Ribavirin (brand names: Copegus, Rebetol, Ribasphere, Vilona and Virazole) is an anti-viral drug indicated for severe RSV infection (individually), hepatitis C infection (used in conjunction with peginterferon alfa-2b or peginterferon alfa-2a) and other viral infections. Ribavirin is a prodrug, which when metabolised resembles purine RNA nucleotides.
In this form it interferes with RNA metabolism required for viral replication. How it exactly affects viral replication is unknown; many mechanisms have been proposed for this (see Mechanisms of Action, below) but none of these has been proven to date. Multiple mechanisms may be responsible for its actions.
The primary observed serious adverse side-effect of ribavirin is hemolytic anemia, which may worsen preexisting cardiac disease. The mechanism for this effect is unknown. It is dose-dependent and may sometimes be compensated by decreasing dose.
Ribavirin is also a teratogen in some animals species and thus poses a theoretical reproductive risk in humans, remaining a hazard as long as the drug is present, which can be as long as 6 months after a course of the drug has ended.
Ribavirin is active against a number of DNA and RNA
viruses. It is a member of the nucleoside antimetabolite drugs that
interfere with duplication of viral genetic material. Though not
effective against all viruses, ribavirin is remarkable as a small
molecule for its wide range of activity, including important activities
against influenzas, flaviviruses and agents of many viral hemorrhagic
In the U.K. & the U.S. the oral (capsule or tablet)
form of ribavirin is used in the treatment of hepatitis C, in
combination with pegylated interferon drugs.
The aerosol form has been used in the past to treat
respiratory syncytial virus-related diseases in children. However, its
efficacy has been called into question by multiple studies, and most
institutions no longer use it. It is still used in some cases.
In Mexico, ribavirin ("ribavirina") has been sold for use
against influenza. Studies have been mixed, but the derivative
viramidine may have more promise.
It has been used (in combination with ketamine, midazolam, and amantadine) in treatment of rabies.
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