Ribavirin                                                                                         

 

What is Ribavirin?

Ribavirin is an anti-viral drug commonly used for the treatment of many diseases including hepatitis C. It is a prodrug that when metabolised resembles purine RNA nucleotides. This transition enables ribavirin to interfere with RNA metabolism required for viral replication, which slows down HCV replication and spread in cells.

 

Mechanism Of Action

The hepatitis C virus (HCV) is an RNA virus. Once metabolised, Ribavirin can resemble the purine nucleotides adenosine or guanine. These can become incorporated into the viral RNA when it replicates inside a living cell; they complementarily pair with uracil or cytosine respectively, inducing mutations in the viral RNA-dependent replication, thus preventing it from fully replicating and spreading between cells.

 

Side Effects

Effects can range from flu like symptoms (particularly in those with acute hepatitis) to anaemia, fatigue and weight loss.

 

One major side effect is haemolytic anaemia, which causes abnormal breakdown of red blood cells (erythrocytes) and thus decreases the body’s ability to pick up oxygen and utilise it. Oxidative damage to erythrocyte cell membranes is usually inhibited by a molecule called glutathione. Ribavirin has a tendency to build up in red blood cells and decrease ATP (adenosine triphosphate) levels which are involved in the production of glutathione. Introducing ribavirin can therefore impair glutathione levels and thus permit oxidative erythrocyte cell lysis (breakdown).

 

It also has possible effects on prenatal development. Ribavirin has a long half life which means it takes a long time to break down and be excreted form the body. Red blood cells are unable to excrete it, which means that it is not completely removed until the body’s entire red blood cell population is turned over, which occurs every six months. Ribavirin has shown to cause anaemia; this could result in serious complications for pregnant women as it will lower the oxygen supply to the baby. It is suggested that couples should not try to conceive after ribavirin treatment, and are recommended to use birth control for six months after treatment.

 

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