Rivabirin and PEG-Interferon Alfa-2A dual therapy is associated with flu-like symptoms, depression, suicide, insomnia, irritability, relapse of drug abuse/overdose, hepatic decompensation in 2% of HIV co-infected patients and bacterial infections each occurring at a frequency of less than 1%.
Ribavirin-induced anemia is a dose-dependent adverse effect where reduced hemoglobin levels can be seen within the first 1-2 weeks in therapy. The mechanism of ribavirin-induced anemia has been shown to involve reductions in reticulocyte counts and erythrocyte Na-K pump activity, and increases in K-Cl cotransport, membrane bound IgG, and C3, and erythrocyte band 3 A19644.
Oral LD50 in rats is 2700 mg/kg. Intraperitoneal LD50 in mouse is 1300 mg/kg. Potential carcinogenic effects of ribavirin to humans cannot be yet excluded as it demonstrates mutagenic activity in the in vitro mouse lymphoma assay.
Producing a broad-spectrum activity against several RNA and DNA viruses, Ribavirin is a synthetic guanosine nucleoside and antiviral agent that interferes with the synthesis of viral mRNA. It is primarily indicated for use in treating hepatitis C and viral hemorrhagic fevers. HCV is a single-stranded RNA virus that is categorized into nine distinct genotypes, with genotype 1 being the most common in the United States, and affecting 72% of all chronic HCV patients L852. It is reported that ribavirin might be only effective in early stages of viral hemorrhagic fevers including Lasser fever, Crimean-Congo hemorrhagic fever, Venezuelan hemorrhagic fever, and Hantavirus infection. Ribavirin is a prodrug that is metabolized into nucleoside analogs that blocks viral RNA synthesis and viral mRNA capping. Before the development of newer drugs, ribavirin and DB00008/DB00022 dual therapy was considered the first-generation and standard antiviral treatment A19626. The dual therapy was administered for 48 weeks in patients with genotype 1, 4, 5, and 6, and 24 weeks in patients with genotype 2 and 3 A19626. Newer drugs developed as Hepatitis C viral infection treatments can be used to reduce or eliminate the use of ribavirin, which are associated with serious adverse effects. They also improve therapeutic efficacy in patients with failed DB00008/DB00022 and ribavirin-based therapy. The potential use of ribavirin as a treatment for acute myeloid leukemia is currently under investigation.
According to 2017 American Association for the Study of Liver Diseases (AASLD) and 2015 consensus guidelines from the Canadian Association for the Study of the Liver (CASL), ribavirin is typically used as an adjunct therapy to various first-line and second-line combination therapies recommended for each genotypes. Ribavirin is added to decrease relapse rates by accelerating viral clearance early in the treatment course A19645. When used to treat Hepatitis C virus (HCV) infections, it is always used as a part of combination therapies as ribavirin monotherapy is not efficacious in the treatment of chronic hepatitis C infection A19644. Additionally, including ribavirin in the regimen can increase the risk of anemia.
In HCV genotye 1/2/3/4/5/6 patients, ribavirin can be used in combination therapy involving DB09102 and DB08934, Eplusa (DB08934, DB11613), Harvoni (DB08934, DB09027), DB06290 and DB08934, Viekira Pak (DB09296, DB09297, DB00503, DB09183), Technivie (DB00503, DB09296, DB09297) and Zepatier (DB11574, DB11575). Addition of weight-based ribavirin to Technivie therapy increased sustained virologic response after 12 weeks of daily therapy (SVR12) from 90% to 97% in patients with HCV genotype 1a and 90.9% to 100% in HCV genotype 4 patients L852. Zepatier therapy along with ribavirin improved SVR in HCV genotype 5 patients. Combination therapy of ribavirin and DB00008 results in the SVR of 44% in patients with genotype 1 infection and 70% in patients with genotype 2-6. The inclusion of ribavirin in the combination therapies depend on individual patient's profile, for example if HCV genotype 3 patient has a Y93H genetic variant and compensated cirrhosis.
Fitur visualisasi ini dikembangkan menggunakan pendekatan Graph Theory untuk memetakan hubungan polifarmasi dan molekuler. Entitas (Obat, Target, Gen) direpresentasikan sebagai Simpul (Nodes), sedangkan hubungan biologisnya sebagai Sisi (Edges).
drugbank-id dan name pada skema XML DrugBank.targets/target yang memuat polipeptida sasaran.gene-name dan varian snp-effects.Tata letak grafik menggunakan algoritma Force-Directed Graph (Barnes-Hut). Model fisika ini menerapkan gaya tolak-menolak antar simpul (Gravitasi: -3000) agar tidak tumpang tindih, serta gaya pegas (Spring: 0.04) pada garis penghubung untuk fleksibilitas interaksi.
Patients with this genotype in IFNL3 have a reduced likelihood of achieving sustained virologic response to ribavirin therapy.
| Interferon alfa-n3 | The risk or severity of anemia can be increased when Interferon alfa-n3 is combined with Ribavirin. |
| Interferon alfa-2a | The risk or severity of anemia can be increased when Interferon alfa-2a is combined with Ribavirin. |
| Interferon alfacon-1 | The risk or severity of anemia can be increased when Interferon alfacon-1 is combined with Ribavirin. |
| Interferon alfa-2b | The risk or severity of anemia can be increased when Interferon alfa-2b is combined with Ribavirin. |
| Entecavir | Ribavirin may increase the hepatotoxic activities of Entecavir. |
| Stavudine | Ribavirin may increase the hepatotoxic activities of Stavudine. |
| Lamivudine | Ribavirin may increase the hepatotoxic activities of Lamivudine. |
| Emtricitabine | Ribavirin may increase the hepatotoxic activities of Emtricitabine. |
| Zalcitabine | Ribavirin may increase the hepatotoxic activities of Zalcitabine. |
| Abacavir | Ribavirin may increase the hepatotoxic activities of Abacavir. |
| Telbivudine | Ribavirin may increase the hepatotoxic activities of Telbivudine. |
| Adefovir | Ribavirin may increase the hepatotoxic activities of Adefovir. |
| Tenofovir | Ribavirin may increase the hepatotoxic activities of Tenofovir. |
| Zidovudine | The risk or severity of adverse effects can be increased when Zidovudine is combined with Ribavirin. |
| Azathioprine | The serum concentration of the active metabolites of Azathioprine can be increased when Azathioprine is used in combination with Ribavirin. |
| Didanosine | The serum concentration of dideoxyadenosine 5’-triphosphate, an active metabolite of Didanosine, can be increased when used in combination with Ribavirin. |
| Cyclosporine | Cyclosporine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Icosapent | Icosapent may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefotiam | Cefotiam may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Mesalazine | Mesalazine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefmenoxime | Cefmenoxime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefmetazole | Cefmetazole may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Pamidronic acid | Pamidronic acid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Tenofovir disoproxil | Tenofovir disoproxil may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Indomethacin | Indomethacin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cidofovir | Cidofovir may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefpiramide | Cefpiramide may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ceftazidime | Ceftazidime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Loracarbef | Loracarbef may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefalotin | Cefalotin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Nabumetone | Nabumetone may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ketorolac | Ketorolac may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Tenoxicam | Tenoxicam may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Celecoxib | Celecoxib may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefotaxime | Cefotaxime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Tolmetin | Tolmetin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Foscarnet | Foscarnet may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Rofecoxib | Rofecoxib may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Piroxicam | Piroxicam may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Methotrexate | Methotrexate may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cephalexin | Cephalexin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Fenoprofen | Fenoprofen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Valaciclovir | Valaciclovir may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Valdecoxib | Valdecoxib may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Diclofenac | Diclofenac may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Sulindac | Sulindac may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Bacitracin | Bacitracin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Amphotericin B | Amphotericin B may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cephaloglycin | Cephaloglycin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Flurbiprofen | Flurbiprofen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Adefovir dipivoxil | Adefovir dipivoxil may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Pentamidine | Pentamidine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Etodolac | Etodolac may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Mefenamic acid | Mefenamic acid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Acyclovir | Acyclovir may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Naproxen | Naproxen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Sulfasalazine | Sulfasalazine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Phenylbutazone | Phenylbutazone may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Meloxicam | Meloxicam may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Carprofen | Carprofen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefaclor | Cefaclor may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Diflunisal | Diflunisal may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Tacrolimus | Tacrolimus may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ceforanide | Ceforanide may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Salicylic acid | Salicylic acid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Meclofenamic acid | Meclofenamic acid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Acetylsalicylic acid | Acetylsalicylic acid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Carboplatin | Carboplatin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Oxaprozin | Oxaprozin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ketoprofen | Ketoprofen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Balsalazide | Balsalazide may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ibuprofen | Ibuprofen may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefditoren | Cefditoren may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Atazanavir | Atazanavir may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Colistimethate | Colistimethate may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefuroxime | Cefuroxime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefapirin | Cefapirin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefadroxil | Cefadroxil may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefprozil | Cefprozil may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ceftriaxone | Ceftriaxone may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Olsalazine | Olsalazine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Lumiracoxib | Lumiracoxib may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefamandole | Cefamandole may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefazolin | Cefazolin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefonicid | Cefonicid may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefoperazone | Cefoperazone may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefotetan | Cefotetan may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefoxitin | Cefoxitin may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ceftizoxime | Ceftizoxime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefradine | Cefradine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Magnesium salicylate | Magnesium salicylate may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Salsalate | Salsalate may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Choline magnesium trisalicylate | Choline magnesium trisalicylate may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefepime | Cefepime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefacetrile | Cefacetrile may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Ceftibuten | Ceftibuten may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Cefpodoxime | Cefpodoxime may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Antrafenine | Antrafenine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Aminophenazone | Aminophenazone may decrease the excretion rate of Ribavirin which could result in a higher serum level. |
| Antipyrine | Antipyrine may decrease the excretion rate of Ribavirin which could result in a higher serum level. |