Antimicrobials
Cidofovir

Cidofovir

Restricted

N/A
N/A

Spectrum of Activity

General Information

  • Serum creatinine and urine protein (at baseline and within 48 hours of each dose)

  • WBC with differential (prior to each dose)

  • Intraocular pressure and visual acuity

  • Signs and symptoms of uveitis/iritis

  • Metabolic acidosis

  • Headache

  • Pain

  • Skin rash

  • Skin discoloration

  • Fanconi's syndrome

  • Diarrhea, nausea, vomiting

  • Oral candidiasis

  • Abdominal pain

  • Proteinuria

  • Urinary incontinence

  • Neutropenia

  • Hypochromic anemia

  • Iritis, uveitis

  • Dyspnea

  • Cladribine: Agents that Undergo Intracellular Phosphorylation may diminish the therapeutic effect of Cladribine. Risk X: Avoid combination.

  • Tenofovir Products: Cidofovir may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Cidofovir.

NOT PART OF TAMPA's RENAL DOSING PROTOCOL

To minimize the likelihood of nephrotoxicity, unless otherwise indicated, premedicate with probenecid 2 g 3 hours prior to the cidofovir dose, then 1 g 2 hours and 8 hours after completion of the infusion.

Patients should also receive 1 L of NS IV infused over 1 to 2 hours immediately prior to each cidofovir infusion.

If tolerated, a second liter may be administered over 1 to 3 hours at the start of cidofovir infusion or immediately following infusion.

With Probenecid:

  • Distribution:
    • Vd: 0.41 L/kg
    • Does not cross significantly into CSF
  • Protein Binding: <6%
  • Metabolism:
    • Minimal
    • Phosphorylation occurs intracellularly to the active metabolite cidofovir diphosphate
  • Half-Life Elimination:
    • ~2.6 hours
    • Intracellular elimination half-lives of metabolites are longer (range: 24-87 hours)
  • Excretion: Urine (70% to 85% as unchanged drug)

Clearance:

  • Renal clearance without probenecid: 150 ± 26.9 mL/minute/1.73 m2
  • Renal clearance with probenecid: 98.6 ± 27.9 mL/minute/1.73 m2