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Foscarnet

Foscarnet

Spectrum Of Activity

General Information

AIDS - CMV retinitis Herpes simplex, Mucocutaneous, Acyclovir-resistant - Patient immunocompromised

Off-label Cytomegaloviral pneumonia AIDS, Intravitreal - CMV retinitis Cytomegaloviral infection - HIV infection Herpes simplex keratitis HIV infection - Varicella-zoster virus infection

MFDS-label CMV Viraemia - Hematopoietic stem cell transplantation

Black Box Warning: Renal impairment is the major toxicity of foscarnet. Foscarnet is indicated for use only in immunocompromised patients with cytomegalovirus retinitis and mucocutaneous acyclovir-resistant herpes simplex virus infections

Calculate and monitor CrCl at baseline and during treatment.

Perform electrolyte panel, including serum calcium, magnesium, potassium, and phosphorus at baseline and during treatment.

Monitor for signs and symptoms of electrolyte abnormalities.

Perform regular ophthalmologic exams in patients with CMV retinitis.

Common

  • Diarrhea
  • Nausea
  • Vomiting
  • Headache
  • Fever
  • Anemia
  • Granulocytopenic disorder

Serious

  • Prolonged QT interval
  • Hypocalcemia
  • Hypokalemia
  • Hypomagnesemia
  • Hypophosphatemia
  • Hyperphosphatemia
  • Pancytopenia
  • Seizure
  • Acute renal failure
  • Renal impairment
  • Tubular necrosis (acute)
  • Serum creatinine raised
  • Hypersensitivity reaction
  • QTc prolongation
  • Nephrotoxic drugs
  • Class IA or Class III antiarrhythmic agents
  • Phenothiazines
  • Tricyclic antidepressants
  • Macrolides
  • Fluoroquinolones

Multiple drug-drug interactions

Antimicrobial class: Antiviral, Pyrophosphate analog

Pregnancy category: C

Average serum half life: 3.3-4 hours (plasma), 87.5 hours (urinary excretion)

Hydration therapy

  • Prior to first infusion: 750-1000 mL of NS or D5W
  • Subsequent dose of 90-120 mg/kg: 750-1000 mL hydration fluid
  • Subsequent dose of 40-60 mg/kg: 500 mL hydration fluid

Precautions:

  • Use caution in patients with altered calcium or other electrolyte levels before treatment, especially those with neurologic or cardiac abnormalities and those receiving other drugs known to influence minerals and electrolytes.
  • Avoid use in patients not able to tolerate a large amount of sodium or water (e.g. patients with cardiomyopathy or who are on a controlled sodium diet).