Ganciclovir: Difference between revisions

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==Administration==
==Administration==
*Type: Antiviral
*Type: [[Antiviral]]
*Routes of Administration: IV, PO
*Routes of Administration: IV, PO
*Common Trade Names: Cytovene
*Common Trade Names: Cytovene
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==Adult Dosing==
==Adult Dosing==
*[[CMV]] prophylaxis, solid organ transplant
*[[CMV]] prophylaxis, solid organ transplant
**IV route: 5 mg/kg IV q12h x7-14 days, then 5 mg/kg IV q24h or 6 mg/kg IV 5x/wk
**IV route: 5mg/kg IV q12h x7-14 days, then 5mg/kg IV q24h or 6mg/kg IV 5x/wk
**PO route: 1000 mg PO tid, give w/ food
**PO route: 1000mg PO tid, give with food


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


*[[CMV]] retinitis, immunocompromised pts
*[[CMV]] retinitis, immunocompromised patients
**Induction tx: 5 mg/kg IV q12h x14-21 days; Info: not 1st-line agent
**Induction treatment: 5mg/kg IV q12h x14-21 days; Info: not 1st-line agent
**Maintenance tx, IV route: 5 mg/kg IV 5-7x/wk; Alt: 6 mg/kg IV 5x/wk; 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 tx, PO route: 1000 mg PO tid; Alt: 500 mg PO q3h while awake (6 doses/day); Info: not 1st-line agent; give w/ food
**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==
==Pediatric Dosing==
*Off label use as pediatric medication
''Off label use as pediatric medication''


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


*[[CMV]] prophylaxis, HIV-assoc: 5 mg/kg IV q24h
*[[CMV]] prophylaxis, HIV-assoc
**5mg/kg IV q24h


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


*[[CMV]] infection, congenital (<1 mo): 6 mg/kg IV q12h x6wk
*[[CMV]] infection, congenital (<1 mo)
**6mg/kg IV q12h x6wk


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]:
*[[Lactation risk categories|Lactation risk]]: Infant risk cannot be ruled out
===Renal Dosing===
===Renal Dosing===
*IV route, induction tx: CrCl 50-69: 2.5 mg/kg q12h; CrCl 25-49: 2.5 mg/kg q24h; CrCl 10-24: 1.25 mg/kg q24h; CrCl <10: 1.25 mg/kg 3x/wk; HD: give dose after dialysis, no supplement
*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 tx: CrCl 50-69: 2.5 mg/kg q24h; CrCl 25-49: 1.25 mg/kg q24h; CrCl 10-24: 0.625 mg/kg q24h; CrCl <10: 0.625 mg/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: 1500 mg/day divided qd-tid; CrCl 25-49: 1000 mg/day divided qd-bid; CrCl 10-24: 500 mg qd; CrCl <10: 500 mg 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==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*hypersens. to acyclovir
* ANC < 500
*ANC <500
* Platelets < 25,000
*Plt <25,000


==Adverse Reactions==
==Adverse Reactions==
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*[[seizures]]
*[[seizures]]
*retinal detachment
*retinal detachment
*[[HTN]]
*[[hypertension]]
*[[pancreatitis]]
*[[pancreatitis]]
===Common===
===Common===
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*[[fever]]
*[[fever]]
*[[leukopenia]]
*[[leukopenia]]
*[[anorexia]]
*anorexia
*[[vomiting]]
*[[vomiting]]


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==References==
==References==
<references/>
<references/>
[[Epocrates, UpToDate]]
Epocrates, UpToDate


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 20:06, 22 September 2019

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

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

Common

Pharmacology

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

Mechanism of Action

Inhibits DNA polymerase and incorporates into viral DNA

Comments

See Also

References

Epocrates, UpToDate

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