Ribavirin: Price, Dosage & Where to Buy

Ribavirin is an antiviral nucleoside analogue used with peginterferon alfa-2a to treat chronic hepatitis C in patients with compensated liver disease, meaning the liver still functions despite damage. It is not effective alone for this infection, and treatment requires monitoring because of potentially serious adverse effects. Ribavirin requires a prescription in the United Kingdom.

Ribavirin tablets are indicated with PEGASYS (peginterferon alfa-2a) for chronic hepatitis C in patients aged 5 years and older who have compensated liver disease and have not previously received interferon alpha. The indication also includes adults with chronic hepatitis C who have HIV coinfection. Compensated liver disease means that the liver remains able to perform its functions despite damage.

Ribavirin alone is not effective for chronic hepatitis C. The safety and effectiveness of the tablet combination have not been established in organ transplant recipients, patients with decompensated liver disease or previous non-responders to interferon.

The tablets should not be used for adenovirus, respiratory syncytial virus, parainfluenza or influenza infections. The inhaled formulation has separate prescribing information.

The label lists 200 mg oral capsules, 200 mg film-coated oral tablets and 6 g powder for inhalation solution. The tablet regimen is used with PEGASYS, with food, and not as treatment alone. The label lists an adult daily tablet dose of 800 mg to 1200 mg, administered in two divided doses, for 24 to 48 weeks according to genotype and body weight.

The label lists 1000 mg daily for adults weighing less than 75 kg and 1200 mg daily for adults weighing at least 75 kg with genotypes 1 or 4, for 48 weeks. The label lists 800 mg daily for genotypes 2 or 3 for 24 weeks. The label lists 800 mg daily for adults with HIV coinfection for 48 weeks, regardless of genotype.

Children's tablet regimens depend on body weight and genotype. Dose reduction or discontinuation is described for certain adverse reactions and renal impairment. The inhalation formulation has separate prescribing information.

Ribavirin belongs to a group of antiviral medicines called nucleoside analogues. These resemble natural building blocks involved in making genetic material. Within cells, medicines in this group can interfere with processes that viruses use to copy their genetic material and multiply.

Ribavirin has several antiviral effects rather than a single simple action. For chronic hepatitis C, its role is as part of combination treatment with peginterferon alfa-2a; it is not effective as treatment on its own.

Ribavirin may cause birth defects or fetal death and is contraindicated in pregnant women and men whose female partners are pregnant. The label requires a negative pregnancy test before treatment, at least two reliable forms of effective contraception during treatment and for 6 months afterwards, and monthly pregnancy testing throughout that period. These precautions apply to female patients and female partners of male patients.

It is not known whether ribavirin enters human milk. Because serious adverse effects in nursing infants are possible, a decision is required about stopping breastfeeding or ribavirin therapy, according to the importance of treatment to the mother.

A missed dose interrupts the prescribed treatment schedule. General pharmacy advice is to resume the prescribed schedule rather than double a dose to compensate. A pharmacist or the treating team can advise on the timing of the next dose, particularly if several doses have been missed or the schedule is unclear.

The label specifies storage at 20° to 25°C, with excursions permitted to 15° to 30°C. The bottle should remain tightly closed to maintain quality.