Oral Ribavirin for RSV

The Pharmacy and Therapeutics Committee voted to add oral ribavirin to the in inpatient formulary in the spring of 2014 after a request was made for use in the immunocompromised adult oncology patient population for the treatment of respiratory syncytial virus (RSV). A multi-disciplinary group met and evaluated the published effectiveness of various ribavirin formulations. Additionally the costs and safety of administration of each formulation were evaluated and the result of this process was a request to add oral ribavirin to the formulary with publication of guidelines for its use.

In the fall of 2015, an additional request was made for use in lung transplant patients. A multi-disciplinary group met to review the published effectiveness of ribavirin for RSV in this patient population. After a review of the literature and groups discussion it was decided that lung transplant recipients infected with RSV represent another high risk group and should be considered for treatment with oral ribavirin. Decisions on the use of ribavirin in this population will be a joint decision involving both the lung transplant group and infectious disease.

Oral Ribavirin Guidelines Treatment Guidelines

Pharmacology

FDA Approved Indications

Mechanism of action:

Pharmacokinetics:6, 16, 17

Dosing:

Table 4: Pharmacokinetics
Absorption/bioavailability 64%
Distribution 2825L
Prolonged in erythrocyte, Does not bind to plasma proteins
Metabolism Hepatic, intracellular
Half-life of elimination 24h (single dose), 298h (multiple doses, BID)
Time to peak serum concentration Capsule: 3h
Tablet: 2h
Excretion Urine 61%, Feces 12% (in 336h); unchanged ribavirin 17% of administered dose; ribavirin and triazole metabolites excreted renally

Administration:

Contraindications to oral ribavirin formulations:6

Warnings/precautions:6

Adverse reactions (oral therapy):2, 7,8

Monitoring:6