What Is Riba Rage?

From Charles Daniel, former About.com Guide

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

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Question: What Is Riba Rage?

Answer: Riba rage is the popular, though misleading, name for certain side effects from treating chronic hepatitis. Chronic hepatitis C is usually treated with a combination of two drugs: pegylated interferon (either Peginterferon Alfa-2a or Peginterferon Alfa-2b) and ribavirin. This combination therapy is considered to have good treatment results, with sustained response rates up to 55% in many patients with Hepatitis C Virus (HCV) genotype 1. This means that more than half of the patients using this treatment will have undetectable levels of HCV in their blood 6 months after finishing treatment. For people with HCV genotypes 2 or 3, the sustained response rate is up to 80%.

• PEGINTERFERON ALFA-2a is a man-made drug that acts like a protein made by the body. It is used to treat chronic hepatitis B and C infections.
  
  This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.
  
  Your health care provider needs to know if you have any of these conditions:
  •alcoholism
  •auto-immune hepatitis
  •blood or bleeding disorders
  •colitis like ulcerative colitis or Crohn's disease
  •depression or other mental disorders
  •diabetes
  •drug abuse or addiction
  •heart disease
  •history of cancer
  •kidney disease
  •lupus
  •psoriasis
  •rheumatoid arthritis
  •thyroid problems
  •an unusual or allergic reaction to peginterferon, other medicines, foods, dyes, or preservatives like benzyl alcohol
  •pregnant or trying to get pregnantSide effects that you should report to your doctor or health care professional as soon as possible:•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
  •bloody diarrhea
  •breathing problems
  •change in blood sugar
  •changes in vision
  •chest pain
  •fast, irregular heartbeat
  •fever
  •high blood pressure
  •increased anger, depression, irritability, or thoughts of suicide
  •pain in lower back or stomach
  •pain, tingling, numbness in the hands or feet
  •trouble passing urine or change in the amount of urine
  •unusual bleeding or bruising
  
  Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
  •aches, pains
  •dry, itchy skin
  •hair loss
  •loss of appetite
  •nausea, stomach upset
  •pain or swelling at site where injected
  •trouble sleeping
  •unusually weak or tired
  
  This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
  
  Visit your doctor or health care professional for regular checks on your progress. You will need regular blood checks.
  
  You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.
  NOTE: This information is not intended to cover all possible uses, precautions, interactions, or adverse effects for this drug. If you have question about theQuestion: What is the difference between Peginterferon alfa 2a & Peginterferon alfa 2b?

  Answer: Interferon is a drug that mimics a protein in the body that the immune system uses to destroy viruses. Pegylated interferon is a modified form of the drug that is able to stay in the body longer, which provides better treatment. Two kinds of pegylated interferons are available -- peginterferon alfa-2a (also called alfa-2a) and peginterferon alfa-2b (also called alfa-2b). The main difference between these two pegylated interferons is in the dosing.
  

  Alfa-2a is used as a fixed weekly dose. Alfa-2b is used as a weekly dose based on the weight of the patient. There are other differences between the two drugs, but they are mostly technical and are used by the prescribing physician. For example, alfa-2a has a relatively constant absorption after injection and is distributed mostly in the blood and organs. But alfa-2b has a rapid absorption and a wider distribution in the body.

  Until January 2008, no data directly compared these two medicines. That has changed with a large clinical study known as IDEAL. This should provide interesting results that will allow physicians additional insight into these powerful chronichepatitis C therapies .

  LamivudinRibavirin

  Source: drug(s)you are taking, check with your health care professional.
  •

While patients generally get good results from this treatment combination, interferon has some nasty side effects. Two of these are depression and general irritability. The type of intense depression and irritability that "heppers" (people with hepatitis) experience while on treatment occurs often enough that it's commonly known as "riba rage," even though it isn't really caused by the ribavirin.

• Treatment Overview
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Patients and family members should be aware of any behavior changes during treatment, because most cases of riba rage, if not all, can be controlled with appropriate medical intervention. For those patients who know they already have problems with depression or mood problems, they should be considered for antidepressant therapy at the start of treatment. For those who have had previous problems with depression but are not currently experiencing problems, they should be monitored closely by a mental health team who can quickly begin appropriate treatment. Be sure to seek out a supportive and experienced treatment team that can anticipate and manage these side effects quickly and efficiently.

_Source:

Friedman L. Liver, Biliary Tract, & Pancreas. In: McPhee S, Papadakis, M, Tierney, L (eds),Current Medical Diagnosis and Treatment 2007, 46e. McGraw-Hill, 2007. 66