegIntron or INTRON A 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 as the brand-name drug Copegus. It’s also available in a generic form. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

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 hepatitis C virus (HCV) infection.

The ribavirin tablet is used with another drug called peginterferon alfa to treat chronic HCV infection. This combination is used in people who don’t have liver disease and who haven’t ever been treated with the drug interferon alpha.

How it works

It isn’t known exactly how ribavirin works to treat hepatitis C. However, it’s thought to interfere with a variety of processes that are important to the hepatitis C virus.

Ribavirin side effects

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

More common side effects

Ribavirin is used with interferon or 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

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:

  • Low red blood cell count (anemia). Symptoms may include:
    • a general feeling of weakness
    • tiredness
    • dizziness
    • fast heart rate
    • trouble sleeping
    • pale skin
  • Swelling and irritation of your pancreas (pancreatitis). 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 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 can not 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 for dangerous side effects due to azathioprine.

Live flu vaccine

Taking ribavirin with the live flu vaccine may decrease the effect of the flu vaccine. Don’t take ribavirin 48 hours before or 2 weeks after receiving a live flu vaccine.

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 for 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). Taking these two medications together should be avoided if possible.
  • Taking didanosine with ribavirin may increase your risk of negative effects. 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 can not 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

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 1-800-593-2214. 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

Brand: Copegus

  • Form: oral tablet
  • Strength: 200 mg
  • Dosage for chronic hepatitis C

    Adult dosage (ages 18 years and older)

    Used with peginterferon alfa:

    • HCV genotype 1: If you weigh:
      • less than 75 kg: 500 mg taken every morning and 500 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.
    • 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 eighteenth birthday during treatment should stay on the child dosage until the end of treatment.

    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.

    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.
    • Treatment duration: The duration of treatment for people who have never been treated with interferon depends on which genotype of the virus you have:
      • genotypes 2 and 3: 24 weeks
      • other genotypes: 48 weeks

    Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not 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 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 may have an increased risk of kidney problems, bleeding inside your body, or heart attack. Get medical help right away if you think you’ve taken too much of this drug.

    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 box 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
    • 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 more suitable for you than others. Talk to your doctor about possible alternatives.

    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 here in 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.

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