抗病毒藥品 Chronic Hepatitis C virus infection (in combination with direct-acting antivirals)
The combination of peginterferon and ribavirin is not recommended (AASLD/IDSA 2020)

Antihepaciviral, Nucleoside (Anti-HCV)
Inhibits replication of RNA and DNA viruses; inhibits influenza virus RNA polymerase activity and inhibits the initiation and elongation of RNA fragments resulting in inhibition of viral protein synthesis

Absorption:
1. Tmax: 2-3 hours; liver impairment: 1.3 to 1.6 hours
2. Bioavailability: 64%
3. Effect of food: 70% increase in AUC and Cmax with high-fat meal
Distribution:
Vd: 2859 L; Protein binding: not protein bound
Metabolism:
Active: Ribavirin monophosphate, Ribavirin diphosphate: active, Ribavirin triphosphate
Excretion:
1. Renal: 61%; Fecal: 12%
2. Dialyzable: Yes (hemodialysis: 50%)
3. Total body clearance: (adults) 26-38.2 L/hr; (pediatrics) 0.27 L/hr/kg
Elimination Half Life:
298 hours

1. Hypersensitivity to ribavirin or any component of the formulation
2. Women who are pregnant or may become pregnant; males whose female partners are pregnant
3. Patients with hemoglobinopathies (eg, thalassemia major, sickle cell anemia)
4. Concomitant use with didanosine, alfa interferons
5. CrCl <50 mL/minute

Contraindicated

Infant risk cannot be ruled out

1. Central nervous system: Headache, fatigue, rigor, anxiety, emotional lability, irritability, insomnia, depression, chills, nervousness, dizziness, lack of concentration, right upper quadrant pain
2. Dermatologic: alopecia, skin rash, pruritus, xeroderma, dermatitis, diaphoresis
3. Endocrine & metabolic: Growth suppression, weight loss
4. Gastrointestinal: anorexia, nausea, vomiting, decreased appetite, diarrhea, abdominal pain, dyspepsia, upper abdominal pain, xerostomia
5. Hematologic & oncologic: Neutropenia, anemia, lymphocytopenia, hemolytic anemia
6. Hepatic: Increased serum bilirubin
7. Infection: Viral infection
8. Local: Injection site reaction
9. Neuromuscular & skeletal: Weakness, myalgia, musculoskeletal pain, arthralgia
10. Respiratory: Flu-like symptoms, upper respiratory tract infection, dyspnea, cough, pharyngitis, sinusitis
11. Miscellaneous: Fever, drug tolerance

Weight-based ribavirin:
1. <75 kg: 1 g/day in 2 divided doses
2. ≥75 kg: 1.2 g/day in 2 divided doses
Low initial dose ribavirin:
600 mg; increase as tolerated (maximum: 1 g/day [<75 kg] or 1.2 g/day [≥75 kg])

Children ≥3 years and Adolescents:
1. <47 kg: 15 mg/kg/day in 2 divided doses
2. 47 to 49 kg: 600 mg/day in 2 divided doses
3. 50 to 65 kg: 800 mg/day in 2 divided doses
4. 66 to 80 kg: 1,000 mg/day in 2 divided doses
5. >80 kg: 1,200 mg/day in 2 divided doses

1. CrCl 30 to 50 mL/min: Daily dose of 200 mg and 400 mg every other day
2. CrCl <30 mL/min or hemodialysis: 200 mg once daily; if severe adverse reactions or laboratory abnormalities occur, discontinue ribavirin

Contraindicated

N/A