Hepatitis C Community
13.4k Members
Avatar universal

Does Ribavirin cause anemia when used with Sovaldi??

My husband just got approved for Sovaldi + Ribavirin for 24 weeks. We are very excited but he needs to get his hemoglobin up before starting his treatment. We already have the  meds in the house but can not start using them. He had a shot of procrit yesterday - labwork in a week to see if his hemoglobin is up from 8.9 (normal range starts at 13.9). His red blood cell count is 2.94 (normal range starts at  4.5).

I am confused. I had been told that when my husband was on triple treatment and had to stop because of severe anemia that ribavirin was the drug that caused the anemia but I just read in some old literature its the interferon shots that cause the anemia.  So which is it? Or, is it both?

Is anyone who is using Ribavirin now with Sovaldi experiencing anemia?  Just want to know what to look out for.

116 Responses
1747881 tn?1546179478
Riba will cause anemia on it's own.


The primary toxicity of Ribavirin is hemolytic anemia, which was observed in approximately 13% of all Ribavirin/peginterferon alfa-2a- treated subjects in clinical trials. Anemia associated with Ribavirin occurs within 1 to 2 weeks of initiation of therapy. Because the initial drop in hemoglobin may be significant, it is advised that hemoglobin or hematocrit be obtained pretreatment and at week 2 and week 4 of therapy or more frequently if clinically indicated. Patients should then be followed as clinically appropriate. Caution should be exercised in initiating treatment in any patient with baseline risk of severe anemia (e.g., spherocytosis, history of gastrointestinal bleeding)

Avatar universal
According to the prescribing info document for Sovaldi the incidence of anemia in all trial groups receiving Soavldi/Ribavirin therapy was 6%-10%

Take a look at page 6 here:

Avatar universal
Thanks for your responses. Both were helpful

I continued reading Page 7 of the prescribing info for Sovaldi and if I am interpreting the info correctly, Ribavirin in combination with interferon has a much higher incidence of anemia.

As I mentioned in my original post my husband had to stop triple treatment after 5 weeks because of severe anemia. It was really awful so no wonder I am apprehensive about the Ribavirin piece of this new treatment. But I think  these statistics make me feel better since interferon is not part of this treatment.  I think his doctor is on top of it because she plans to start him on a lower dosage of Ribavirin and increase it in increments.

He has been through hell these three years and I am praying that he will see SVR with this treatment  and be able to address his other complications without Hep C taunting him/us any more.

Your prayers and good thoughts on his behalf (and everyone in similar circumstance)  for a successful treatment will mean so much everyone.

Thank you.

Avatar universal
Hi Nan, This subject is of interest to me as well since I am now on day 4 of Sovaldi/Ribavirin therapy. Keep in mind the statistics cited in the prescribing info is from trials. There is a relatively small amount of data used to compile these results, just a few hundred patients total. Some patients groups are quite small. There are multiple variables, such as co-morbidities, etc that may not have been represented in the trial group. Many trials explicitly exclude certain conditions. Since we are now in the "real world" of this therapy being prescribed more information will become available as time passes. I have been asked to report any side effects or anything at all that might be relevant to Gilead through supportpath.com  so they may expand their database. So far I have nothing to report thankfully. I will await the results of my 2 week blood draw with great interest.....
1747881 tn?1546179478

Anemia observed with SOF+RBV and SOF+PEG/RBV treatment

Hemoglobin reductions with SOF+RBV similar to historical data with RBV monotherapy 1,2

RBV monotherapy results in ~2 g/dL reduction

Interferon contributes to anemia through bone marrow suppression

PEG/RBV results in ~3.5 g/dL reduction

Avatar universal
Having gone through the triple treatment (with Incivik) experience, I know exactly what you mean. The thinking was that that would be the end of the virus also. How disappointing it was when he had to stop treatment.  The real world results are what counts.

Please let us know how your treatment progresses (any signs of anemia, side effects, etc.)  I am praying that you will soon see/hear the word "undetected".

Have an Answer?
Top Hepatitis Answerers
317787 tn?1473362051
683231 tn?1467326617
Auburn, WA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Answer a few simple questions about your Hep C treatment journey.

Those who qualify may receive up to $100 for their time.
Explore More In Our Hep C Learning Center
image description
Learn about this treatable virus.
image description
Getting tested for this viral infection.
image description
3 key steps to getting on treatment.
image description
4 steps to getting on therapy.
image description
What you need to know about Hep C drugs.
image description
How the drugs might affect you.
image description
These tips may up your chances of a cure.
Popular Resources
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.
In You Can Prevent a Stroke, Dr. Joshua Yamamoto and Dr. Kristin Thomas help us understand what we can do to prevent a stroke.
Smoking substitute may not provide such a healthy swap, after all.