Adverse Effects Contraindications and Drug Interactions

Most adverse effects associated with aerosol ribavirin are local. Pulmonary function may decline if aerosol rib-avirin is used in adults with chronic obstructive lung disease or asthma. Deterioration of pulmonary and cardiovascular function has also been seen in severely ill infants given this preparation. Rash, conjunctivitis, and rare cases of anemia have been reported. Health care workers exposed to aerosol ribavirin during its adminis tration have reported adverse effects including headache, conjunctivitis, rash, and rarely, bronchospasm.

Oral and intravenous ribavirin are associated with additional adverse effects. When given via these routes, ribavirin can produce hemolytic anemia that is reversible following dosage reduction or cessation of therapy. When given in combination with interferon-a, rib-avirin increases the incidence of many of its side effects, such as fatigue, nausea, insomnia, depression, and anemia, and may cause fatal or nonfatal pancreatitis. Ribavirin is mutagenic, teratogenic, and embryotoxic in animals at doses below the therapeutic level in humans. It is contraindicated in pregnant women and in the male partners of pregnant women. Women of childbearing potential and male partners of these women must use two effective forms of contraception during ribavirin treatment and for 6 months post therapy. Pregnant women should not directly care for patients receiving ribavirin.

Ribavirin is contraindicated in patients with sickle cell anemia and other hemoglobinopathies because of its propensity to cause anemia. Similarly, persons with coronary disease should not use ribavirin, because anemia may cause deterioration of cardiac function. Oral ribavirin should not be given to individuals with severe renal impairment; no dosage adjustment is necessary for the inhaled formulation. However, patients with hepatic impairment may require dosage adjustment.

Little information on the drug interactions of ribavirin is available. In vitro, ribavirin inhibits the phos-phorylation reactions that are required for activation of zidovudine and stavudine.

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