8 mins read

Overview: Ribavirin is commonly used to treat chronic hepatitis C virus (HCV) infection. It works by interfering with how the virus makes copies of itself. Common side effects include feeling unusually weak or tired, headache, fever, nausea, vomiting, loss of appetite, and muscle aches.

Uses

What is ribavirin used for?

Ribavirin is commonly used to treat chronic hepatitis C virus (HCV) infection.

Ribavirin may also be used for other conditions as determined by your health care provider.

See also: Ribavirin inhaled (Virazole)

How does ribavirin work (mechanism of action)?

Ribavirin interferes with how the hepatitis C virus makes copies of itself, which helps your body get rid of the infection.

How is ribavirin supplied (dosage forms)?

Brands and other names

  • Copegus
  • Moderiba
  • Rebetol
  • RibaPak
  • Ribasphere
  • RibaTab

Dosage forms and strengths

  • 200 mg oral capsules
  • 200 mg oral tablets

How should I store ribavirin?

Ribavirin should be stored tightly closed at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of ribavirin?

The most common side effects of ribavirin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Blood disorders (see below)
  • Feeling unusually weak or tired
  • Headache
  • Shivering
  • Fever
  • Nausea, vomiting, diarrhea
  • Muscle or joint aches
  • Mood changes or trouble sleeping
  • Loss of appetite 

There may be other side effects of ribavirin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of ribavirin?

While less common, the most serious side effects of ribavirin are described below, along with what to do if they happen.

Blood Disorders. Ribavirin may cause your red blood cells to be destroyed, which is called hemolytic anemia. Your health care provider may run tests and stop ribavirin if you have hemolytic anemia.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking ribavirin. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish (also called jaundice)

Severe Skin Reactions. Ribavirin can cause severe skin reactions, called Stevens-Johnson syndrome (SJS), that can lead to death if not treated. If you develop a rash, stop ribavirin and call your health care provider right away. Get emergency help if you have any of the following symptoms of SJS.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes
  • Flu-like symptoms, including fever, chills, and muscle aches

Severe Depression or Suicidal Thoughts. Ribavirin may increase the risk of suicidal thoughts or actions. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you are about to harm yourself, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your health care provider right away if you have any of the following symptoms.

  • New or increased thoughts of suicide or death
  • Suicide attempt
  • New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior

Pneumonia. Pneumonia is an infection of the lungs that can make it hard to breathe. Some people taking ribavirin have developed pneumonia. Contact your health care provider right away if you have any of the following symptoms of pneumonia.

  • Trouble breathing
  • Increased mucus or change in mucus color
  • Worsening cough
  • Fever or chills

Bone Marrow Suppression. Ribavirin may cause your bone marrow to not make enough cells. This can lead to low blood levels of important cells, such as red blood cells, white blood cells, platelets, and neutrophils. Bone marrow suppression can lead to infections or bleeding. This can be serious or even life-threatening. Keep all appointments to have your blood checked. Tell your health care provider right away if you have any of the following symptoms of bone marrow suppression.

  • Fever
  • Shortness of breath
  • Pale or yellowish skin
  • Easy bruising or bleeding
  • Frequent infections
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache
  • Fast or abnormal heartbeat

Inflammation of the Pancreas (Pancreatitis). Ribavirin may cause inflammation of the pancreas, which is called pancreatitis. Stop taking ribavirin and call your health care provider right away if you have symptoms of pancreatitis, including vomiting or severe pain in the upper part of your belly that travels to your back.

Vision Problems. Ribavirin may increase your risk of eye problems or cause eye problems to get worse. Call your health care provider right away if you notice any change in vision while taking this medicine.

Dental Problems. Ribavirin may cause tooth decay and gum disease. Tell your health care provider if you have any of the following symptoms.

  • Sudden tooth pain, particularly when you drink or eat cold, hot, or sweet things
  • Pain when biting or chewing
  • Gums that bleed when you brush your teeth
  • Pain or tenderness in the gums

Severe Allergic Reactions. Ribavirin may cause allergic reactions, which can be serious. Stop taking ribavirin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Warnings & Precautions

Who should not use ribavirin?

Allergies to Ingredients. People who are allergic to any of the following should not take ribavirin.

  • Copegus
  • Moderiba
  • Rebetol
  • RibaPak
  • Ribasphere
  • RibaTab
  • Ribavirin
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific ribavirin products they stock.

Pregnancy. Ribavirin should not be taken if you are pregnant or are planning to become pregnant. If your sexual partner is pregnant, you should not take ribavirin.

Liver Problems. Ribavirin should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to determine if it is working well enough to take this medicine.

Kidney Problems. Ribavirin should not be taken if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your health care provider may do tests to determine if they are working well enough to take this medicine.

Blood Disorders. Ribavirin should not be taken if you have a blood disorder, such as thalassemia or sickle-cell anemia.

Drug Interactions. Ribavirin should not be taken while you are using certain other medicines. Before taking ribavirin, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about ribavirin before using it?

Do not take ribavirin unless it has been prescribed to you by a health care provider. Take it as prescribed.

Each dose of ribavirin should be taken with food. If you are taking ribavirin capsules, swallow them whole (do not chew, cut, or crush them). 

Do not share ribavirin with other people, even if they have the same condition as you. It may harm them.

Keep ribavirin out of the reach of children.

Ribavirin can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how ribavirin affects you.

Your health care provider will likely ask you to get lab tests done prior to starting this medicine and routinely while you are taking it. This is to monitor your blood counts and liver function.

Your health care provider will likely perform an eye exam before starting this medicine.

What should I tell my health care provider before using ribavirin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if ribavirin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Liver problems, including hepatitis B
  • Previously failed treatment for hepatitis C 
  • Lung problems
  • Dental problems
  • Vision problems
  • Blood disorders
  • Diabetes
  • Thyroid problems
  • High blood pressure
  • Heart problems, including history of heart attack
  • HIV or AIDS
  • Weakened immune system
  • Organ transplant recipient
  • Mental health problems, including substance use disorder

Pregnancy. Ribavirin may cause harm to a fetus. Tell your health care provider if you are pregnant or plan to become pregnant. If you can become pregnant, your health care provider will likely ask you to get a pregnancy test before starting this medicine. Effective birth control is recommended while taking ribavirin and for nine months after stopping it. Talk to your health care provider about which birth control option is best for you. If your sexual partner can become pregnant, you must use effective birth control while taking ribavirin and for six months after stopping it.

Breastfeeding. It is not known if ribavirin passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should take ribavirin while breastfeeding.

Interactions

Does ribavirin interact with foods or drinks?

There are no known interactions between ribavirin and foods or drinks.

Do not drink alcohol while taking ribavirin. Drinking alcohol while taking ribavirin could increase the risk for liver damage or cause your hepatitis C infection to worsen.

Does ribavirin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using ribavirin.

  • A medicine for HIV, AIDS, or hepatitis C
  • Azathioprine, which is a medicine that suppresses your immune system

This may not be a complete list of medicines that can interact with ribavirin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much ribavirin?

If you or someone else has used too much ribavirin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of ribavirin?

If you miss a dose, take it as soon as you remember on the same day. If it is the next day, skip the missed dose and only take the next dose. Do not take double or extra doses.

Missing doses of ribavirin can cause it to not work as well over time. So it is important not to miss or skip doses.