Ganciclovir

Administration

• Type: Antiviral
• Routes of Administration: IV, PO
• Common Trade Names: Cytovene

Adult Dosing

• CMV prophylaxis, solid organ transplant
  • IV route: 5mg/kg IV q12h x7-14 days, then 5mg/kg IV q24h or 6mg/kg IV 5x/wk
  • PO route: 1000mg PO tid, give with food

• CMV prophylaxis, HIV-assoc.
  • IV route: 5mg/kg IV 5-7x/wk; Info: not 1st-line agent
  • PO route: 1000mg PO tid; Info: not 1st-line agent; give with food

• CMV retinitis, immunocompromised patients
  • Induction treatment: 5mg/kg IV q12h x14-21 days; Info: not 1st-line agent
  • Maintenance treatment, IV route: 5mg/kg IV 5-7x/wk; Alt: 6mg/kg IV 5x/wk; Info: not 1st-line agent
  • Maintenance treatment, PO route: 1000mg PO tid; Alt: 500mg PO q3h while awake (6 doses/day); Info: not 1st-line agent; give with food

Pediatric Dosing

Off label use as pediatric medication

• CMV prophylaxis, solid organ transplant
  • Induction: 5mg/kg IV q12h x7-14 days
  • Maintenance: 5mg/kg IV q24h; Alt: 6mg/kg IV 5x/wk

• CMV prophylaxis, HIV-assoc
  • 5mg/kg IV q24h

• CMV infection
  • Induction: 5mg/kg IV q12h x14-21 days; Info: may increase dose to 7.5mg/kg IV q12h
  • Maintenance: 5mg/kg IV q24h; Alt: 6mg/kg IV 5x/wk

• CMV infection, congenital (<1 mo)
  • 6mg/kg IV q12h x6wk

Special Populations

• Pregnancy Rating: C
• Lactation risk: Infant risk cannot be ruled out

Renal Dosing

• IV route, induction treatment: CrCl 50-69: 2.5mg/kg q12h; CrCl 25-49: 2.5mg/kg q24h; CrCl 10-24: 1.25mg/kg q24h; CrCl <10: 1.25mg/kg 3x/wk; HD: give dose after dialysis, no supplement
• IV route, maintenance treatment: CrCl 50-69: 2.5mg/kg q24h; CrCl 25-49: 1.25mg/kg q24h; CrCl 10-24: 0.625mg/kg q24h; CrCl <10: 0.625mg/kg 3x/wk; HD: give dose after dialysis, no supplement
• PO route: CrCl 50-69: 1500mg/day divided QD-tid; CrCl 25-49: 1000mg/day divided QD-bid; CrCl 10-24: 500mg QD; CrCl <10: 500mg 3x/wk; HD: give dose after dialysis, no supplement

Contraindications

• Allergy to class/drug
• ANC < 500
• Platelets < 25,000

Adverse Reactions

Serious

• thrombocytopenia
• neutropenia
• pancytopenia
• sepsis
• nephrotoxicity
• seizures
• retinal detachment
• hypertension
• pancreatitis

Common

• diarrhea
• fever
• leukopenia
• anorexia
• vomiting

Pharmacology

• Half-life: 3hr
• Metabolism: CYP450
• Excretion: Urine

Mechanism of Action

Inhibits DNA polymerase and incorporates into viral DNA

References

Epocrates, UpToDate