ribavirin
Regulatory sources consulted
Approved indications
- Treatment of chronic hepatitis C only in combination with the antiviral or interferon authorized for the patient profile; do not use as monotherapy.
Contraindications
Absolute
- Pregnancy, pregnancy potential without effective contraception, or a pregnant partner of a male patient.
- Creatinine clearance <50 mL/min or need for hemodialysis.
- Breastfeeding.
- Severe pre-existing cardiac disease, including unstable or uncontrolled disease during the previous 6 months.
- Child-Pugh B or C hepatic impairment, decompensated cirrhosis, autoimmune hepatitis, or history of autoimmune disease in the interferon regimen.
- Hemoglobinopathies, including thalassemia and sickle-cell anemia.
Clinical warnings
- It is teratogenic and embryocidal; pregnancy testing and effective contraception are required for patients and partners during treatment and the specified post-treatment period. — CIMA/AEMPS, ficha técnica 73658
- It may cause severe hemolytic anemia and worsen cardiac disease; monitor blood counts before and during treatment. — CIMA/AEMPS, ficha técnica 73658
Drug interactions
- ModerateDidanosine
Mechanism: It increases the active didanosine metabolite and may cause potentially fatal mitochondrial toxicity, lactic acidosis, pancreatitis, and liver failure.
Recommendation: Do not combine.
CIMA/AEMPS, ficha técnica 73658
- HighAzathioprine
Mechanism: It may increase myelotoxicity and pancytopenia.
Recommendation: Avoid the combination or monitor blood counts closely.
CIMA/AEMPS, ficha técnica 73658
- HighZidovudine
Mechanism: The combination may increase anemia and reduce zidovudine efficacy.
Recommendation: It is not recommended; consider replacing zidovudine if anemia worsens.
CIMA/AEMPS, ficha técnica 73658
Adverse events
Common (≥1%)
Anemia, neutropenia, fatigue, headache, nausea, insomnia, and rash
Rare but serious
Hemolytic anemia, pancytopenia, aplastic anemia, severe skin reaction, and lactic acidosis
Pregnancy and lactation
It is contraindicated during pregnancy. Test before treatment and monthly: treated women and female partners use contraception during treatment and for 9 months afterward; treated men and partners use contraception during treatment and for 6 months afterward, with condoms if the partner is pregnant. Stop breastfeeding.
Recent literature (PubMed)
Hantaviruses are a significant and emerging global public health threat, impacting more than 200,000 individuals worldwide each year. The single-stranded RNA viruses belong to the Hantaviridae family and are responsible for causing two acute febrile diseases in humans: Hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). Currently, there are no licensed treatments or vaccines available globally for HTNV infection. Various candidate drugs have shown efficacy in increasing survival rates during the early stages of HTNV infection. Some of these drugs include lactoferrin, ribavirin, ETAR, favipiravir and vandetanib. Immunotherapy utilizing neutralizing antibodies (NAbs) generated from Hantavirus convalescent patients show efficacy against HTNV. Monoclonal antibodies such as MIB22 and JL16 have demonstrated effectiveness in protecting against HTNV infection. The development of vaccines and antivirals, used independently and/or in combination, is critical for elucidating hantaviral infections and the impact on public health. RNA interference (RNAi) arised as an emerging antiviral therapy, is a highly specific degrades RNA, with post-transcriptional mechanism using eukaryotic cells platform. That has demonstrated efficacy against a wide range of viruses, both in vitro and in vivo. Recent antiviral methods involve using small interfering RNA (siRNA) and other, immune-based therapies to target specific gene segments (S, M, or L) of the Hantavirus. This therapeutic approach enhances viral RNA clearance through the RNA interference process in Vero E6 cells or human lung microvascular endothelial cells. However, the use of siRNAs faces challenges due to their low biological stability and limited in vivo targeting ability. Despite their successful inhibition of Hantavirus replication in host cells, their antiviral efficacy may be hindered. In the current review, we focus on advances in therapeutic strategies, as antiviral medications, immune-base
Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. Familiarity of t
With an increasing global incidence in children younger than the age of five, respiratory syncytial virus (RSV) is one of the most common viral respiratory infections worldwide. Despite the increasing number of cases among infants and young children, RSV can infect any age group; however, some individuals are more high risk than others. Premature infants, young children, elderly, and immunocompromised individuals are the most likely to suffer a more severe presentation of RSV in comparison to healthy adults. RSV is transmitted through respiratory droplets via direct contact with an infected individual or with contaminated surfaces. The viral genome of RSV consists of 11 proteins. Out of these 11, two proteins allow for the attachment of the virus to the respiratory epithelial cells and fusion with host cells. Upon fusion, the viral material transfers to the host cell, where viral replication occurs. It is important to acknowledge that an individual is considered infectious and can transmit the virus even before the symptomatic presentation of RSV begins. As long as the individual is shedding the virus, he or she is considered infectious. The length of viral shedding also differs depending on the severity of the infection, who is infected, and the underlying immune status of an individual. Currently, there is no definitive treatment for RSV; however, supportive therapy is considered the mainstay treatment. Some pharmaceutical treatments such as ribavirin have been FDA-approved; however, the administration is typically limited to children and infants. Palivizumab is also administered as an immune prophylaxis; however, both therapies are constantly at the end of a cost-effective debate due to their extensively expensive nature and questionable adverse effect profiles. Supportive therapy includes hydration, supplemental oxygen, and mechanical ventilation in hospitalized cases; however, most RSV cases can be treated as outpatient cases. Prevention techniques such as hand