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Ribavirin (Virazole)
(rye-bah- VYE-rin)
Pregnancy Category: X Virazole (Rx)

Classification: Antiviral agent

See Also: See also Antiviral Drugs.

Action/Kinetics: Has antiviral activity against respiratory syncytial virus (RSV), influenza virus, and HSV. Precise mechanism not known; may act as a competitive inhibitor of cellular enzymes that act on guanosine and xanthosine. Ribavirin is distributed to the plasma, respiratory tract, and RBCs and is rapidly taken up by cells. t 1/2 from plasma: 9.5 hr; from RBCs: 40 days. Eliminated through both the urine and feces.

Uses: Hospitalized pediatric clients (including infants) with severe lower respiratory tract infections (viral pneumonia including bronchiolitis) due to RSV. Underlying conditions, such as prematurity or cardiopulmonary disease, may increase the severity of the RSV infection. Ribavirin is intended to be used along with standard treatment (including fluid management) for such clients with severe lower respiratory tract infections. Investigational: Ribavirin aerosol has been used against influenza A and B. Oral ribavirin has been used against herpes genitalis, acute and chronic hepatitis, measles, and Lassa fever.

Contraindications: Use in adults. Infants requiring artificial respiration (the drug may precipitate in the equipment and interfere with appropriate ventilation of the client). Children with mild RSV lower respiratory tract infections who require a shorter hospital stay than required for a full course of ribavirin therapy. Pregnancy or women who may become pregnant during drug therapy (the drug may cause fetal harm and is known to be teratogenic). Lactation.

Special Concerns: Deterioration of respiratory function in infants with COPD or asthma.

Side Effects: Pulmonary: Worsening of respiratory status, pneumothorax, apnea, bacterial pneumonia, dependence on ventilator, bronchospasm pulmonary edema, hypoventilation, cyanosis, dyspnea, atelectasis. CV: Hypotension, cardiac arrest manifestations of digitalis toxicity, bradycardia, bigeminy, tachycardia. Hematologic: Anemia (with IV or PO ribavirin), reticulocytosis. Other: Conjunctivitis and rash (with the aerosol).
NOTE: The following symptoms have been noted in health care workers: headache, conjunctivitis, rhinitis, nausea, rash, dizziness, pharyngitis, lacrimation, bronchospasm, chest pain. Also, damage to contact lenses after prolonged close exposure to the aerosolized product.

How Supplied: Lyophilized powder for aerosol reconstitution: 6 g

?Aerosol Only, to an Infant Oxygen Hood Using the Small Particle Aerosol Generator-2 (SPAG-2)
The concentration administered is 20 mg/mL and the average aerosol concentration for a 12-hr period is 190 mcg/L of air. Treatment is continued for 12-18 hr a day for 3 (minimum)-7 days (maximum). See Administration/Storage.