Ribavirin

Asian Intensive Care: coming of age
International intensive care conference, Hong Kong, December 14th-15th
Register now!
Click here for details

Ribavirin (1-ß-D-ribofuranosyl-1,2,4-triazole). Broad spectrum antiviral nucleoside.

Pharmacokinetics

• Administration
  • oral
  • inhalation
  • intravenous
  • topical
• Inside cells metabolized from nucleoside to ribavirin monophosphate and then diphosphate and triphosphate

Mode of action

Hypotheses include:

• ribovarin monophosphate inhibits inosine monophosphate dehydrogenase which results in decreased synthesis of guanosine triphosphate (GTP). GTP is required for translation, DNA and RNA virus transcription and RNA virus replication
• inhibition of capping of viral transcripts
• direct inhibition of viral RNA polymerase by ribavirin triphosphate
• modulation of immune response resulting in a reduction of immune-mediated tissue damage
• ribavirin triphosphate is utilized by viral RNA-dependent RNA polymerase and causes lethal mutagenesis of the viral genome

Clinical uses

• hepatitis C virus infection (with interferon-alpha)
• severe respiratory syncytial vius infection
• Lassa fever
• some herpes virus infections
• used experimentally to treat:
  • hepatitis B infection
  • Hantaan virus
  • dengue
  • parainfluenza virus
  • adenovirus
  • severe acute respiratory syndrome

Adverse effects

• teratogenesis
• interferes with sperm development
• haemolysis
• inhaled form:
  • may precipitate in ventilator and interfere with its function
  • COPD and asthma for deterioration of respiratory function
• fatigue, headache, insomnia
• nausea, anorexia

Drug interactions

Interacts with other antiretroviral agents including adefovir, didanosine, lamivudine, stavudine, zalcitabine and zidovudine

Further reading

Cameron CE, Castro C. The mechanism of action of ribavirin: lethal mutagenesis of RNA virus genomes mediated by the viral RNA-dependent RNA polymerase. Current Opinion in Infectious Diseases, 2001; 14:757-64

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
Copyright policy    Contributors