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Didanosine Delayed-Release Enteric-Coated Capsules and Ribavirin Inhalation Solution

Determining the interaction of Didanosine Delayed-Release Enteric-Coated Capsules and Ribavirin Inhalation Solution and the possibility of their joint administration.

Check result:

Didanosine Delayed-Release Enteric-Coated Capsules <> Ribavirin Inhalation Solution

Relevance: 07.10.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using didanosine together with ribavirin is not recommended. Combining these medications can increase the blood levels of didanosine to dangerous levels. This may increase the risk of severe injury to the pancreas, liver, muscles, and nerves. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

CONTRAINDICATED: Coadministration with ribavirin, a nucleoside analog, may increase exposure to didanosine (ddI) or its active triphosphate metabolite. Both the antiretroviral effect and clinical toxicities of ddI may be enhanced. The mechanism is inhibition of inosine 5'-monophosphate (IMP) dehydrogenase by an initial metabolite of ribavirin, resulting in decreased synthesis of guanine nucleotides that would otherwise compete with the active ddI metabolite for HIV-1 reverse transcriptase. In addition, ddI phosphorylation to the active metabolite may be enhanced by the accumulation of IMP, which is an efficient phosphate donor. Pharmacodynamically, the risk of mitochondrial toxicities such as lipodystrophy, peripheral neuropathy, pancreatitis, and lactic acidosis associated with ddI and other nucleoside reverse transcriptase inhibitors may also be increased during coadministration with ribavirin. Nucleoside analogs alone and in combination have been associated with these and other toxicities. Isolated cases of fatal hepatic failure have also been reported during coadministration of ribavirin and didanosine.

MANAGEMENT: The concomitant use of oral ribavirin and didanosine is considered contraindicated by US authorities.

References

"Product Information. Copegus (ribavirin)." Roche Laboratories, Nutley, NJ.
"Product Information. Rebetron (interferon-alfa-2b-ribavirin)." Schering Laboratories, Kenilworth, NJ.
Harvie P, Omar RF, Dusserre N, et al "Ribavirin potentiates the efficacy and toxicity of 2',3'-dideoxyinosine in the murine acquired immunodeficiency syndrome model." J Pharmacol Exp Ther 279 (1966): 1009-17
Salmon-Ceron D, Chauvelot-Moachon L, Abad S, Silberman B, Sogni P "Mitochondrial toxic effects and ribavirin." Lancet 357 (2001): 1803-4
Canadian Pharmacists Association "e-CPS. Available from: URL: http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink."
Guyader D, Poinsignon Y, Cano Y, Saout L "Fatal lactic acidosis in a HIV-positive patient treated with interferon and ribavirin for chronic hepatitis C." J Hepatol 37 (2002): 289-91
Balzarini J, Lee CK, Herdewijn P, De Clercq E "Mechanism of the potential effect of ribavirin on the activity of 2',3'-dideoxyinosine against human immunodeficiency virus." J Biol Chem 266 (1991): 21509-14
Lafeuillade A, Hittinger G, Chadapaud S "Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection." Lancet 357 (2001): 280-1
Japour AJ, Lertora JJ, Meehan PM, et al "A phase-I study of the safety, pharmacokinetics, and antiviral activity of combination didanosine and ribavirin in patients with HIV-1 disease. AIDS Clinical Trials Group 231 Protocol Team." J Acquir Immune Defic Syndr Hum Retrovirol 13 (1996): 235-46
Kakuda TN, Brinkman K "Mitochondrial toxic effects and ribavirin." Lancet 357 (2001): 1802-3

Didanosine Delayed-Release Enteric-Coated Capsules

Generic Name: didanosine

Brand name: Videx, Videx EC

Synonyms: Didanosine

What is Didanosine Delayed-Release Enteric-Coated Capsules?

Ribavirin Inhalation Solution

Generic Name: ribavirin

Brand name: Rebetol, RibaPak, Ribasphere, RibaTab, Virazole, Copegus, RibaPak 600, Moderiba, Moderiba 800 Dose Pack, Moderiba 1200 Dose Pack, Moderiba 1000 Dose Pack, Moderiba 600 Dose Pack

Synonyms: Ribavirin, Ribavirin (Oral Inhalation)

What is Ribavirin Inhalation Solution?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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