Valganciclovir

Dosing

CMV retinitis

  • Induction: 900 mg PO q12h x21d

  • Maintenance: 900 mg PO q24h

CMV disease prevention

  • Heart or kidney-pancreas transplant patients: 900 mg PO q24h (until 100 post-transplant days)

  • Kidney transplant patients: 900 mg PO q24h (until 200 post-transplant days)

Safety and efficacy in pediatric patients <4m of age have not been established

CMV disease prevention in heart or kidney transplant patients Once daily dose= 7 mg x body surface area by Mosteller formula x CrCl (modified by Schwart formula) (max 900 mg/d)

CrCl ≥60CrCl 40-59CrCl 25-39CrCl 10-24CrCl <10, HDNo dose adjustment450 mg PO q12h450 mg PO q24h450 mg PO q48hAvoid

CrCl ≥60CrCl 40-59CrCl 25-39CrCl 10-24CrCl <10, HDNo dose adjustment450 mg PO q24h450 mg PO q48h450 mg PO 2 times/wAvoid

General Information

AIDS - Cytomegaloviral retinitis Cytomegalovirus infection, In high risk kidney, heart, or kidney-pancreas transplant patients; Prophylaxis

Black Box Warning: Severe leukopenia, neutropenia, anemia, thrombocytopenia, pancytopenia, bone marrow failure including aplastic anemia have been reported in patients treated with valganciclovir hydrochloride. Based on animal and limited human data, it may cause temporary or permanent inhibition of spermatogenesis in males and suppression of fertility in females. Based on animal data, potential to cause birth defects in humans. and cancers in humans.

Ophthalmic follow-up examination at least every 4-6 weeks during treatment.

Perform CBC with differential and platelet counts frequently.

Perform pregnancy testing before initiating therapy in females.

Monitor renal function, serum creatinine.

Common

  • Diarrhea

  • Nausea

  • Vomiting

  • Headache

  • Tremor

  • Urinary tract infectious disease

  • Upper respiratory infection

  • Fever

  • Fatigue

Serious

  • Anemia

  • Aplastic anemia

  • Bone marrow depression

  • Leukopenia

  • Neutropenia

  • Pancytopenia

  • Thrombocytopenia

  • Imipenem- may result in CNS toxicity

  • Didanosine

  • Probenecid

  • Tacrolimus

Antimicrobial class: Antiviral, Nucleoside analog

Pregnancy category: C

Average serum half life: 4 hours (Ganciclovir)

Precautions: Absolute neutrophil count <500 cells/mcL, hemoglobin <8 g/dL, or platelet count <25,000/mcL; do not use.

Dose reduction recommended in renal impairment; not recommended in hemodialysis.

Consider hematopoietic growth factor treatment in patients with severe leukopenia, neutropenia, anemia, or thrombocytopenia.

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