Viral Hepatitis

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Management and Treatment of Hepatitis C Viral Infection: Table 9

for Health Care Providers

Table 9. General Guidelines for Ribavirin Dose Reduction or Discontinuation
PARAMETERRECOMMENDATION
In stable underlying cardiac disease, reduce ribavirin by 200 mg/day for ≥2 g/dL drop in Hb over a four-wk period. If the Hb level is <12 g/dL after four wk of dose reduction, discontinue ribavirin until resolution and reevaluation.
Hemoglobin (Hb)
<11.0 but >10 g/dLNo change in ribavirin dose if patient has minimal symptoms
In a symptomatic patient, consider ribavirin dose reduction by 200 mg/day and/or starting an erythropoietic growth factor
<10.0 but >8.5 g/dLDecrease ribavirin by 200 mg/day and/or consider starting an erythropoietic growth factor
Recheck Hb levels at least every 2 wk or more frequently if indicated
<8.5 g/dLDiscontinue until resolution