Nucleoside antiviral

Ribavirin

Brand names: Copegus, Rebetol

Adult dose

Dose: Chronic hepatitis C: 800–1,400mg/day PO in 2 divided doses (weight-based, with DAA). Viral haemorrhagic fevers: per UKHSA

Route: PO/IV

Frequency: BD

Dose adjustments

Renal

Avoid if CrCl <50; reduce in moderate impairment

Clinical pearls

Hepatitis C (with DAAs in selected genotypes); now largely replaced by DAA-only regimens
Pregnancy prevention 6 months post-treatment in both sexes

Contraindications

Pregnancy (teratogen — both partners)
Severe heart disease
Haemoglobinopathies
Severe renal impairment
Autoimmune hepatitis

Side effects

Haemolytic anaemia (dose-limiting)
Cough
Pruritus
Teratogenicity
Pancreatitis
Pulmonary deterioration (RSV — controversial)

Interactions

Didanosine (avoid)
Zidovudine (anaemia)
Azathioprine

Monitoring

FBC weekly initially
Pregnancy testing
TFTs

Reference: BNF; NICE TA75; UKHSA; https://bnf.nice.org.uk/drugs/ribavirin/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways