Firstline - Clinical Decisions

C difficile risk None

Oral Bioavailability Excellent

Spectrum of Activity

General Spectrum of Activity

Dosing

Adult

Renal

General Information

Common Usage

Treatment and prophylaxis of CMV disease in immunocompromised hosts.

Drug Monitoring

Laboratory:

BMP and CBC

Clinical

Mental status changes/seizures

Adverse Effects

Common

Hematologic toxicity (neutropenia > thrombocytopenia) - reversible
Carcinogenic/teratogenic

Rare

Anemia
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

Teratogenic/carcinogenic - do not crush the valganciclovir tablets and avoid direct skin and/or mucous membrane contact with broken or crushed tablets.

Valganciclovir should be taken with food to optimize absorption.

Pharmacology

Antimicrobial class: Antiviral - synthetic guanine analog

Pregnancy category: C

Average serum half life: 4 hours

Urine penetration: High

CSF penetration: Moderate/high

Lung penetration: Moderate

Biliary penetration: Moderate