USE OF AEROSOLIZED VIRAZOLE IN PATIENTS REQUIRING MECHANICAL VENTILATOR ASSISTANCE SHOULD BE UNDERTAKEN ONLY BY PHYSICIANS AND SUPPORT STAFF FAMILIAR WITH THE SPECIFIC VENTILATOR BEING USED AND THIS MODE OF ADMINISTRATION OF THE DRUG. 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 INCREASED PULMONARY PRESSURES (SEE WARNINGS).
SUDDEN DETERIORATION OF RESPIRATORY FUNCTION HAS BEEN ASSOCIATED WITH INITIATION OF AEROSOLIZED VIRAZOLE USE IN INFANTS. RESPIRATORY FUNCTION SHOULD BE CAREFULLY MONITORED DURING TREATMENT. IF INITIATION OF AEROSOLIZED VIRAZOLE TREATMENT APPEARS TO PRODUCE SUDDEN DETERIORATION OF RESPIRATORY FUNCTION, TREATMENT SHOULD BE STOPPED AND REINSTITUTED ONLY WITH EXTREME CAUTION, CONTINUOUS MONITORING AND CONSIDERATION OF CONCOMITANT ADMINISTRATION OF BRONCHODILATORS (SEE WARNINGS).
VIRAZOLE IS NOT INDICATED FOR USE IN ADULTS. PHYSICIANS AND PATIENTS SHOULD 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); (SEE CONTRAINDICATIONS).
Virazole® is a brand name for ribavirin, a synthetic nucleoside with antiviral activity. VIRAZOLE for inhalation solution is a sterile, lyophilized powder to be reconstituted for aerosol administration. Each 100 mL glass vial contains 6 grams of ribavirin, and when reconstituted to the recommended volume of 300 mL with sterile water for injection or sterile water for inhalation (no preservatives added), will contain 20 mg of ribavirin per mL, pH approximately 5.5. Aerosolization is to be carried out in a Small Particle Aerosol Generator (SPAG-2) nebulizer only.
VIRAZOLE is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to respiratory syncytial virus. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy.
Only severe RSV lower respiratory tract infection should be treated with VIRAZOLE. The vast majority of infants and children with RSV infection have disease that is mild, self-limited, and does not require hospitalization or antiviral treatment. Many children with mild lower respiratory tract involvement will require shorter hospitalization than would be required for a full course of VIRAZOLE aerosol (3 to 7 days) and should not be treated with the drug. Thus the decision to treat with VIRAZOLE should be based on the severity of the RSV infection.
The presence of an underlying condition such as prematurity, immunosuppression or cardiopulmonary disease may increase the severity of clinical manifestations and complications of RSV infection.
Use of aerosolized VIRAZOLE in patients requiring mechanical ventilator assistance should be undertaken only by physicians and support staff familiar with this mode of administration and the specific ventilator being used (see WARNINGS, and DOSAGE AND ADMINISTRATION).
RSV infection should be documented by a rapid diagnostic method such as demonstration of viral antigen in respiratory tract secretions by immunofluorescence3,4 or ELISA5 before or during the first 24 hours of treatment. Treatment may be initiated while awaiting rapid diagnostic test results. However, treatment should not be continued without documentation of RSV infection.
Non-culture antigen detection techniques may have false positive or false negative results. Assessment of the clinical situation, the time of year and other parameters may warrant reevaluation of the laboratory diagnosis.
: In two placebo controlled trials in infants hospitalized with RSV lower respiratory tract infection, aerosolized VIRAZOLE treatment had a therapeutic effect, as judged by the reduction in severity of clinical manifestations of disease by treatment day 3.3,4 Treatment was most effective when instituted within the first 3 days of clinical illness. Virus titers in respiratory secretions were also significantly reduced with VIRAZOLE in one of these original studies.4 Additional controlled studies conducted since these initial trials of aerosolized VIRAZOLE in the treatment of RSV infection have supported these data.
: A randomized, double-blind, placebo controlled evaluation of aerosolized VIRAZOLE at the recommended dose was conducted in 28 infants requiring mechanical ventilation for respiratory failure caused by documented RSV infection.6 Mean age was 1.4 months (SD, 1.7 months). Seven patients had underlying diseases predisposing them to severe infection and 21 were previously normal. Aerosolized VIRAZOLE treatment significantly decreased the duration of mechanical ventilation required (4.9 vs. 9.9 days, p=0.01) and duration of required supplemental oxygen (8.7 vs 13.5 days, p=0.01). Intensive patient management and monitoring techniques were employed in this study. These included endotracheal tube suctioning every 1 to 2 hours; recording of proximal airway pressure, ventilatory rate, and F1 O2 every hour; and arterial blood gas monitoring every 2 to 6 hours. To reduce the risk of VIRAZOLE precipitation and ventilator malfunction, heated wire tubing, two bacterial filters connected in series in the expiratory limb of the ventilator (with filter changes every 4 hours), and water column pressure release valves to monitor internal ventilator pressures were used in connecting ventilator circuits to the SPAG-2.
Employing these techniques, no technical difficulties with VIRAZOLE administration were encountered during the study. Adverse events consisted of bacterial pneumonia in one case, staphyloccus bacteremia in one case and two cases of post-extubation stridor. None were felt to be related to VIRAZOLE administration.
Media Articles Related to Virazole (Ribavirin)
Respiratory Syncytial Virus
Source: MedicineNet Aches, Pain, Fever Specialty [2015.11.18]
Title: Respiratory Syncytial Virus
Category: Diseases and Conditions
Created: 12/31/1997 12:00:00 AM
Last Editorial Review: 11/18/2015 12:00:00 AM
PodMed: A Medical News Roundup From Johns Hopkins (with audio)
Source: MedPage Today Pulmonology [2015.11.21]
(MedPage Today) -- This week's topics include health impact of coffee, measuring body temperature, germ line mutations and cancer in kids, and a treatment for respiratory syncytial virus.
Published Studies Related to Virazole (Ribavirin)
The combination of MK-5172, peginterferon, and ribavirin is effective in
treatment-naive patients with hepatitis C virus genotype 1 infection without
without cirrhosis... CONCLUSIONS: Once-daily MK-5172 (100 mg) with PR for 24 or 48 weeks was highly
[Efficacy and safety of ribavirin aerosol in children with hand-foot-mouth
disease]. [Article in Chinese] 
with hand-foot-mouth disease (HFMD)... CONCLUSIONS: Ribavirin aerosol can be effectively and safely used for treating
[Effects of ribavirin aerosol on viral exclusion of patients with hand-foot-mouth
disease]. [Article in Chinese] 
treatment of hand-foot-mouth disease (HFMD)... CONCLUSIONS: Ribavirin aerosol has multiple advantages of lower dose, quicker
Daclatasvir combined with peginterferon alfa-2a and ribavirin in Japanese
patients infected with hepatitis C genotype 1. 
infection... CONCLUSIONS: Daclatasvir combined with alfa-2a/ribavirin in treatment-naive
A randomized trial of daclatasvir with peginterferon alfa-2b and ribavirin for
HCV genotype 1 infection. 
infection... CONCLUSIONS: Daclatasvir 60 mg combined with peginterferon alfa-2b and ribavirin
Clinical Trials Related to Virazole (Ribavirin)
Pharmacodynamic Effects of Ribavirin in Patients With Tonsil and/or Base of Tongue Squamous Cell Carcinoma [Active, not recruiting]
Human papillomavirus (HPV-16) is an important factor in the development of many tonsil
and/or base of tongue squamous cell cancers. Although HPV-16 is not thought to cause cancer
by itself, it appears to contribute to the development of tonsil and/or base of tongue
cancer in many patients. It is likely that treatment for many patients with tonsil and/or
base of tongue cancer could be improved if effective therapy to control HPV-16 is developed.
The investigators in this study want to learn if ribavirin shows evidence of activity
Ribavirin is a pill therapy that is approved by the Food and Drug Administration (FDA) as
part of the standard treatment for Hepatitis C. Laboratory experiments suggest that
ribavirin might also be useful in the treatment of head and neck cancers. However, ribavirin
has not yet been tested against head and neck cancer in patients. The purpose of this study
is to find out the effects of ribavirin on tonsil and base tongue squamous cell cancer in
The main purpose of this study is to see if ribavirin changes the expression of certain
proteins related to HPV infection in the tumor. The study will also find out if ribavirin
changes how the tumor appears in a PET/CT scan (positron emission tomography/computed
Intermittent Use of Aerosolized Ribavirin for Treatment of RSV [Completed]
1. To determine whether aerosolized ribavirin is effective when given at an intermittent
dose over 3 hours every 8 hours for therapy of RSV upper respiratory tract infection
(URI) and whether it can prevent progression to pneumonia.
2. To determine the effect of this regimen on persistence of viral shedding.
In Hepatitis C Patients Treated With Interferon and Ribavirin, Does Hepcidin Contribute to Treatment Induced Anaemia [Recruiting]
The standard treatment of chronic hepatitis C infection is pegylated interferon alpha
combined with ribavirin. Anaemia is a common complication occurring in up to 30% of
subjects. Unfortunately, side effects of interferon and ribavirin therapy can require dose
reductions, reducing the likelihood of sustained viral response. Recent data shows that
interferon alpha may increase hepcidin (a key iron regulator) production, resulting in
impaired iron availability for production of red blood cells. In this study, we will
evaluate hepcidin levels in 30 patients with Hepatitis C who are treated with interferon
containing regimes. If hepcidin plays a role in interferon-induced anaemia, cheap and
readily available oral hepcidin inhibitors could be trialled to potentially reduce the
impact of interferon alpha induced anaemia.
Treatment of Viral Hemorrhagic Fevers With Intravenous Ribavirin in Military Treatment Facilities [Enrolling by invitation]
This is a Phase 2 study of the safety and efficacy of Intravenous (IV) Ribavirin in treating
patients presenting with a probable or suspected case of viral hemorrhagic fever (either
Crimean Congo or Lassa Fever) at a military medical treatment hospital. All patients will be
treated with a 10 day course of IV Ribavirin if they meet all the inclusion and none of the
Adherence in Patients Receiving PegIntron/Rebetol for Hepatitis C in Conjunction With a Psychotherapy Support Program (Study P04252) [Completed]
Several psychiatric adverse events (eg, depression, fatigue, psychoses, behavior troubles,
anxiety, irritability, deteriorated concentration, and insomnia) that are likely to occur
during the treatment course with PegIntron plus Rebetol may prompt patients to discontinue
their treatment early. The goal of this study is to assess whether a psychotherapy support
program may contribute to a better adherence rate.
Page last updated: 2015-11-21