Ganciclovir

Administration

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

Adult Dosing

Indications by Disease

Disease	Dose	Context
CMV colitis	5mg/kg IV q12hrs x 21 days	Until symptom resolution
CMV neurologic disease	5mg/kg IV q12hrs x 21 days then 5mg/kg IV q24hrs	Combined with Foscarnet
CMV pneumonia	5mg/kg IV q12hrs x 3 weeks	CMV pneumonia
Encephalitis	5mg/kg IV every 12hr	CMV

Pediatric Dosing

Indications by Disease

Disease	Dose	Context
Encephalitis	5mg/kg IV q12hrs	Pediatric CMV

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