What Are the Adverse Effects of Ribavirin Treatment?

Ribavirin Is an Antiviral Medication Taken With Interferon

Man asleep in bed
Tara Moore/Stone/Getty Images

Ribavirin (also known as Copegus or Rebetol) is an antiviral drug that treats hepatitis C and is always prescribed with an interferon (usually peginterferon). Side effects from the combination of ribavirin and interferon (or peginterferon) are common and some people can have them so severe that they interfere with treatment. Since ribavirin can't be used alone as a hepatitis C treatment, the side effects are actually from the combination of ribavirin and an interferon.

Here is a list of the most common side effects:

  • Anemia, a blood disorder where there aren't enough red blood cells to carry oxygen. The result is that you're tired. After about two weeks of ribavirin treatment, about 10% of people develop a severe form of anemia.
  • Headache
  • Irritability and anxiety
  • Depression. Sometimes people taking ribavirin develop severe depression and can even have suicidal thoughts. These side effects, along with general irritability, are unofficially known as Riba Rage, even though they're really caused by the interferon. For most people, these side effects can be controlled with antidepressants or other medicines. It's important to look for signs of behavioral change during treatment so your doctor can help control any developing depression as quickly as possible. For people with known psychiatric problems, it's possible your doctor will want to start you on a preventative therapy before you start treatment. Some people with severe depression or a history of suicidality may not be able to start treatment of hepatitis C.
  • Alopecia (hair loss)
  • Itchiness
  • Insomnia (having trouble sleeping)
  • Arthralgia (joint pain)
  • Myalgia (muscle pain)
  • Anorexia (loss of appetite)
  • Neutropenia. Neutropenia is a blood disorder caused by a loss of neutrophils, a type of white blood cell that destroys bacteria. Neutropenia is probably the result of decreased bone marrow function, which the combination therapy suppresses, and may mean your body will have trouble fighting off bacterial infections.
  • Nausea and vomiting
  • Fever
  • Chills
  • Fatigue (tiredness)

Some people may experience many more side effects.

What Exactly Is Ribavirin?

Ribavirin belongs to a class of antiviral medications called nucleoside analogues. When taken with interferon, such as peginterferon alfa-2a (Pegasys) or peginterferon alpha-2b (PEG-Intron), Ribavirin helps stop the spread of hepatitis C in the body. It is unclear whether Ribavirin combined with other medications is actually curative, prevents the spread of hepatitis C to other people or prevents further liver damage.

Ribavirin is taken orally as a capsule, tablet or oral solution. Ribavirin is usually taken with food twice a day. Ribavirin capsules need to be swallowed intact and not split. When taking liquid Ribavirin, it's important to shake the solution well and use a measuring spoon.

Can Ribavirin Treat Diseases Other Than Hepatitis?

Interestingly, Ribavirin can be used to treat viral hemorrhagic fever caused by diseases like Ebola. Ebola is a deadly disease spread by direct contact with body fluids or blood.

Ebola is a disease that made headlines the world over when there was the largest Ebola outbreak ever in West Africa in 2014. Fortunately, the chances that an Ebola outbreak will occur in the United States is low.

Ribavirin may also be used to treat severe acute respiratory syndrome (SARS).


Copegus Prescribing Information and Medical Guide

Katzung, BG. Basic and Clinical Pharmacology, 10e. New York, McGraw-Hill, 2007.

Rebetol Product Information.

Continue Reading