Ribavirin and Coronavirus

You may have read ribavrin is being tested on the COVID-19 coronavirus. You may think getting some is a good idea just in case you need it. Before you walk into a minefield please take the time to read this.

Over the years I’ve used a lot of ribavirin in my Hepatitis C patients and while it might help slightly with this new coronavirus SARS-CoV-2 and the COVID-19 illness it causes this drug is pretty much the last thing I would personally be reaching for. Here’s some background that explains why.

Ribavirin has been used against all sort of viruses – everything from HIV to HVC – and it does have an impact but that impact is small. It also has a large number of serious and largely unavoidable side effects because of the way it works. My usual explanation is that ribavirin is like using a shotgun to kill a rat. Yes, it kind of works but there is a lot of collateral damage you could live without.

So how does ribavirin work against a virus like COVID-19?

It’s actually very simple. COVID-19, like HIV and HCV is an RNA virus. RNA is a single strand of genetic code made up of the letters C G A U and ribavirin is a fake letter U. So say the virus is trying to spell out C G A U – if ribavirin is floating about it will spell C G A R and this, in genetic terms is the equivalent of giving a toddler a Texta and asking them to cross out all the letter U’s they see.

So that messes with the virus and we’re all good so far. The problem is that we, that’s you and I use RNA in every single cell in our bodies and ribavirin messes with each and every one of them.

Ribavirin Side Effects

Now do you see the problem here? You need to make fresh blood and infection fighting cells all the time as they wear out. Add some ribavirin and you can’t do that so you get anaemic amongst other things.

Your stomach acid it continually trying to digest you so our bodies have a strategy of replacing the stomach lining roughly every 3 days. Add some ribavirin and, you guessed it, stomach upset.

The list of side effects of ribavirin is so long, and so infamous, it even has a whole complete Wikipedia page dedicated to the topic list of adverse effects of ribavirin.

They are not even really side effects. They are just effects. It does what it does and with that comes everything else except for something nobody have ever really explained well – the so-called “riba rage” which manifests as mild-mannered people becoming unusually irritable.

Ribavirin Is Weak

Ribavirin has what is called a log kill of 0.5 which, in English, means it will kill 2 out of 3 viruses. Hooray you say! Well yes and no.

If we look at a drug like Sovaldi® (Sofosbuvir) that is used to treat a similar RNA virus (Hepatitis C) we will see that the log kill is 4.5 which, once again in English, means it will kill 31,999 out of 32,000 viruses.

While Sovaldi is best in class most of our direct-acting antiviral drugs, the ones we currently use for HIV, HCV, Herpes and other viral diseases, run in the log kill range of 3 to 4 meaning they kill all but 1 of every 1000 to 10000 viruses.

Ribavirin is like throwing rocks at a virus. Direct-acting antivirals are more like nuking it.

Ribavirin is not something you use at home unsupervised

While we know there are literally millions of patients taking HIV drugs almost entirely unsupervised (for example HIV PrEP) we know that patients taking ribavirin fall into 3 broad categories.

• Those that seem to handle it well (25%)
• Those that get quite a lot of side effects but struggle through (50%)
• hose that get near-dead sick and we have to stop the drug or else risk killing the patient (25%)

When I put a patient on ribavirin I only do that if I think they really need it and if I think they will check in every 2 weeks for blood tests to see how we are going. If I’m not convinced it’s safe for them to use, we skip it.

So, it’s not the sort of thing you should do at home, even in the event the hospital system is overflowing. The statistics are you’re much more likely to run into problems from the ribavirin than you are from the virus.

If you are a doctor and would like ribavirin for your patients and are happy to write the script we can supply it, but if you’re a patient who’s heard it might help please look to the much stronger, much safer alternatives.