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Ribavirin Dosage

Medically reviewed by Drugs.com. Last updated on Jul 31, 2023.

Applies to the following strengths: 200 mg; 200 mg-400 mg; 400 mg; 400 mg-600 mg; 600 mg; 40 mg/mL; 6 g; 500 mg

Usual Adult Dose for Chronic Hepatitis C

CAPSULES, ORAL SOLUTION:
In combination with peginterferon alfa-2b:
Less than 66 kg: 400 mg orally twice a day
66 to 80 kg: 400 mg orally in the morning and 600 mg in the evening
81 to 105 kg: 600 mg orally twice a day
Greater than 105 kg: 600 mg orally in the morning and 800 mg in the evening

Duration of therapy:


In combination with interferon alfa-2b:
75 kg or less: 400 mg orally in the morning and 600 mg in the evening
Greater than 75 kg: 600 mg orally twice a day

Duration of therapy:

Comments:

Approved indication: In combination with peginterferon alfa-2b or interferon alfa-2b, for treatment of chronic hepatitis C in patients with compensated liver disease

TABLETS:
In combination with peginterferon alfa-2a:

Comments:

Approved indication: In combination with peginterferon alfa-2a, for treatment of patients with chronic hepatitis C who have compensated liver disease and have not been previously treated with interferon alfa

Usual Adult Dose for Respiratory Syncytial Virus

(Not approved by FDA)

Case Review: One vial (6 g) dissolved and delivered through a Small Particle Aerosol Generator (SPAG-2) over a continuous 22-hour period, daily for 5 consecutive days

Usual Pediatric Dose for Respiratory Syncytial Virus

20 mg/mL as the starting solution in the drug reservoir of the SPAG-2 unit, with continuous aerosol administration for 12 to 18 hours per day for 3 to 7 days

Comments:


Approved indication: For treatment of hospitalized infants and young children with severe lower respiratory tract infections due to respiratory syncytial virus

Usual Pediatric Dose for Chronic Hepatitis C

CAPSULES, ORAL SOLUTION:
3 years or older:
In combination with peginterferon alfa-2b or interferon alfa-2b: 15 mg/kg orally per day in 2 divided doses

Ribavirin dosages according to weight:
Less than 47 kg: 15 mg/kg (oral solution) orally per day in 2 divided doses
47 to 59 kg: 400 mg orally twice a day
60 to 73 kg: 400 mg orally in the morning and 600 mg in the evening
Greater than 73 kg: 600 mg orally twice a day

Duration of therapy:


Comments:

Approved indication: In combination with peginterferon alfa-2b or interferon alfa-2b, for treatment of chronic hepatitis C in patients with compensated liver disease

TABLETS:
5 years or older:
In combination with peginterferon alfa-2a:
23 to 33 kg: 200 mg orally twice a day
34 to 46 kg: 200 mg orally in the morning and 400 mg in the evening
47 to 59 kg: 400 mg orally twice a day
60 to 74 kg: 400 mg orally in the morning and 600 mg in the evening
75 kg or more: 600 mg orally twice a day

Duration of therapy:

Comments:

Approved indication: In combination with peginterferon alfa-2a, for treatment of patients with chronic hepatitis C who have compensated liver disease and have not been previously treated with interferon alfa

Renal Dose Adjustments

CAPSULES, ORAL SOLUTION:
CrCl less than 50 mL/min: Contraindicated

TABLETS:
Adults:
In combination with peginterferon alfa-2a:
CrCl 30 to 50 mL/min: Alternating doses, 200 mg and 400 mg orally every other day
CrCl less than 30 mL/min: 200 mg orally once a day

Comments:


Pediatrics: Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage must be individualized to patient's specific disease characteristics (e.g., genotype), preexisting cardiac disease, and development of side effects or laboratory abnormalities.

If severe side effects or laboratory abnormalities develop during combination therapy, the dose should be modified or discontinued, if appropriate, until the side effects abate or decrease in severity. Combination therapy should be discontinued if intolerance persists after dose adjustment.

ADULTS (with normal renal function):
CAPSULES, ORAL SOLUTION:
Hemoglobin (Hgb) 8.5 to less than 10 g/dL in patients without history of cardiac disease:
First dose reduction: Dose should be reduced by 200 mg/day (except in patients receiving 1400 mg/day, dose should be reduced by 400 mg/day).
Second dose reduction (if needed): Dose should be reduced by an additional 200 mg/day.

2 g/dL or greater decrease in Hgb during any 4 week period during therapy in patients with history of stable cardiac disease: Dose should be permanently reduced by 200 mg/day.

Interferon alfa-2b (pegylated or nonpegylated) plus ribavirin should be discontinued if:


Discontinuation of therapy:

TABLETS:
Patients with no cardiac disease:
Hgb less than 10 g/dL: 200 mg orally in the morning and 400 mg in the evening
Hgb less than 8.5 g/dL: Discontinue.

Patients with history of stable cardiac disease:
2 g/dL or greater decrease in Hgb during any 4 week period: 200 mg orally in the morning and 400 mg in the evening
Hgb less than 12 g/dL despite 4 weeks at reduced dose: Discontinue.

Comments:

Discontinuation of therapy:

PEDIATRICS (with normal renal function):
CAPSULES, ORAL SOLUTION:
Hgb 8.5 to less than 10 g/dL in patients without history of cardiac disease:
First dose reduction: Dose should be reduced to 12 mg/kg/day orally in 2 divided doses.
Second dose reduction (if needed): Dose should be reduced to 8 mg/kg/day orally in 2 divided doses.

2 g/dL or greater decrease in Hgb during any 4 week period during therapy in pediatric patients with preexisting cardiac conditions: Weekly evaluations and hematology testing are recommended.

Interferon alfa-2b (pegylated or nonpegylated) plus ribavirin should be discontinued if:

Discontinuation of therapy:

TABLETS:
Hgb less than 10 g/dL in patients with no cardiac disease or decrease in Hgb of 2 g/dL or more during any 4 week period in patients with history of stable cardiac disease:
23 to 33 kg: 200 mg orally in the morning
34 to 59 kg: 200 mg orally twice a day
60 kg or more: 200 mg orally in the morning and 400 mg in the evening

Hgb less than 8.5 g/dL in patients with no cardiac disease or Hgb less than 12 g/dL despite 4 weeks at reduced dose in patients with history of stable cardiac disease: Discontinue.

Comments:

Discontinuation of therapy:

Precautions

US BOXED WARNINGS: Risk of Serious Disorders and Ribavirin-Associated Effects; Teratogenic and Embryocidal Effects; Sudden Deterioration of Respiratory Function with Inhalation Solution:
CAPSULES, ORAL SOLUTION, TABLETS:

INHALATION THERAPY: This formulation is not indicated for use in adults.

Oral: Safety and efficacy have not been established in patients younger than 3 years.
Inhalation: Safety and efficacy have only been established in hospitalized infants and young children; not for use in adults

Consult WARNINGS section for additional precautions.

Dialysis

Oral ribavirin is not effectively removed by hemodialysis.

CAPSULES, ORAL SOLUTION:
CrCl less than 50 mL/min: Contraindicated

TABLETS:
Adults:
In combination with peginterferon alfa-2a:
Hemodialysis: 200 mg orally once a day

Comments:


Pediatrics: Data not available

Other Comments

Administration advice:


Storage requirements:

Reconstitution/preparation techniques:
Inhalation solution: The manufacturer's product information should be consulted.

General:

Monitoring:

Patient advice:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.