{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T14:25:21Z","timestamp":1791037521758,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":1741,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2007,4]]},"abstract":"<jats:p><jats:bold>Study Objectives<\/jats:bold>. To distinguish adverse events related to ribavirin therapy from those attributable to severe acute respiratory syndrome (SARS), and to determine the rate of potential ribavirin\u2010related adverse events.<\/jats:p><jats:p><jats:bold>Design<\/jats:bold>. Retrospective cohort study.<\/jats:p><jats:p><jats:bold>Setting<\/jats:bold>. Hospitals in Toronto, Ontario, Canada.<\/jats:p><jats:p><jats:bold>Patients<\/jats:bold>. A cohort of 306 patients with confirmed or probable SARS, 183 of whom received ribavirin and 123 of whom did not, between February 23, 2003, and July 1, 2003. Of the 183 treated patients, 155 (85%) received very high\u2010dose ribavirin; the other 28 treated patients received lower\u2010dose regimens.<\/jats:p><jats:p><jats:bold>Measurements and Main Results<\/jats:bold>. Data on all patients with SARS admitted to hospitals in Toronto were abstracted from charts and electronic databases onto a standardized form by trained research nurses. Logistic regression was used to evaluate the association between ribavirin use and each adverse event (progressive anemia, hypomagnesemia, hypocalcemia, bradycardia, transaminitis, and hyperamylasemia) after adjusting for SARS\u2010related prognostic factors and corticosteroid use. In the primary logistic regression analysis, ribavirin use was strongly associated with anemia (odds ratio [OR] 3.0, 99% confidence interval [CI] 1.5\u20136.1, p&lt;0.0001), hypomagnesemia (OR 21, 99% CI 5.8\u201373, p&lt;0.0001), and bradycardia (OR 2.3, 99% CI 1.0\u20135.1, p=0.007). Hypocalcemia, transaminitis, and hyperamylasemia were not associated with ribavirin use. The risk of anemia, hypomagnesemia, and bradycardia attributable to ribavirin use was 27%, 45%, and 17%, respectively.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>. High\u2010dose ribavirin is associated with a high rate of adverse events. The use of high\u2010dose ribavirin is appropriate only for the treatment of infectious diseases for which ribavirin has proven clinical efficacy, or in the context of a clinical trial. Ribavirin should not be used empirically for the treatment of viral syndromes of unknown origin.<\/jats:p>","DOI":"10.1592\/phco.27.4.494","type":"journal-article","created":{"date-parts":[[2007,3,26]],"date-time":"2007-03-26T08:47:38Z","timestamp":1174898858000},"page":"494-503","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Adverse Events Associated with High\u2010Dose Ribavirin: Evidence from the Toronto Outbreak of Severe Acute Respiratory Syndrome"],"prefix":"10.1002","volume":"27","author":[{"given":"Matthew 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