CautionCopegus
Ribavirin
Nucleoside analogue antiviral
Teratogenic — contraindicated in pregnancy and in male partners of pregnant women.
OralInhaled
First-line for
- Chronic HCV (legacy regimens — now mostly DAA-based)
- Severe RSV in immunocompromised (inhaled)
- Viral haemorrhagic fevers (Lassa)
Mechanism
Guanosine analogue — inhibits viral RNA polymerase and depletes GTP pools.
“Ribavirin = Risk to baby”
- Category X — teratogenic & embryocidal
- Contraception 6 months after last dose (both sexes)
Dosing
- Adult oral
- Weight-based 800–1200 mg/day divided
Contraindications
- AbsolutePregnancy (Category X)
- AbsoluteMale partners of pregnant women (excreted in semen)
- AbsoluteHaemolytic anaemia, severe hepatic dysfunction, autoimmune hepatitis
Side effects
- Haemolytic anaemia (dose-limiting)
- Teratogenicity
- Cough, fatigue
- Depression
Fetal & maternal notes
- • Absolutely contraindicated in pregnancy and 6 months pre-conception (both partners)
- • Avoid breastfeeding
Key interactions
Zidovudine
AvoidAdditive anaemia — avoid
Didanosine
AvoidMitochondrial toxicity
Clinical pearls
- 💡 Now largely replaced by direct-acting antivirals (DAAs) for HCV
- 💡 Pregnancy test monthly during therapy + 6 months after
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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