Firstline - Clinical Decisions

Restricted

C difficile risk None

Oral Bioavailability Poor (Less than 20%)

Cost $$/day (70kg patient)

Spectrum of Activity

General Spectrum of Activity

Dosing

Restricted Criteria

Renal

General Information

Common Usage

Treatment of CMV disease.

Drug Monitoring

Laboratory:

BMP and CBC

Clinical

Mental status changes/seizures

Adverse Effects

Common

Hematologic toxicity (neutropenia>thrombocytopenia)-reversible
Carcinogenic/teratogenic
Increased serum creatinine
Fever

Rare

Rash
CNS toxicity (headache, seizure, confusion)
GI intolerance
Hepatotoxicity

Major Interactions

Imipenem/cilastatin: increase risk of seizure when given with ganciclovir/valganciclovir.

Cyclosporine and Amphotericin B: enhanced nephrotoxic effects of cyclosporine and amphotericin B when co-administered with ganciclovir/valganciclovir.

Mycophenolate: increased serum concentration of ganciclovir/valganciclovir when co-administered.

Additional Information

For oral use, vanganciclovir is utilized due to much higher bioavailability. Ganciclovir PO bioavailability is only ~5%.

Pharmacology

Antimicrobial class: antiviral - synthetic guanine analog

Pregnancy category: C

Average serum half life: 3.5 hours

Urine penetration: high

CSF penetration: moderate/high

Lung penetration: moderate

Biliary penetration: moderate