Metabolism and side effects of ribavirin

Ribavirin (Ribavirin, commonly known as riavirin) is an antiviral drug of the synthetic nucleoside class synthesized by Joseph T. Witkowski, ICN Pharmaceuticals, in 1970. It has an inhibitory effect on many DNA and RNA viruses, the mechanism of which is still unclear. The US Food and Drug Administration (FDA) only approves the treatment of hepatitis C, human respiratory fusion virus (RSV), and certain hemorrhagic fevers (WHO) with long-acting interferon.

Function:
Ribavirin can inhibit the growth of respiratory syncytial virus, influenza virus, hepatitis A virus, adenovirus and other viruses in vitro, but its mechanism is not fully understood. Ribavirin did not alter viral adsorption, invasion, or molting, nor did it induce interferon production. Ribavirin enter the cells infected by the virus rapidly phosphorylation and its product as competitive inhibitors of virus synthetase, inhibition of inosine monosodium phosphate dehydrogenase, influenza virus RNA polymerase and mRNA guanosine transferase, causing cell guanosine triphosphate, damage the virus RNA and protein synthesis, inhibition of viral replication and spread. It may also have immune and neutralizing antibody effects on respiratory syncytial virus.
Drug metabolism:
The concentration of ribavirin in respiratory secretions was mostly higher than that in blood. This product can enter the red blood cell, and the accumulation of large. The concentration of drugs in cerebrospinal fluid can reach 67% of the blood concentration in the same period after long-term medication. This product can cross the placenta, can also enter the milk. It's metabolized in the liver. Intravenous administration eliminated tl/2 in about 0.5-2 hours. It is mainly excreted through the kidney. The urine excretion rate is 30%-55% at 72-80 hours. The fecal excretion rate in 72 hours is about 15%. The drug can accumulate in red blood cells for weeks.
Abuse and Side Effects:

The US Food and Drug Administration has clearly stated that ribavirin is not suitable for the treatment of influenza, and the indications are strictly defined, and the abuse of ribavirin to treat various viral infections is very common in China. Ribavirin also has teratogenic side effects. Any woman under 50 should avoid ribavirin as much as possible. If taking medication, she must use two or more reliable forms of birth control, such as condoms and oral contraceptives, and ensure that she has not become pregnant within 6 months of the last use of ribavirin.

Notes for use:
The 2013 edition of the latest Essential Medicines List of the World Health Organization emphasizes that ribavirin is only used to treat epidemic hemorrhagic fever when used in children; When used in adults, in addition to the treatment of epidemic hemorrhagic fever, only in combination with interferon for the treatment of chronic hepatitis C. Ribavirin has been shown to be an important treatment option for patients with chronic hepatitis E virus (HEV) infection.

Caution: Ribavirin is not a "broad spectrum antiviral", and even if used, the indications should be strictly controlled. In particular, avoid ribavirin from contraindicated groups, such as pregnant women, women trying to become pregnant, and patients with anemia.

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