Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • Ribavirin aerosol is indicated for the treatment of carefully selected infants with severe lower respiratory tract infections due to respiratory syncytial virus (RSV)


  • Ribavirin is a synthetic nucleoside analog which resembles guanosine; it appears to interfere with viral messenger RNA and inhibit viral protein synthesis

Side Effects

  • the following side effects have been associated with the use of Ribavirin:
    1. Pulmonary
      worsening of respiratory status, bacterial pneumonia, pneumothorax, apnea and ventilator dependence
    2. Cardiovascular
      cardiac arrest, hypotension, digoxin toxicity
    3. Other
      rash, conjunctivitis, reticulocytosis, anemia


  • please see attached SJHC NICU Policy and Procedure Statements and Teaching Package for "Care of Infant Receiving Ribavirin Therapy"

Dose and Administration

  • Ribavirin solution (6g/300mL in sterile water) prepared by the Pharmacy Department; the final concentration is 20mg/mL; the solution is stable for 24h at room temperature
  • Respiratory Therapists administer an aerosol which is generated by the SPAG-2 (Small Particle Aerosol Generator)
  • treatment lasts for 12-18 hours per day, for 3 to 7 days
  • please note that the cost of RIBAVIRIN therapy is $400/day
  • Ribavirin has been administered to infants in a hood box as well as ventilated infants (see Nursing Care Guidelines)


  1. "Virazole" Product Monograph, ICN Pharmaceuticals, 1986.
  2. Committee on Infectious Diseases: Ribavirin therapy of respiratory syncytial virus, Pediatrics 1987; 79: 475-478.

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