Ribavirin: The Need for Exposure Precautions

Abstract

Ribavirin is used in the treatment of respiratory syncytial virus (RSV) in high-risk patients, including patients who have undergone hematopoietic stem cell transplantation, to reduce mortality from RSV pneumonia. It is classified as a hazardous drug with potential for carcinogenicity and teratogenicity. Very few recent studies have examined the risk of exposure, and recommendations for exposure precautions are lacking. Administration should include the use of personal protective equipment and terminal cleaning of the patient room after each administration. This article examines ribavirin use among patients who have undergone hematopoietic stem cell transplantation and have RSV-related pneumonia and explores safety considerations for staff. Nursing leaders on a hematopoietic stem cell transplantation unit addressed gaps in knowledge about ribavirin therapy, and completed a review of the hospital's ribavirin policy, which led to policy revisions, increased knowledge about the safe administration of ribavirin, and improvements in staff and patient education.

Graft Loss and CLAD-Onset Is Hastened by Viral Pneumonia After Lung Transplantation

“…Although specific anti-viral medications are only available for a limited number of CARV, the decision to administer adjunctive therapy or inhaled ribavirin is complicated by issues of cost, physical isolation of patients, potential aggravation of respiratory symptoms, and concerns of teratogenicity among healthcare personnel. 26,27 The finding that infections caused by adenovirus and parainfluenza virus were more likely to progress to CLAD is probably because these viruses were more often associated with viral pneumonia when encountered. We were not able to statistically demonstrate this for Coxsackie/echovirus group, but we suspect the association with CLAD is being driven by a subpopulation of the viruses detected with this PCR reaction, thereby diminishing our ability to see an association with viral pneumonia in this viral group.…”

ISOPP Standards for the Safe Handling of Cytotoxics

“…These may offer additional economic benefit and offset the cost of CSTD usage. [34][35][36][37][38] A Cochrane review on CSTD with safe handling vs safe handling was released in 2018. 39 The review makes reference to a number of studies that examined the effects on workplace contamination with the introduction of a CSTD, whilst a limited number attempted to address operator exposure by measuring urine levels of cytotoxic drugs.…”

“…[20][21][22][23] Studies have found that most work surfaces in areas where cytotoxic drugs are handled are contaminated with the drugs. 12,13,[24][25][26][27][28][29][30][31][32][33][34][35][36][37] In studies from several countries, working surfaces of biological safety cabinets, counter tops, floors, equipment and other surfaces have been shown to be contaminated.…”

Rhein Suppresses Lung Inflammatory Injury Induced by Human Respiratory Syncytial Virus Through Inhibiting NLRP3 Inflammasome Activation via NF-κB Pathway in Mice

“…However, the effectiveness of ribavirin is extremely limited, and it has more additional side effects. For example, it may cause hemolytic anemia (Krilov, 2011;Mooney et al, 2014). Therefore, it is important to identify good therapeutic strategies to treat the inflammation and lung tissue damage caused by RSV.…”