This medication can also cause a blood condition called hemolytic anemia, which can worsen existing heart disease and lead to a heart attack.
Also, Rebetol on its own is not effective for the treatment of chronic hepatitis C. It must be used as part of a combination treatment.
Ribavirin must be used in combination with another drug called interferon alfa-2b (pegylated and nonpegylated). Its mechanism of action related to the hepatitis C virus (HCV) is not fully understood. It works against many RNA and DNA viruses. However, ribavirin alone is ineffective against hepatitis C and must be used as part of combination therapy. When used with interferon alfa-2b, it stops the virus that causes hepatitis C from replicating and spreading.
Rebetol carries several warnings associated with its use, including an increased risk of hemolytic anemia, in which the red blood cells are destroyed faster than usual. This condition may worsen heart disease and lead to a heart attack. It can also be harmful if used during or nine months before pregnancy.
Rebetol is available as capsules or solution (liquid) to be taken by mouth. Oral ribavirin is available under the brand name Rebetol or generically.
What Is Rebetol Used For?
The Food and Drug Administration (FDA) has approved Rebetol to treat long-term hepatitis C. It is approved for use only if you have compensated liver disease, which means your liver is able to maintain its function despite the damage. It should also be used with another hepatitis medication called interferon alfa-2b (pegylated and nonpegylated), which is an injectable medication. Rebetol should not be used on its own.
Brand Name(s): Rebetol
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: Antiviral
Available Generically: Yes
Controlled Substance: N/A
Active Ingredient: Ribavirin
Dosage Form(s): Capsule, solution
Hepatitis occurs when the liver is swollen or inflamed. There are several types of hepatitis, which don’t always require treatment. Specifically, hepatitis C is a viral hepatitis caused by HCV. Other types of hepatitis can be caused by alcohol consumption or, more rarely, excessive nonsteroidal anti-inflammatory drug (NSAID) use.
Antiviral treatment is designed to remove HCV from the body and slow or prevent liver damage and complications. The goal of HCV treatment is to drop your viral load (the amount of virus measured in the blood) to undetectable levels and keep it that way (i.e., sustained virologic response).
However, Rebetol may not have as much benefit if you have any of the characteristics below:
You didn’t respond to a previous treatment Previous use of pegylated interferon treatment Significant liver scarring or cirrhosis Genotype 1 hepatitis C
How to Take Rebetol
Always follow directions from your prescribing healthcare provider on how to take this medication. Rebetol is usually taken twice a day with food. Drink plenty of water and other fluids, but stay away from caffeinated beverages. Continue taking it even if you feel well. Treatment duration can range from 24 to 48 weeks, depending on your condition and response to therapy. How much you take may depend on body weight.
Rebetol comes in capsule and solution formulations; oral ribavirin is also available in a generic version. When taking the capsules, swallow them whole; do not chew, cut, or break them. If you are taking the solution, shake the liquid before each use and mix it evenly.
Storage
Rebetol should be stored in a cool, dry place. Generally, medications should be kept away from areas with high amounts of heat, like above your stove or in humid areas like your bathroom. These environments can impact how well medications work. Additionally, keep this medication out of reach of children and pets to prevent accidental consumption.
Refilling and traveling with this medication carries no special instructions. Ask your pharmacist or prescriber to request a refill if you need more medication.
Off-Label Uses
Rebetol has uses outside of hepatitis C that are commonly accepted by the medical community. This is called off-label use.
Off-label uses for Rebetol include:
Long-term and chronic hepatitis E infection Respiratory syncytial virus (RSV) infection if you are immunocompromised Fever caused by viruses that can cause bleeding
Hepatitis E shares similarities with hepatitis C, as they both are caused by viruses and can lead to liver damage. However, hepatitis E is caused by the hepatitis E virus (HEV) and is spread by consuming contaminated substances. It is not as common in the United States as hepatitis C.
Ribavirin can also treat other viral infections, such as an RSV infection, if you are immunocompromised. RSV infections are usually mild; most people will generally recover within a few weeks. Sometimes you may need to be admitted to the hospital if you have severe infections.
Rebetol can treat certain types of viruses, such as the Lassa virus or certain arenaviruses and bunyaviruses that can cause infections and deadly fevers.
What Are the Side Effects of Rebetol?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
The most common side effects associated with Rebetol include:
Anemia, or a decrease in red blood cells Fatigue Headache Fever Nausea Muscle pain Anxiety
Severe Side Effects
Call your healthcare provider immediately if you have serious side effects. Call 911 if your side effects feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:
Depression Suicidal ideation Suicidal attempts Hemolytic anemia Signs of an allergic reaction, such as rash/hives, trouble breathing, or swelling of the mouth, face, lips, tongue, or throat Signs of a pancreas problem (pancreatitis), such as severe stomach pain, back pain, or upset stomach and vomiting Vision changes or loss Lung problems that affect your breathing Heart attack
Long-Term Side Effects
Examples of long-term side effects associated with Rebetol are:
Fatigue Dyspnea, or shortness of breath Anemia
Dosage: How Much Rebetol Should I Take?
Modifications
Rebetol dosage is often based on your response to the treatment and whether you are experiencing any side effects.
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For hepatitis C virus infection, in combination with interferon alfa-2b: For oral dosage form (capsules): Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 1000 to 1200 milligrams (mg) per day, given in 2 divided doses and taken in the morning and evening. Each capsule contains 200 mg of ribavirin. Weighing more than 75 kilograms (kg)—3 capsules in the morning and 3 capsules in the evening. Weighing at least 75 kg—2 capsules in the morning and 3 capsules in the evening. Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening. Each capsule contains 200 mg of ribavirin. Children younger than 3 years of age—Use and dose must be determined by your doctor. For oral dosage form (solution): Adults—Dose is based on body weight and must be determined by your doctor. The oral solution form of this medicine is not usually prescribed for adults and teenagers. Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening. Children younger than 3 years of age—Use and dose must be determined by your doctor. For hepatitis C virus infection, in combination with peginterferon alfa-2b: For oral dosage form (capsules): Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 800 to 1400 milligrams (mg) per day, given in 2 divided doses and taken in the morning and evening. . Each capsule contains 200 mg of ribavirin. Weighing more than 105 kilograms (kg)—3 capsules in the morning and 4 capsules in the evening. Weighing 81 to 105 kg—3 capsules in the morning and 3 capsules in the evening. Weighing 66 to 80 kg—2 capsules in the morning and 3 capsules in the evening. Weighing less than 66 kg—2 capsules in the morning and 2 capsules in the evening. Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in 2 divided doses and taken in the morning and evening. Each capsule contains 200 mg of ribavirin. Weighing more than 73 kilograms (kg)—3 capsules in the morning and 3 capsules in the evening. Weighing 60 to 73 kg—2 capsules in the morning and 3 capsules in the evening. Weighing 47 to 59 kg—2 capsules in the morning and 2 capsules in the evening. Weighing less than 47 kg—Use of oral solution is recommended. Children younger than 3 years of age—Use and dose must be determined by your doctor. For oral dosage form (solution): Adults—Dose is based on body weight and must be determined by your doctor. The oral solution form of this medicine is not usually prescribed for adults and teenagers. Children 3 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 15 milligrams (mg) per kilogram (kg) of body weight per day, given in two divided doses and taken in the morning and evening. Children younger than 3 years of age—Use and dose must be determined by your doctor. For hepatitis C virus infection, in combination with peginterferon alfa-2a: For oral dosage form (tablets): Adults—Dose is based on body weight and must be determined by your doctor. The dose is usually 800 to 1200 milligrams (mg) per day, given in 2 divided doses and taken in the morning and evening. Children 5 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 400 to 1200 mg per day, given in 2 divided doses and taken in the morning and evening. Children younger than 5 years of age—Use and dose must be determined by your doctor. For hepatitis C with HIV virus coinfection, in combination with peginterferon alfa-2a: For oral dosage form (tablets): Adults—800 milligrams (mg) per day. Children—Use and dose must be determined by your doctor.
Your healthcare provider may monitor toxicities through hemoglobin monitoring. Hemoglobin monitoring is a way to measure the function of your red blood cells. If hemoglobin is too low, a lower dose may be needed. You may also need a lower dose if your kidneys aren’t working properly.
Missed Dose
If you miss a dose of Rebetol, take the next dose as soon as you remember. If it is close to the next dose, skip the missed dose and return to your normal schedule. You should not take more than one dose on the same day. If you do miss a dose, it may take longer than normal to clear the infection.
Overdose: What Happens If I Take Too Much Rebetol?
No specific dose indicates an overdose of Rebetol; still, you should not take more than prescribed. Neither is there a specific antidote for this drug, and conventional forms of removal such as dialysis are not viable.
The most common effects associated with an overdose of this drug are:
Kidney failure, which can be seen by lack of energy and fatigue, loss of appetite, muscle weakness, abnormal heartbeat, or loss of consciousness Excessive bleeding Heart attack
In an overdose, symptoms must be treated as soon as possible to reduce the risk of complications.
Precautions
What Are Reasons I Shouldn’t Take Rebetol?
Do not take Rebetol if any of the following apply to you:
If someone collapses or isn’t breathing after taking Rebetol, call 911 immediately.
Using this medicine while you are pregnant can harm your unborn baby. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start using this medicine to make sure you are not pregnant. This medicine may also cause birth defects if the father is using it when his sexual partner becomes pregnant. Female patients should use an effective form of birth control during treatment with this medicine and for at least 9 months after the last dose. Male patients who have female partners should use effective birth control during treatment with this medicine and for at least 6 months after the last dose. If you think you have become pregnant or your partner has become pregnant while using this medicine, tell your doctor right away.
Do not use Copegus® in combination with didanosine (Videx®, Videx® EC). Using these medicines together may cause serious medical problems.
Ribavirin may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child’s doctor right away.
Check with your doctor right away if you or your child have back, leg, or stomach pains, bleeding gums, chills, dark urine, difficulty breathing, fever, general body swelling, headache, loss of appetite, nausea or vomiting, nosebleeds, pale skin, sore throat, unusual tiredness or weakness, or yellowing of the eyes or skin. These could be symptoms of a blood disorder called anemia.
This medicine may cause serious types of allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you or your child have itching, hives, hoarseness, trouble with breathing, trouble with swallowing, or any swelling of the hands, face, or mouth while you are using this medicine.
Serious skin reactions can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, fever or chills, hives, red skin lesions, a severe skin rash or acne, or sores or ulcers on the skin while you are using this medicine.
Pancreatitis may occur while you are using this medicine. Check with your doctor right away if you or your child have sudden and severe stomach pain, chills, constipation, nausea, vomiting, fever, or lightheadedness.
This medicine may cause lung or breathing problems (eg, pulmonary infiltrates, pneumonitis, pulmonary hypertension, and pneumonia). Check with your doctor right away if you have chest pain or tightness, chills, cough, fever, general feeling of discomfort or illness, sneezing, thickening of bronchial secretions, trouble breathing, unusual tiredness or weakness.
You should not drink alcoholic beverages (including beer, wine, or liquor) while you are taking this medicine.
This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you or your teenager drive, operate machinery, or do anything else that could be dangerous if you are not alert.
Check with your doctor if blurred vision, decreased vision, or any other change in vision occurs while you or your child are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Peginterferon injection combined with ribavirin can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets in the blood, which are necessary for proper blood clotting. If this occurs, there are certain precautions you or your child can take, especially when your blood count is low, to reduce the risk of infection or bleeding:
If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination. Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done. Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime. Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters. Avoid contact sports or other situations where bruising or injury could occur.
This medicine may cause teeth and gum problems. This medicine may cause dryness of the mouth, and a dry mouth may damage your teeth and gums if you take the medicine for a long time. To help prevent this condition, carefully brush your teeth at least two times a day and have regular visits with your dentist. For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute.
Some patients who have used this medicine have had vomiting. If you vomit during your treatment, rinse your mouth out with water. This may also help prevent damage to your teeth and gums.
Ribavirin used together with injectable peginterferon alfa-2a or peginterferon alfa-2b may affect your child’s growth. Your doctor may need to check your child’s height and weight during and after treatment with these medicines.
This medicine could cause infertility in men. Talk with your doctor before using this medicine if you plan to have children.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
If you are pregnant or have a pregnant partner If you have had Stevens-Johnson Syndrome and toxic epidermal necrolysis or symmetrical skin redness or rash after taking ribavirin or any component of the drug If you have autoimmune hepatitis If you have any blood disorder such as sickle-cell anemia If you have poor kidney function, specifically measured by a creatinine clearance of less than 50 milliliters (mL) per minute
What Other Medications Interact With Rebetol?
Certain medications can interact with Rebetol, including:
Didanosine: Taking Rebetol and didanosine at the same time can increase concentrations of the active metabolite of didanosine in the body, which can cause liver failure, nerve damage, or inflammation of your pancreas. Other nucleoside analogues, such as stavudine and zidovudine: The specific antiviral class that Rebetol belongs to is the nucleoside analogue class. Many drugs in this class carry similar side effects and toxicities. Taking these drugs together can increase the risk of complications, such as liver damage and anemia. Azathioprine is commonly used after an organ transplant and in rheumatoid arthritis. Rebetol and azathioprine have similar side effects, such as muscle ache, fever, nausea, and fatigue. Taking these drugs together increases the risk of side effects and blood disorders, specifically pancytopenia and azathioprine-related bone marrow suppression.
What Medications Are Similar?
Rebetol is an antiviral drug in the nucleoside analogue drug class.
Epclusa (sofosbuvir and velpatasvir) is another medication sometimes used along with Rebetol to treat hepatitis C. However, it differs in its mechanism of action. Epclusa targets different viral enzymes to prevent the virus from multiplying.
Other antivirals used to treat hepatitis C include:
Zepatier (elbasvir and grazoprevir) Harvoni (ledipasvir and sofosbuvir) Mavyret (glecaprevir and pibrentasvir)
This is a list of drugs also prescribed for hepatitis C. It is NOT a list of drugs recommended to take with Rebetol. Discuss any questions or concerns about your medication with a healthcare provider or pharmacist.
How Can I Stay Healthy While Taking Rebetol?
To stay healthy while taking Rebetol, it is important to take it exactly as your pharmacist or healthcare provider directed. Taking it consistently will help treat HCV and prevent long-term complications like liver damage.
Drink plenty of water and take your doses with food to reduce side effects such as headache, nausea, and upset stomach. Adhering to a healthy eating plan can also help. If nausea is a problem for you, avoid acidic, spicy, sweet, or greasy foods, and stick to clear fluids and dry foods like toast and crackers.
You are likely taking other medications along with Rebetol. Take all medications as prescribed, following the dosing instructions for each. If you have trouble remembering when to take your doses, try using a pill box or reminder app to track your regimen.
Don’t hesitate to discuss any questions or concerns with your healthcare team. They are there to help you through your journey and get you healthy again.
