Rebetol (Ribavirin) - Oral

Warning:

People who are pregnant or have pregnant partners should not take Rebetol (ribavirin). Pregnancy should also be avoided for nine months for female patients and nine months for female partners of male patients.

This medication can also cause a blood condition called hemolytic anemia, which can worsen existing heart disease and lead to a heart attack.

Also, Rebetol on its own is not effective for the treatment of chronic hepatitis C. It must be used as part of a combination treatment.

What Is Rebetol?

Rebetol (ribavirin) is a prescription antiviral medication used to treat chronic (long-term) hepatitis C virus infection. It belongs to the drug class known as nucleoside analogues.

Ribavirin must be used in combination with another drug called interferon alfa-2b (pegylated and nonpegylated). Its mechanism of action related to the hepatitis C virus (HCV) is not fully understood. It works against many RNA and DNA viruses. However, ribavirin alone is ineffective against hepatitis C and must be used as part of combination therapy. When used with interferon alfa-2b, it stops the virus that causes hepatitis C from replicating and spreading.

Rebetol carries several warnings associated with its use, including an increased risk of hemolytic anemia, in which the red blood cells are destroyed faster than usual. This condition may worsen heart disease and lead to a heart attack. It can also be harmful if used during or nine months before pregnancy.

Rebetol is available as capsules or solution (liquid) to be taken by mouth. Oral ribavirin is available under the brand name Rebetol or generically.

Drug Facts

Generic Name: Ribavirin

Brand Name(s): Rebetol

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Antiviral

Available Generically: Yes

Controlled Substance: N/A

Active Ingredient: Ribavirin

Dosage Form(s): Capsule, solution

What Is Rebetol Used For?

The Food and Drug Administration (FDA) has approved Rebetol to treat long-term hepatitis C. It is approved for use only if you have compensated liver disease, which means your liver is able to maintain its function despite the damage. It should also be used with another hepatitis medication called interferon alfa-2b (pegylated and nonpegylated), which is an injectable medication. Rebetol should not be used on its own.

Hepatitis occurs when the liver is swollen or inflamed. There are several types of hepatitis, which don't always require treatment. Specifically, hepatitis C is a viral hepatitis caused by HCV. Other types of hepatitis can be caused by alcohol consumption or, more rarely, excessive nonsteroidal anti-inflammatory drug (NSAID) use.

Antiviral treatment is designed to remove HCV from the body and slow or prevent liver damage and complications. The goal of HCV treatment is to drop your viral load (the amount of virus measured in the blood) to undetectable levels and keep it that way (i.e., sustained virologic response).

However, Rebetol may not have as much benefit if you have any of the characteristics below:

  • You didn’t respond to a previous treatment
  • Previous use of pegylated interferon treatment
  • Significant liver scarring or cirrhosis
  • Genotype 1 hepatitis C

How to Take Rebetol

Always follow directions from your prescribing healthcare provider on how to take this medication. Rebetol is usually taken twice a day with food. Drink plenty of water and other fluids, but stay away from caffeinated beverages. Continue taking it even if you feel well. Treatment duration can range from 24 to 48 weeks, depending on your condition and response to therapy. How much you take may depend on body weight.

Rebetol comes in capsule and solution formulations; oral ribavirin is also available in a generic version. When taking the capsules, swallow them whole; do not chew, cut, or break them. If you are taking the solution, shake the liquid before each use and mix it evenly.

Storage

Rebetol should be stored in a cool, dry place. Generally, medications should be kept away from areas with high amounts of heat, like above your stove or in humid areas like your bathroom. These environments can impact how well medications work. Additionally, keep this medication out of reach of children and pets to prevent accidental consumption.

Refilling and traveling with this medication carries no special instructions. Ask your pharmacist or prescriber to request a refill if you need more medication.

Off-Label Uses

Rebetol has uses outside of hepatitis C that are commonly accepted by the medical community. This is called off-label use.

Off-label uses for Rebetol include:

Hepatitis E shares similarities with hepatitis C, as they both are caused by viruses and can lead to liver damage. However, hepatitis E is caused by the hepatitis E virus (HEV) and is spread by consuming contaminated substances. It is not as common in the United States as hepatitis C.

Ribavirin can also treat other viral infections, such as an RSV infection, if you are immunocompromised. RSV infections are usually mild; most people will generally recover within a few weeks. Sometimes you may need to be admitted to the hospital if you have severe infections.

Rebetol can treat certain types of viruses, such as the Lassa virus or certain arenaviruses and bunyaviruses that can cause infections and deadly fevers.

How Long Does Rebetol Take to Work?

You may see improvement in your hepatitis C after 12 weeks of taking Rebetol. However, this is not the case with everyone, depending on their health status and condition being treated. It is always important to communicate any concerns (or if you are not feeling better) with your prescriber.

What Are the Side Effects of Rebetol?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects associated with Rebetol include:

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your side effects feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

  • Depression
  • Suicidal ideation
  • Suicidal attempts
  • Hemolytic anemia
  • Signs of an allergic reaction, such as rash/hives, trouble breathing, or swelling of the mouth, face, lips, tongue, or throat
  • Signs of a pancreas problem (pancreatitis), such as severe stomach pain, back pain, or upset stomach and vomiting
  • Vision changes or loss
  • Lung problems that affect your breathing
  • Heart attack

Long-Term Side Effects

Examples of long-term side effects associated with Rebetol are:

  • Fatigue
  • Dyspnea, or shortness of breath
  • Anemia

Report Side Effects

Rebetol may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).

Dosage: How Much Rebetol Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For hepatitis C virus infection, in combination with interferon alfa-2b:
    • For oral dosage form (capsules):
      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 1000 to 1200 milligrams (mg) per day, given as two or three capsules in the morning and three capsules at night.
      • Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening.
      • Children younger than 3 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (solution):
      • Adults—Dose is based on body weight and must be determined by your doctor. The oral solution form of this medicine is not usually prescribed for adults and teenagers.
      • Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening.
      • Children younger than 3 years of age—Use and dose must be determined by your doctor.
  • For hepatitis C virus infection, in combination with peginterferon alfa-2b:
    • For oral dosage form (capsules):
      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 800 to 1400 milligrams (mg) per day, given as two to three capsules in the morning and two to four capsules at night.
      • Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening.
      • Children younger than 3 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (solution):
      • Adults—Dose is based on body weight and must be determined by your doctor. The oral solution form of this medicine is not usually prescribed for adults and teenagers.
      • Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in two divided doses and taken in the morning and evening.
      • Children younger than 3 years of age—Use and dose must be determined by your doctor.
  • For hepatitis C virus infection, in combination with peginterferon alfa-2a:
    • For oral dosage form (tablets):
      • Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 800 to 1200 milligrams (mg) per day, given in 2 divided doses and taken in the morning and evening.
      • Children 5 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 400 to 1200 mg per day, given in 2 divided doses and taken in the morning and evening.
      • Children younger than 5 years of age—Use and dose must be determined by your doctor.
  • For hepatitis C with HIV virus coinfection, in combination with peginterferon alfa-2a:
    • For oral dosage form (tablets):
      • Adults—800 milligrams (mg) per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

Rebetol dosage is often based on your response to the treatment and whether you are experiencing any side effects.

Your healthcare provider may monitor toxicities through hemoglobin monitoring. Hemoglobin monitoring is a way to measure the function of your red blood cells. If hemoglobin is too low, a lower dose may be needed. You may also need a lower dose if your kidneys aren't working properly.

Missed Dose

If you miss a dose of Rebetol, take the next dose as soon as you remember. If it is close to the next dose, skip the missed dose and return to your normal schedule. You should not take more than one dose on the same day. If you do miss a dose, it may take longer than normal to clear the infection.

Overdose: What Happens If I Take Too Much Rebetol?

No specific dose indicates an overdose of Rebetol; still, you should not take more than prescribed. Neither is there a specific antidote for this drug, and conventional forms of removal such as dialysis are not viable.

The most common effects associated with an overdose of this drug are:

  • Kidney failure, which can be seen by lack of energy and fatigue, loss of appetite, muscle weakness, abnormal heartbeat, or loss of consciousness
  • Excessive bleeding
  • Heart attack

In an overdose, symptoms must be treated as soon as possible to reduce the risk of complications.

What Happens If I Overdose on Rebetol?

If you think you or someone else may have overdosed on Rebetol, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Rebetol, call 911 immediately.

Precautions

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It is very important that your doctor check the progress of you or your child at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. The medicine may also cause birth defects if the father is using it when his sexual partner becomes pregnant. If a pregnancy occurs while you are using this medicine, tell your doctor right away.

It is important to tell your doctor if you or your female sexual partner become pregnant. Your doctor may want you to join a pregnancy registry for patients taking this medicine.

A negative pregnancy test is needed in women who are of childbearing age before starting treatment with this medicine. Two forms of birth control must be used together during treatment and for 6 months after treatment ends. You will need to have pregnancy tests done regularly to make sure you are not pregnant while being treated with this medicine and after your treatment ends.

Do not use Copegus® in combination with didanosine (Videx®, Videx® EC). Using these medicines together may cause serious medical problems.

Ribavirin may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child's doctor right away.

Check with your doctor right away if you or your child have back, leg, or stomach pains; bleeding gums; chills; dark urine; difficulty breathing; fever; general body swelling; headache; loss of appetite; nausea or vomiting; nosebleeds; pale skin; sore throat; unusual tiredness or weakness; or yellowing of the eyes or skin. These could be symptoms of a blood disorder called anemia.

This medicine may cause serious types of allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Stop taking this medicine and call your doctor right away if you or your child have itching, hives, hoarseness, trouble with breathing, trouble with swallowing, or any swelling of the hands, face, or mouth while you are using this medicine.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin; fever or chills; hives or welts; red skin lesions; a severe skin rash or acne; or sores or ulcers on the skin while you are using this medicine.

Pancreatitis may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.

You or your teenager should not drink alcoholic beverages (including beer, wine, or liquor) while you are taking this medicine.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you or your teenager drive, operate machinery, or do anything else that could be dangerous if you are not alert.

Check with your doctor if blurred vision, decreased vision, or any other change in vision occurs while you or your child are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Peginterferon injection combined with ribavirin can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets in the blood, which are necessary for proper blood clotting. If this occurs, there are certain precautions you or your child can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

This medicine may cause teeth and gum problems. This medicine may cause dryness of the mouth, and a dry mouth may damage your teeth and gums if you take the medicine for a long time. To help prevent this condition, carefully brush your teeth at least two times a day and have regular visits with your dentist. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute.

Some patients who have used this medicine have had vomiting. If you vomit during your treatment, rinse your mouth out with water. This may also help prevent damage to your teeth and gums.

Ribavirin used together with injectable peginterferon alfa-2a or peginterferon alfa-2b may affect your child's growth. Your doctor may need to check your child's height and weight during and after treatment with these medicines.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Rebetol?

Do not take Rebetol if any of the following apply to you:

  • If you are pregnant or have a pregnant partner
  • If you have had Stevens-Johnson Syndrome and toxic epidermal necrolysis or symmetrical skin redness or rash after taking ribavirin or any component of the drug
  • If you have autoimmune hepatitis
  • If you have any blood disorder such as sickle-cell anemia
  • If you have poor kidney function, specifically measured by a creatinine clearance of less than 50 milliliters (mL) per minute

What Other Medications Interact With Rebetol?

Certain medications can interact with Rebetol, including:

  • Didanosine: Taking Rebetol and didanosine at the same time can increase concentrations of the active metabolite of didanosine in the body, which can cause liver failure, nerve damage, or inflammation of your pancreas.
  • Other nucleoside analogues, such as stavudine and zidovudine: The specific antiviral class that Rebetol belongs to is the nucleoside analogue class. Many drugs in this class carry similar side effects and toxicities. Taking these drugs together can increase the risk of complications, such as liver damage and anemia.
  • Azathioprine is commonly used after an organ transplant and in rheumatoid arthritis. Rebetol and azathioprine have similar side effects, such as muscle ache, fever, nausea, and fatigue. Taking these drugs together increases the risk of side effects and blood disorders, specifically pancytopenia and azathioprine-related bone marrow suppression.

What Medications Are Similar?

Rebetol is an antiviral drug in the nucleoside analogue drug class.

Epclusa (sofosbuvir and velpatasvir) is another medication sometimes used along with Rebetol to treat hepatitis C. However, it differs in its mechanism of action. Epclusa targets different viral enzymes to prevent the virus from multiplying.

Other antivirals used to treat hepatitis C include:

This is a list of drugs also prescribed for hepatitis C. It is NOT a list of drugs recommended to take with Rebetol. Discuss any questions or concerns about your medication with a healthcare provider or pharmacist.

Frequently Asked Questions

  • How can I manage the side effects of Rebetol?

    Take Rebetol with food and stay hydrated to lessen side effects such as nausea, upset stomach, and headaches. You can also minimize these side effects by having a healthy eating plan with ample amounts of fiber and nutrients. Tell your healthcare provider if side effects become intolerable, as they may prescribe a lower dose.

  • What should I do if I get pregnant or my partner gets pregnant while taking this drug or within six months of taking this medication?

    If pregnancy occurs, contact your healthcare provider immediately to stop the medication and get medical advice on the next step. If you are a female, protect yourself from pregnancy for nine months after treatment. If you have a female partner, they should avoid becoming pregnant within nine months after your last dose. Use at least two types of birth control during and after treatment.

  • How much does Rebetol cost? Is there a way I can get help paying for it?

    Rebetol can be an expensive medication. How much you pay will depend on your health insurance and pharmacy. However, a generic version is available if you cannot afford the brand name. It has the same active ingredient and works just as well. Talk to your healthcare team if you need further financial assistance, as special patient assistance programs might be available through the manufacturer or nonprofit organizations.

How Can I Stay Healthy While Taking Rebetol?

To stay healthy while taking Rebetol, it is important to take it exactly as your pharmacist or healthcare provider directed. Taking it consistently will help treat HCV and prevent long-term complications like liver damage.

Drink plenty of water and take your doses with food to reduce side effects such as headache, nausea, and upset stomach. Adhering to a healthy eating plan can also help. If nausea is a problem for you, avoid acidic, spicy, sweet, or greasy foods, and stick to clear fluids and dry foods like toast and crackers.

You are likely taking other medications along with Rebetol. Take all medications as prescribed, following the dosing instructions for each. If you have trouble remembering when to take your doses, try using a pill box or reminder app to track your regimen.

Don't hesitate to discuss any questions or concerns with your healthcare team. They are there to help you through your journey and get you healthy again.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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