title: Blood ribavirin concentration in high-dose ribavirin for adenovirus-induced haemorrhagic cystitis - a case report.
abstract: Blood ribavirin concentration was monitored after the administration of high-dose oral ribavirin in a case of adenovirus-induced haemorrhagic cystitis post-stem-cell transplantation. Combination use of intravenous gamma immunoglobulin (15 g/3 days) and high-dose ribavirin (RBV; 9000 mg/4 days) provided plasma ribavirin concentration of 24.3 microM and achieved virus eradication. High level of erythrocyte ribavirin (1085 microM; mostly as phosphorylated metabolites) with long half-life (15 days) caused severe anaemia, which required several blood transfusions for 2 weeks after the cessation of the ribavirin treatment. It was suggested that blood transfusion and intensive haemoglobin level monitoring is necessary for at least 4 weeks after the RBV, because of the high accumulation of phosphorylated ribavirin in erythrocytes even after stopping ribavirin administration.
authors.affiliation: Department of Pharmaceutical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan. masatoh@md.tsukuba.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Homma
authors.forename: Y
authors.initials: Y
authors.lastname: Inoue
authors.forename: Y
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: H
authors.initials: H
authors.lastname: Kojima
authors.forename: Y
authors.initials: Y
authors.lastname: Kohda
mesh_terms: D000256:Adenoviridae / Q000187:drug effects; D000257:Adenoviridae Infections / Q000188:drug therapy* / Q000209:etiology; D000740:Anemia / Q000139:chemically induced; D000998:Antiviral Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001803:Blood Transfusion; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D004912:Erythrocytes / Q000187:drug effects / Q000378:metabolism; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D033581:Stem Cell Transplantation / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous; D012254:Ribavirin