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Interferon alfa-2b / ribavirin Disease Interactions

There are 15 disease interactions with interferon alfa-2b / ribavirin:

Major

Interferon alfa (applies to interferon alfa-2b/ribavirin) renal dysfunction

Major Potential Hazard, High plausibility.

Proteinuria (rare), not associated with a decrease in serum protein, is the most common renal toxicity observed with interferon- alfa therapy. Increased BUN and serum creatinine levels, hematuria, acute renal failure and nephrotic syndrome have also been reported. Therapy with interferon alfa should be administered cautiously to patients with severe renal dysfunction. Renal function should be evaluated in all patients before initiation of interferon- alfa therapy. In addition, patients with any degree of renal impairment should be carefully monitored for laboratory abnormalities and decreased creatinine clearance. A reduced dose of medication is recommended in patients with low CrCl (less than 50 mL/min - 30 mL/min).

References

  1. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  2. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
Major

Interferon- alfa (applies to interferon alfa-2b/ribavirin) autoimmune diseases

Major Potential Hazard, Moderate plausibility. Applicable conditions: Autoimmune Disorder

Antiviral interferons may exacerbate autoimmune disorders such as myositis, thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, psoriasis, or autoimmune hepatitis. Therapy should be avoided or administered with extreme caution in patients with autoimmune disorders.

References

  1. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  2. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
Major

Interferon-alfa (applies to interferon alfa-2b/ribavirin) hepatic dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Liver Disease

Dose-related increases in liver transaminase levels occur frequently during interferon-alfa therapy. Changes in LDH and alkaline phosphatase have been reported, primarily in patients with preexisting hepatic impairment. Patients with autoimmune hepatitis who have received interferon-alfa have experienced severe, life-threatening exacerbation of their disease. Therapy with interferon-alfa should be administered cautiously in patients with liver disease and should not be initiated in patients with autoimmune hepatitis.

References

  1. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
Major

Interferons (applies to interferon alfa-2b/ribavirin) cardiac disease

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Arrhythmias, Ischemic Heart Disease, Cardiovascular Disease

Hypertension, arrhythmias, angina, myocardial infarction, cardiomyopathy, and congestive heart failure have been reported during interferon therapy. Therapy with interferons should be administered with caution in patients with compromised cardiac function.

References

  1. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Betaseron (interferon beta-1b)." Berlex, Richmond, CA.
  3. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  4. "Product Information. Avonex (interferon beta-1a)." Biogen, Cambridge, MA.
View all 4 references
Major

Interferons (applies to interferon alfa-2b/ribavirin) CNS dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Parkinsonism, Psychosis, Seizures

Reversible CNS effects such as seizures, mental status changes, manic behavior or psychotic reactions, gait disturbances, and dizziness have occurred in patients receiving interferons. Therapy with interferons should be administered cautiously in patients with or predisposed to seizures, psychiatric disorders, or conditions affecting posture or gait.

References

  1. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  3. "Product Information. Avonex (interferon beta-1a)." Biogen, Cambridge, MA.
  4. "Product Information. Betaseron (interferon beta-1b)." Berlex, Richmond, CA.
View all 4 references
Major

Interferons (applies to interferon alfa-2b/ribavirin) depression

Major Potential Hazard, Moderate plausibility.

Interferons (alfa or beta) can induce depression and suicidal behavior. Suicidal attempts and suicides have been reported. Therapy with interferons (alfa or beta) should be administered cautiously to patients with or predisposed to mental depression. Clinical monitoring of psychological status is recommended.

References

  1. "Product Information. Avonex (interferon beta-1a)." Biogen, Cambridge, MA.
  2. "Product Information. Betaseron (interferon beta-1b)." Berlex, Richmond, CA.
  3. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  4. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
View all 4 references
Major

Interferons (applies to interferon alfa-2b/ribavirin) thyroid dysfunction

Major Potential Hazard, High plausibility. Applicable conditions: Hypothyroidism, Hyperthyroidism

Thyroid abnormalities, hypothyroidism or hyperthyroidism, have been reported in patients administered interferons. Therapy with interferons should be administered cautiously to patients with thyroid dysfunction. If thyroid control cannot be maintained within normal limits with medication, interferon-alfa should be discontinued. Clinical monitoring of thyroid function is recommended.

References

  1. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  2. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
Major

Ribavirin (applies to interferon alfa-2b/ribavirin) anemia

Major Potential Hazard, High plausibility. Applicable conditions: Arrhythmias, Congestive Heart Failure, Ischemic Heart Disease

Oral ribavirin may cause anemia. The decrease in hemoglobin generally occurs within 1 to 2 weeks after initiation of therapy and stabilizes by week 4. Because significant anemia may adversely affect cardiac function, oral ribavirin should not be used in patients with severe anemia of any etiology or a history of serious or unstable heart disease. It should also be avoided in patients with hemoglobinopathies such as thalassemia or sickle- cell anemia. Therapy with oral ribavirin may be administered cautiously in patients with stable heart conditions. Both the hemoglobin level and cardiovascular status must be closely monitored. A permanent dosage reduction is required in these patients if the hemoglobin decreases by >= 2 g/dL during any 4- week period. If, after 4 weeks on the reduced dosage, the hemoglobin remains < 12 g/dL, therapy should be discontinued. The drug should also be withdrawn if cardiovascular status deteriorates. For all patients, a dosage reduction is recommended when hemoglobin is < 10 g/dL. If hemoglobin falls below 8.5 g/dL, oral ribavirin should be permanently discontinued. In clinical trials, hemoglobin values generally returned to baseline 4 to 8 weeks after cessation of therapy.

References

  1. "Product Information. Rebetron (interferon-alfa-2b-ribavirin)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Virazole (ribavirin)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
Major

Ribavirin (applies to interferon alfa-2b/ribavirin) mechanical ventilation

Major Potential Hazard, Moderate plausibility.

The use of aerosolized ribavirin in patients requiring mechanical ventilation demands meticulous care by a trained staff in order to prevent complications associated with drug precipitation within the respiratory equipment. Close, continuous monitoring, as well as frequent cleaning and changes of line valves and ventilator tubings and filters, are conducive to favorable outcomes. Certain equipment implementations and settings are also essential, but specific details regarding equipment circuitry maintenance and modifications are beyond the scope of this application and should be obtained from the SPAG-2 Operator's Manual.

References

  1. Rodriguez WJ, Parrott RH "Ribavirin aerosol treatment of serious respiratory syncytial virus infection in infants." Infect Dis Clin North Am 1 (1987): 425-39
  2. "Product Information. Virazole (ribavirin)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  3. Janai HK, Marks MI, Zaleska M, Stutman HR "Ribavirin: adverse drug reactions, 1986 to 1988." Pediatr Infect Dis J 9 (1990): 209-11
  4. Meert KL, Sarnaik AP, Gelmini MJ, Lieh-Lai MW "Aerosolized ribavirin in mechanically ventilated children with respiratory syncytial virus lower respiratory tract disease: a prospective, double-blind, randomized trial." Crit Care Med 22 (1994): 566-72
View all 4 references
Major

Ribavirin (applies to interferon alfa-2b/ribavirin) pulmonary deterioration

Major Potential Hazard, Moderate plausibility. Applicable conditions: Pulmonary Impairment

The use of aerosolized ribavirin has been associated with deterioration in pulmonary function, most significantly in patients with chronic obstructive pulmonary disease or asthma. Respiratory status should be monitored in all patients receiving aerosolized ribavirin, but in particular, patients with underlying respiratory disorders. Therapy should be stopped if sudden deterioration occurs, and reinstituted only with extreme caution and consideration of concomitant bronchodilator therapy.

References

  1. Hebert MF "Ribavirin." Bulletin of the Hospital Pharmacy and The Drug Information Analysis Service University of California 36 (1988): 1-4
  2. "Product Information. Virazole (ribavirin)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  3. Janai HK, Marks MI, Zaleska M, Stutman HR "Ribavirin: adverse drug reactions, 1986 to 1988." Pediatr Infect Dis J 9 (1990): 209-11
Major

Ribavirin (applies to interferon alfa-2b/ribavirin) renal dysfunction

Major Potential Hazard, High plausibility.

Orally administered ribavirin is metabolized by the liver, and both parent drug and metabolites are eliminated by the kidney. In patients with creatinine clearance between 10 and 30 mL/min, the mean area under the concentration-time curve has been shown to be three times greater than that in patients with normal renal function, presumably due to decreased clearance of the drug. Therapy with oral ribavirin should be administered cautiously in patients with creatinine clearance below 50 mL/min. Dosage adjustments may be necessary. The drug is not recommended for use in patients with severe renal impairment.

References

  1. "Product Information. Rebetron (interferon-alfa-2b-ribavirin)." Schering Laboratories, Kenilworth, NJ.
  2. Paroni R, Del Puppo M, Borghi C, et al "Pharmacokinetics of ribavirin and urinary excretion of the major metabolite 1,2,4-triazole-3-carboxamide in normal volunteers." Int J Clin Pharmacol Ther Toxicol 27 (1989): 302-7
Moderate

Interferon alfa (applies to interferon alfa-2b/ribavirin) colitis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Ulcerative Colitis

Fatal and nonfatal ulcerative or hemorrhagic/ischemic colitis have been observed within 12 weeks of the start of alpha interferon treatment. Abdominal pain, bloody diarrhea, and fever are the typical manifestations. Treatment should be discontinued immediately in patients who develop these signs and symptoms. The colitis usually resolves within 1 to 3 weeks of discontinuation of alpha interferons.

Moderate

Interferon alfa (applies to interferon alfa-2b/ribavirin) diabetes mellitus

Moderate Potential Hazard, Moderate plausibility.

Flu-like symptoms frequently associated with interferon-alfa therapy can precipitate ketoacidosis in diabetic patients. Therapy with interferon alfa should be administered cautiously in patients with diabetes mellitus. Clinical monitoring of blood glucose concentrations and anti-diabetic therapy is recommended.

References

  1. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  2. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
Moderate

Interferons (applies to interferon alfa-2b/ribavirin) myelosuppression

Moderate Potential Hazard, High plausibility. Applicable conditions: Bone Marrow Depression/Low Blood Counts

Interferons (alfa and gamma) induce a dose-dependent, generally mild, myelosuppression. Leukopenia is the primary manifestation. Thrombocytopenia and anemia occur less frequently. Therapy with interferons (alfa and gamma) should be administered cautiously to patients with bone marrow suppression. Clinical monitoring of hematopoietic function is recommended.

References

  1. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.
  2. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
Moderate

Interferons (applies to interferon alfa-2b/ribavirin) peripheral neuropathy

Moderate Potential Hazard, Moderate plausibility.

Paresthesia and numbness have been reported during interferon therapy. Therapy with interferons should be administered cautiously in patients with or predisposed to peripheral neuropathy.

References

  1. "Product Information. Intron A (interferon alfa-2b)." Schering Laboratories, Kenilworth, NJ.
  2. "Product Information. Infergen (interferon alfacon-1)." Amgen, Thousand Oaks, CA.

Interferon alfa-2b / ribavirin drug interactions

There are 214 drug interactions with interferon alfa-2b / ribavirin

Interferon alfa-2b / ribavirin alcohol/food interactions

There is 1 alcohol/food interaction with interferon alfa-2b / ribavirin

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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