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ribavirin dosing

i'm 13 weeks into treatment.  I started taking Ribapak 1000mg in two divided doses per day.  My hgb dropped to 9.2 so my NP decreased the dosage to Ribavirin 600mg once a day.  He assured me that this change would not affect my outcome due to the long half life of Ribavirin.  Looking for reassurance, reluctant about change from twice a day dosing to once a day dosing.
3 Responses
1747881 tn?1546179478
If you are on triple therapy for genotype 1 and undetectable then your doc is following AASLD protocol for anemia management

Anemia developed among recipients of both PIs. Hemoglobin decreases below 10 g/dL (grade 2 toxicity)  occurred in 49% of patients who received a BOC regimen compared to 29% of those who received the SOC
regimen, whereas 9% had a hemoglobin decline of <8.5 g/dL (grade 3 toxicity).12 Among patients treated with T12PR, hemoglobin levels of <10 g/dL were observed in 36% of patients compared to in 14% of patients who
received SOC, and 9% had hemoglobin decreases to <8.5 g/dL.16 Because hematopoietic growth factors were not permitted during the TVR trials, there was a 5%-6% higher rate of treatment discontinuation among
those who developed anemia than among those who did not. However, neither anemia nor RBV dose reduction adversely affected the SVR rate. Of note is that in the BOC trial, SVR rates in patients managed by RBV dose reduction alone were comparable to those in patients managed with erythropoietin therapy.23 Similarly, in the TVR trials, dose reduction of RBV had no effect on SVR rates, and therefore dose reduction should be the initial response to management of anemia.24 Because the duration of BOC therapy (24 to 44 weeks) is longer than the duration of TVR therapy (12 weeks), the frequency of anemia is likely to be greater in BOC-containing regimens, leading to more RBV dose reductions and consideration of erythropoietin use. However, the potential benefits of erythropoietin must be weighed against its potential side effects, the fact that its use in HCV therapy is not approved by the FDA, and its considerable cost.


Avatar universal
thanks for your reply.  I'm not concerned about the dose reduction.  My concern is taking the medication once a day versus divided doses twice a day.
1747881 tn?1546179478
Table 2 Ribasphere (ribavirin, USP) Dosage Modification Guidelines

Reduce Only Ribasphere (ribavirin, USP) Dose to
600 mg/day* if:
Laboratory Values
Hemoglobin in patients with no cardiac disease <10 g/dL

12.3 Pharmacokinetics
The terminal half-life of ribavirin following administration of a single oral dose of ribavirin is about 120 to 170 hours. The total apparent clearance following administration of a single oral dose of ribavirin is about 26 L/h.
There is extensive accumulation of ribavirin after multiple dosing (twice daily) such that the Cmax at steady state was four-fold higher than that of a single dose.


Ribasphere RibaPak (ribavirin, USP) doesn't give a designation as to reduce too 1 or 2 times a day dosing, copegus does.

COPEGUS Dose Modification Guidelines in Adults
Laboratory Values, Hemoglobin <10 g/dL in patients with
no cardiac disease, Any weight
1 x 200 mg tablet A.M - 2 x 200 mg tablets P.M.


It is always best to follow the advice of your treatment doc

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