Hepatitis C and Riba Rage Side Effects

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Question: What Is Riba Rage?

Answer: Riba rage is the popular, though misleading, the name for certain side effects from treating chronic hepatitis. Chronic hepatitis C is usually treated with a combination of two drugs: pegylated interferon (either Peginterferon Alfa-2a or Peginterferon Alfa-2b) and ribavirin. This combination therapy is considered to have good treatment results, with sustained response rates up to 55% in many patients with Hepatitis C Virus (HCV) genotype 1.

This means that more than half of the patients using this treatment will have undetectable levels of HCV in their blood 6 months after finishing treatment. For people with HCV genotypes 2 or 3, the sustained response rate is up to 80%.

While patients generally get good results from this treatment combination, interferon has some nasty side effects. Two of these are depression and general irritability. The type of intense depression and irritability that "heppers" (people with hepatitis) experience while on treatment occurs often enough that it's commonly known as "riba rage," even though it isn't really caused by the ribavirin.

Patients and family members should be aware of any behavior changes during treatment, because most cases of riba rage, if not all, can be controlled with appropriate medical intervention.

For those patients who know they already have problems with depression or mood problems, they should be considered for antidepressant therapy at the start of treatment. For those who have had previous problems with depression but are not currently experiencing problems, they should be monitored closely by a mental health team who can quickly begin appropriate treatment.

Be sure to seek out a supportive and experienced treatment team that can anticipate and manage these side effects quickly and efficiently.


Friedman L. Liver, Biliary Tract, & Pancreas. In: McPhee S, Papadakis, M, Tierney, L (eds), Current Medical Diagnosis and Treatment 2007, 46e. McGraw-Hill, 2007. 667.

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