antibioticsbooks

250 PART 5 Antiviral Drugs
administered with oral ribavirin, can exacerbate
this effect because they cause cytopenias as well.
Ribavirin is also associated with fatigue, headaches,
and insomnia, though it is difficult to determine
whether ribavirin itself, interferons, or the
combination are responsible. In practice it does
not matter as the effects must be managed during
combination therapy.
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Important Facts
• Ribavirin must always be used in combination
with pegylated interferon for the treatment
of HCV infection. As monotherapy, ribavirin
rapidly leads to resistant-mutants of HCV.
• Ribavirin causes birth defects and is pregnancy
category X. Fertile women taking ribavirin
should use reliable contraception. Pregnant
women must also avoid aerosolized ribavirin
and pregnant healthcare workers should avoid
caring for patients receiving it, if possible.
• The primary means of managing ribavirininduced
anemia is dose-reduction. While it
seems natural to be concerned that this may
lead to a loss of effectiveness, that is not the
case (in fact, the opposite may be true). If anemia
becomes severe or persistent, erythropoietin
can be given.
• Aerosolized ribavirin is principally used to
treat RSV infection in young children, but it has
also been used to treat RSV in immunocompromised
adults, most notably patients with lung
or hematopoietic stem cell transplants.