Interactions between virazole(ribavirin) and Azt (zidovudine)
zidovudine and ribavirin (Moderate Drug-Drug)
GENERALLY AVOID: Ribavirin, a nucleoside analog, has been shown to antagonize the in vitro antiviral activity of zidovudine against HIV. The mechanism is feedback inhibition of thymidine kinase induced by ribavirin, resulting in decreased intracellular phosphorylation of zidovudine to its active triphosphate metabolite. The clinical relevance of this finding is unknown. Preliminary data from a small number of HCV-HIV coinfected patients receiving interferon-ribavirin therapy and different antiretroviral regimens containing zidovudine do not support a major clinical impact related to the in vitro effect. However, the potential for diminished antiretroviral activity should be considered, as three patients in one study had an increase in HIV viral load of more than 0.5 log after 3 to 6 months of interferon-ribavirin therapy which led to discontinuation of ribavirin in one. In addition, the risk of myelosuppression and mitochondrial toxicities such as lipodystrophy, peripheral neuropathy, pancreatitis, and lactic acidosis associated with nucleoside reverse transcriptase inhibitors may be increased during coadministration with ribavirin. Nucleoside analogs alone and in combination have been associated with these and other toxicities.
MANAGEMENT: Coadministration of ribavirin with zidovudine should generally be avoided. Patients should be advised to promptly seek medical attention if they experience symptoms of toxicity such as nausea, vomiting, abdominal pain/distention, fatigue, infection, unexplained weight loss, tachypnea, dyspnea, motor weakness, numbness, tingling, and pain in hands and feet. Dosage reduction or discontinuation of ribavirin should be considered if worsening toxicities are observed.
