Antimicrobials
Ganciclovir

Ganciclovir

None
N/A

Spectrum of Activity

Dosing

General Information

HEALTH CANADA APPROVED

  • Treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients
  • Prevention of CMV disease in transplant recipients

NON HEALTH CANADA APPROVED INDICATION BUT SUBSTANTIATED IN THE LITERATURE

  • Treatment of other life-threatening CMV infections
  • Hypersensitivity to ganciclovir or valGANciclovir
  • Cross-hypersensitivity with acyclovir and valACYclovir is possible
  • Patients with pre-existing cytopenias, with a history of cytopenic reactions to other drugs or with a history of exposure to known marrow toxic drugs, chemicals or irradiation
  • Patient should be adequately hydrated to promote renal excretion of drug
  • Mycophenolate can increase ganciclovir concentration
  • Zidovudine: concomitant therapy may increase hematological toxicity. Avoid giving zidovudine during induction phase of ganciclovir. Monitor hematologic function and adjust dose as necessary

REQUIRED

  • Monitor peripheral IV site for pain, redness or swelling prior to initiating infusion and every 15 minutes until completion of infusion

RECOMMENDED

  • Advise patients to report burning/stinging/pain at IV site promptly
  • Baseline CBC and platelet count, then

    • Every two days during induction phase of therapy and weekly thereafter. If counts are low, counts should be performed more often
    • Daily in: hemodialysis patients; those in whom ganciclovir or other drugs have previously resulted in neutropenia; those with a baseline neutrophil count less than 1x10⁷/L
  • Baseline serum creatinine, then at least every 2 weeks

  • Environmental concerns - Use cytotoxic precautions
  • IM and subcutaneous administration: not recommended due to high pH
  • valGANciclovir PO is rapidly converted to ganciclovir in the body. valGANciclovir 900 mg PO is comparable to ganciclovir 5 mg/kg IV

Antimicrobial class: Antiviral - irritant

pH: 9 to 11