Ribavirin (Oral Inhalation)

• Antiviral Agent

Treatment for RSV in adult hematopoietic stem cell or heart/lung transplant recipients

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Continuous aerosolization: Per the manufacturer, reconstitute 6 g vial with at least 75 mL of preservative free sterile water for injection or inhalation; shake vial well to mix. Transfer vial contents to the clean, sterile 500 mL SPAG-2 reservoir and further dilute to a final volume of 300 mL with preservative free sterile water for injection or inhalation; final concentration: 20 mg/mL. Alternatively, sterile NS has been used for dilution rather than sterile water to achieve a near isotonic solution (Meert 1994).

Intermittent aerosolization: Reconstitute 6 g vial with 100 mL of preservative free sterile water; final concentration: 60 mg/mL (Englund 1994).

Inhalation: Ribavirin should be administered in well-ventilated rooms (at least 6 air changes/hour). In mechanically-ventilated patients, ribavirin can potentially be deposited in the ventilator delivery system depending on temperature, humidity, and electrostatic forces; this deposition can lead to malfunction or obstruction of the expiratory valve, resulting in inadvertently high positive end-expiratory pressures. The use of one-way valves in the inspiratory lines, a breathing circuit filter in the expiratory line, and frequent monitoring and filter replacement have been effective in preventing these problems. Solutions in SPAG-2 unit should be discarded at least every 24 hours and when the liquid level is low before adding newly reconstituted solution. Should not be mixed with other aerosolized medication.

Store vials in a dry place at 15°C to 30°C (59°F to 86°F). Reconstituted solution is stable for 24 hours at room temperature.

Use of ribavirin in patients requiring mechanical ventilator assistance should be undertaken only by health care providers and support staff familiar with this mode of administration and the specific ventilator being used. Strict attention must be paid to procedures that have been shown to minimize the accumulation of drug precipitate, which can result in mechanical ventilator dysfunction and associated increases in pulmonary pressures.

Sudden deterioration of respiratory function has been associated with the initiation of ribavirin use in infants. Carefully monitor respiratory function during treatment. If the initiation of ribavirin treatment appears to produce sudden deterioration of respiratory function, stop treatment and reinstitute only with extreme caution, continuous monitoring, and consideration of coadministration of bronchodilators.

Aerosolized ribavirin is not indicated for use in adults. Be aware that ribavirin has been shown to produce testicular lesions in rodents and to be teratogenic in all animal species in which adequate studies have been conducted (rodents and rabbits).