Ribavirin

Who is this information for?

This page provides an overview of treatment and important information for patients starting on treatment with ribavirin for hepatitis E and hepatitis C infections.

What is ribavirin and what does it do?

Ribavirin is an antiviral medication used to treat hepatitis E virus infection on its own and occasionally to treat hepatitis C virus infection in combination with other medication (ribavirin must not be used on its own to treat hepatitis C). Hepatitis E and hepatitis C virus infections can cause inflammation and damage to the liver. Ribavirin stops replication of many types of virus, including the hepatitis E and C viruses, however its exact mechanism is unknown.

How do I take my ribavirin tablets?

The number of ribavirin tablets needed per day is based on multiple factors including your body weight, kidney function and hepatitis E or C genotype and the dose will be calculated by your doctor or liver nurse specialist. You should take the total daily dose in two divided doses, ideally 12 hours apart. Tablets should be taken with food and swallowed whole. The tablets must not be broken or crushed. The duration of treatment will depend on your hepatitis E or C genotype, the extent of your liver disease and the medication taken in combination with ribavirin if being treated for hepatitis C.

Are there any side effects of ribavirin?

Like all medicines, ribavirin can cause side effects, although not everybody experiences them. Known side effects include:

• Anaemia
• Depression
• Sleeplessness or insomnia headache or dizziness
• Irritability or lack of concentration
• Hair loss, dermatitis, itchy or dry skin
• Shortness of breath or cough
• High temperatures (fevers), shivering, weakness or fatigue
• Muscle pains and joint stiffness
• Diarrhoea, feeling sick or abdominal pain

If you experience any adverse effects, please contact your doctor, pharmacist or liver nurse specialist. This includes any possible side effects not listed above. Some patients may require a dose adjustment.

Do I need to have any tests or be monitored because I take ribavirin?

Because of the effects ribavirin can cause you will have regular blood tests to monitor your iron levels, red and white blood cells and liver function. These will usually be linked with your clinic visits.

Pregnancy and breastfeeding

• Ribavirin is known to harm the development of unborn infants.
• Female patients: Ribavirin must not be used by women who are pregnant and extreme care must be taken to avoid pregnancy in female patients. Women of childbearing potential must use an effective form of contraception during treatment and for 9 months after treatment.
• Male patients and their female partners: Extreme care must be taken to avoid pregnancy in female partners of male patients taking ribavirin. Male patients or their female partners must use an effective form of contraception during treatment and for 6 months after treatment.
• It is not known whether ribavirin can pass into breast milk. Because of the potential for adverse reactions in breastfed infants, breastfeeding is not recommended whilst taking ribavirin.

Do I need to have any tests or be monitored because I take ribavirin?

Because of the adverse effects ribavirin can cause, you will have regular blood tests to monitor your iron levels, red and white blood cells and liver function. These will usually be linked with your clinic visits.

Special warnings and precautions when taking ribavirin

You should not take ribavirin if you have had problems with your heart (including a heart attack) in the last six months, or if you have a blood disorder (e.g. thalassaemia or sickle cell anaemia).

Are there any problems taking ribavirin with any other medications?

Ribavirin can be problematic when taken with medicines for the treatment of HIV. If you are taking medicines for HIV, then these should be discussed with your doctor or pharmacist to check they are safe to take together.

Only take medicines prescribed for you by your doctor and check with your doctor, liver nurse specialist or pharmacist before taking any new medicines. This includes medicines initiated by your GP or medicines / remedies bought over the counter.

Who I can contact to discuss ribavirin?

Hepatitis C nurse specialists: 01223 596094

Specialist pharmacist: 01223 217611

Further information

Further information about your tablet can be found in the patient information leaflet in the tablet / capsule box or on the container.

If you have any other questions about your medication, please contact the medicines helpline on 01223 217502.