What Are the Benefits and Functions of Ribavirin?

Ribavirin, commonly known as Virazole, is a broad-spectrum antiviral drug prescribed for various diseases, including severe bronchiolitis and pneumonia in infants, chronic hepatitis C, and others. It is strictly regulated and can only be used under the guidance of a doctor. Its main function is to inhibit the growth of various viruses such as respiratory syncytial virus, influenza virus, hepatitis A virus, and adenovirus. Clinically, it can also be combined with interferon for the treatment of hepatitis C, epidemic hemorrhagic fever, and early-stage treatment of measles virus.

Indications for ribavirin include: severe hospitalized patients with bronchiolitis and pneumonia caused by respiratory syncytial virus (RSV) in infants and young children (aerosol); treatment of Lassa fever or epidemic hemorrhagic fever with renal syndrome or pneumonia manifestations (intravenous drip or oral administration); treatment of chronic hepatitis C (combined with recombinant interferon α2b or pegylated interferon α); prevention and treatment of viral upper respiratory tract infections (nasal drops).

When prescribing ribavirin, the following precautions should be taken into account:

(1) It should only be prescribed to patients with a negative pregnancy test. Reliable contraception must be implemented during the treatment period and for six months after discontinuation of the drug.

(2) Breastfeeding women should stop nursing during treatment, and the breast milk should be discarded. Ribavirin is not recommended for breastfeeding women with respiratory syncytial virus infection due to its self-limiting nature.

(3) As the drug may precipitate on the respirator, hampering safe and effective ventilation, ribavirin aerosol should not be used in infants receiving assisted respiration.

(4) The risk of toxic reactions to ribavirin is increased in patients with renal impairment. Renal function should be monitored during treatment, and the dosage should be adjusted accordingly. The drug should not be used in patients with creatinine clearance ≤50ml/min. It is not recommended for elderly patients.

(5) During treatment and the follow-up period after discontinuation of the drug, the risk of suicidal ideation or attempts is higher in pediatric patients (primarily adolescents) compared to adults.

(6) Ribavirin-induced anemia can lead to myocardial infarction. Before initiating treatment, patients should be assessed for the possibility of cardiac disease, and those with unstable cardiac history should avoid using the drug. If cardiac disease worsens during treatment, the drug should be discontinued. It is not suitable for patients with severe anemia.

(7) When used in combination with interferon α2b or pegylated interferon α, ribavirin should be temporarily discontinued if signs or symptoms of pancreatitis occur. If pancreatitis is confirmed, the drug should be stopped. If there is evidence of lung infiltration or lung function impairment, close monitoring or discontinuation of the drug is recommended.

(8) Oral or intravenous administration of ribavirin can cause an increase in blood bilirubin up to 25%. High doses can cause a decrease in hemoglobin levels. Hemoglobin or hematocrit should be checked before treatment and every two weeks or four weeks during treatment.

(9) Ribavirin aerosol should not be administered simultaneously with other aerosols.