Ribavirin for Hepatitis C

Ribavirin is a powerful antiviral drug used to treat chronic hepatitis C infection. It's not completely understood how ribavirin but, but in general terms, it interferes with the virus's ability to replicate. Ribavirin is approved by the Food and Drug Administration (FDA) for the treatment of hepatitis C and is on the World Health Organization's List of Essential Medicine.

Ribavirin is marketed under a number of a variety of brand names, including Copegus, Rebetol, Ribasphere, and RibaPak.

Woman Taking Out Pills From Bottle
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Drug Efficacy

Prior to the introduction of direct-acting antivirals (DAAs) in 2013 — which include the drugs Sovaldi, Harvoni, Daklinza, and Viekira Pak, among others — the most effective way to treat hepatitis C was with a combination of ribavirin and peginterferon. Dual therapy is known to have a high level of treatment side effects, some of which can be profound. Still, the combination therapy was able to achieve a sustained virologic response (the clinical definition of a cure) in about 50% of cases.

Today, with the newer class DAAs, the use of ribavirin has decreased somewhat although it is still prescribed in certain combination therapies, particularly with certain genetic strains (genotypes) of the virus and in patients with previously failed treatment and/or advanced liver disease.

Drug Administration

Ribavirin is taken orally, typically in two doses taken 12 hours apart. Standard dosages range from 800 mg to 1,400 mg per day. Your healthcare provider will determine how much ribavirin to prescribe based on the genotype of your virus, your weight, and which other drugs will be co-administered in therapy.

Treatment Side Effects

The side effects of ribavirin will vary from person to person, with some individuals managing will minimal ill events while others experience symptoms they consider intolerable. The most common side effects associated with peginterferon use are:

  • Anemia (10% of cases)
  • Headache
  • Irritability and anxiety
  • Depression
  • Hair loss (alopecia)
  • Itchiness
  • Insomnia
  • Joint pain (arthralgia)
  • Muscle pain (myalgia)
  • Anorexia
  • Neutropenia
  • Nausea and vomiting
  • Fever
  • Chills
  • Fatigue

Patients on treatment will often speak of Riba Rage, typified by general irritability and sudden emotional outbursts. While the term suggests the cause is ribavirin, it is more commonly associated with peginterferon. Antidepressants are sometimes prescribed to treat this condition, particularly in patients with pre-existing psychiatric issues.

Treatment Cost and Access

A full course of ribavirin treatment can be costly but, luckily, with newer class DAAs, the duration of treatment is far shorter than before. In the past, it could cost in the range of $12,000 for a full course. Today, expect it to cost more in the range of $2,500 for a 12-week course and $5,000 for a 16-week course.

Medicaid, Medicare, and private insurance will generally cover the cost of interferon when hepatitis C treatment is approved. Co-pay assistance can be sought through the drug manufacturer for qualified patients, as well as patient assistance programs (PAPs) for uninsured or low-income patients.

Treatment Contraindications

Ribavirin is considered safe for most people, but there are some individuals in whom treatment is contraindicated. Ribavirin should be avoided in the following circumstances:

  • If you are pregnant. Clinical research has shown that ribavirin can cause fetal birth defects. Women should only be prescribed ribavirin if a pre-treatment pregnancy test is negative. Additionally, two forms of contraception are advised for both the woman and her partner during the course of therapy and for six months following completion of therapy.
  • If you are breastfeeding
  • If you have advanced kidney disease, acute heart disease or advanced liver disease
  • If you have autoimmune hepatitis

Always be sure that your healthcare provider has your complete medical history, including information about any other chronic infections you may have (e.g., HIV, diabetes) or any plans you may have to conceive.

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By Charles Daniel
 Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.