Interacting drugs- summary

Ribavirin+ Zalcitabine

 associated with peripheral neuropathy Avoid concomittant use when possible 

Lower respiratory tract infection 

Pulmonary-

Worsening of respiratory status, bacterial pneumonia, pneumothroax, apnea, ventilator dependence

Cadiovascular - cardiac arrest, hpotenson, digitalis toxocity

Hematologic - anemia has not been reported with use of aerosol, it occurs frequently with oral use and IV ribavarin Body as a whole- rash, conjunctivitis

Hypersens, pregnancy, lactation.

Special precautions:

Patients with extensive hepatic fibrosis, renal impairment, anaemias.

Warnings-

Do not use for infants requiring assisted ventilation, precipitationof drug in the respirstory equipment may interfere with safe and effective patient ventilation.

Deterioration of respiratory functin has been associated with ribavirin use in adults with chronic respiratory lung disease or asthma and in infants

Carefully monitor respiratory function during tratment If ribavarin aerosol treatment produces sudden deterioration of respiratory function, stop treatment and reinstate only with extreme caution.

Indications:

Hospitalised infants and young children with lower respiratory tract infection due to RSV..

Dosage:

For aerosol administration only.

Treatment carried out for 12 to 18 hours per day for atleast 3 but no more than 7 days..

EVIDENCE- BASED MEDICINE (April 2003)

Genital Herpes Comparative effectiveness of various interventions Beneficial

1. Oral antiviral therapy in first episodes

2. Oral antiviral treatment taken at start of a recurrence

3. Daily oral antiviral treatment in people with high rates of recurrence.

Likely to be beneficial

1. Daily oral antiviral treatment in late pregnancy. In women with a hostory of genital herpes.

Unknown effectivess

1. Psychotherapy to reduce recurrence

2. Interventions to prevent sexual transmision

3. Serological screening and counselling in late pregnancy

Likely to be ineffective or harmful

1. Abdominal delivery in women with genital lesions at terms.

KEY POINTS

1. Clinical trials have found that oral antiviral treatment reduces the duration of symptoms, lesions, and viral shedding in first and recurrent episodes of general herpes, and that daily treatment reduces the rate of recurrence.

2. Trials have found no significant difference in effectivenes or adverse effects beween acyclovir, valacyclovir and famcyclovir.

3. There is insufficient evidence on the role of interventions to prevent sexual transmission.

4. The highest risk of mother-to-baby transmission is in women newly infected with genital herpes in late pregnancy. There is inadquate evaluation of intervention to prevent infection in late pregnancy (such as serological screening and counselling)

5. It has been found that the effect of abdominal delivery on mother-to-baby transmission had not been adequately evaluated. The procedure has the risk of increased maternal morbidity and mortality.

6. Limited evidence from trials suggests that antiviral treatment may reduce the number of pregnant women with genital lesions at term. Since women with genital lesions are usually offered abdominal deliveries, antiviral treatment may reduce the risk of abdomnal delivery

Pharmacology:

Ribavarin has antiviral inhibitory activity in vitro against respiratory syncytial virus (RSV). influenza virus and herpes simplex. Mechanism of action is unknown.

Phamacokinetics:

Ribavarin adminstered by aerosol is absorbed systamatically.

None reported

Use contraindicated Observe caution.