Letermovir

C difficile risk
None
Oral Bioavailability
Excellent (90 to 100%)
Cost
PO: $250/day IV: $500/day

Dosing

Requires AMS review within 72 hours. See below for more information.

Concomitant cyclosporine therapy:480 mg PO/IV q24h 240 mg PO/IV q24h

Child-Pugh C (score 10-15)Use not recommended

CrCl < 50 mL/minCrCl < 10 mL/minUse with caution and use PO if possible Potential accumulation of IV vehicle (hydroxypropyl betadex)No data

CrCl > 10 mL/minCrCl < 10 mL/minNo renal adjustment requiredNo data

No data

General Information

CMV primary/secondary prophylaxis in adult allogenic hematopoietic stem cell transplant patients when ganciclovir or valganciclovir cannot be used.

  • Letermovir retains activity against virus with mutations at UL54 and UL97 (confer resistance to ganciclovir, foscarnet, cidofovir).

  • In treatment or prophylaxis of herpes viruses besides CMV

  • Treatment of CMV disease

Stop if develop detectable viral load on letermovir, because low genetic barrier for resistance. Consult Infectious Diseases.

  • Well tolerated overall

  • Nausea or vomiting

  • Cough

  • Headache

  • Peripheral edema

  • Many CYP (3A4, 2C8) and OATP interactions

  • Recommend review of concomitant medications due to high frequency of significant interactions

  • Contraindicated with concomitant: pimozide, ergot alkaloids (ergotamine, dihydroergotamine)

  • Cyclosporine reduces letermovir metabolism and requires reduced letermovir dose

Antimicrobial class: Antiviral. Non-nucleoside terminase complex inhibitor

Pregnancy category: Inadequate human data

Average serum half life: 12 hours

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