Adult

Ribavirin

General Information

Restricted formulary antimicrobial: 

  • Oral ribavirin is approved for use in:
    1. Treatment of hepatitis C
    2. Treatment of Respiratory Syncytial Virus in haematology patients (unlicensed use)
  • Oral and inhaled ribavirin is also available following approval/prescribing by Microbiology/ID consultant or registrar

Renal and hepatic impairment

Renal impairment

  • Check renal function before treatment is started.
  • In patients with renal impairment- monitor full blood count (haemoglobin level) for anaemia.

eGFR (mL/min/1.73m2)

Oral dose

more than 50

Dose as in normal renal function

30-50

200mg and 400mg on alternate days

10-30

200mg OD

Less than 10

200mg OD
HD

Dose as in eGFR less than 10ml/min/1.73m2.

Not dialysed
HDF/High Flux

Dose as in eGFR less than 10ml/min/1.73m2.

Unknown dialysability
PD

Dose as in eGFR less than 10ml/min/1.73m2.

Unlikely to be dialysed

 

Hepatic impairment

Dose adjustment is not required in patients with hepatic impairment. Liver function tests should be checked before treatment is started and during treatment.

Pregnancy and breastfeeding

Pregnancy

  • Contraindicated in pregnancy; teratogenicity seen in animal studies. Exclude pregnancy before treatment is started. Effective contraception must be used during treatment and for 4 months after treatment in women and for 7 months after treatment in men. Routine monthly pregnancy tests are recommended. Consult product literature for further details.
  • When inhaled ribavirin is used, pregnant women (and those planning pregnancy) should avoid exposure to the aerosol.

 

Breastfeeding

  • Discuss with pharmacy.

Additional information

  • Monitoring parameters include:
      1. An ECG is recommended before and during treatment—discontinue if deterioration.  
      2. Haemoglobin level should be monitored during treatment.
      3. Full blood count, platelets, electrolytes, glucose, serum creatinine, liver function tests and uric acid should be monitored before starting treatment and then on weeks 2 and 4 of treatment, then as indicated clinically—adjust dose if adverse reactions or laboratory abnormalities develop (consult product literature).

References

  • Summary of Product Characteristics (SPC) for Ribavirin 200mg Capsules. Accessed via www.medicines.org.uk 26/03/18. Last updated 10/08/17
  • The Renal Drug Database. Ribavirin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 22/02/18
  • BNF online accessed via www.medicinescomplete.com 7/1/19; last updated 11/12/18

Editorial Information

Next review date: 02 Mar 2026