Ganciclovir

Administration

  • Type: Antiviral
  • Routes of Administration: IV, PO
  • Common Trade Names: Cytovene

Adult Dosing

  • CMV prophylaxis, solid organ transplant
    • IV route: 5mg/kg IV q12h x7-14 days, then 5mg/kg IV q24h or 6mg/kg IV 5x/wk
    • PO route: 1000mg PO tid, give with food
  • CMV prophylaxis, HIV-assoc.
    • IV route: 5mg/kg IV 5-7x/wk; Info: not 1st-line agent
    • PO route: 1000mg PO tid; Info: not 1st-line agent; give with food
  • CMV retinitis, immunocompromised patients
    • Induction treatment: 5mg/kg IV q12h x14-21 days; Info: not 1st-line agent
    • Maintenance treatment, IV route: 5mg/kg IV 5-7x/wk; Alt: 6mg/kg IV 5x/wk; Info: not 1st-line agent
    • Maintenance treatment, PO route: 1000mg PO tid; Alt: 500mg PO q3h while awake (6 doses/day); Info: not 1st-line agent; give with food

Pediatric Dosing

Off label use as pediatric medication

  • CMV prophylaxis, solid organ transplant
    • Induction: 5mg/kg IV q12h x7-14 days
    • Maintenance: 5mg/kg IV q24h; Alt: 6mg/kg IV 5x/wk
  • CMV prophylaxis, HIV-assoc
    • 5mg/kg IV q24h
  • CMV infection
    • Induction: 5mg/kg IV q12h x14-21 days; Info: may increase dose to 7.5mg/kg IV q12h
    • Maintenance: 5mg/kg IV q24h; Alt: 6mg/kg IV 5x/wk
  • CMV infection, congenital (<1 mo)
    • 6mg/kg IV q12h x6wk

Special Populations

  • Pregnancy Rating: C
  • Lactation risk: Infant risk cannot be ruled out

Renal Dosing

  • IV route, induction treatment: CrCl 50-69: 2.5mg/kg q12h; CrCl 25-49: 2.5mg/kg q24h; CrCl 10-24: 1.25mg/kg q24h; CrCl <10: 1.25mg/kg 3x/wk; HD: give dose after dialysis, no supplement
  • IV route, maintenance treatment: CrCl 50-69: 2.5mg/kg q24h; CrCl 25-49: 1.25mg/kg q24h; CrCl 10-24: 0.625mg/kg q24h; CrCl <10: 0.625mg/kg 3x/wk; HD: give dose after dialysis, no supplement
  • PO route: CrCl 50-69: 1500mg/day divided QD-tid; CrCl 25-49: 1000mg/day divided QD-bid; CrCl 10-24: 500mg QD; CrCl <10: 500mg 3x/wk; HD: give dose after dialysis, no supplement

Contraindications

  • Allergy to class/drug
  • ANC < 500
  • Platelets < 25,000

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 3hr
  • Metabolism: CYP450
  • Excretion: Urine

Mechanism of Action

Inhibits DNA polymerase and incorporates into viral DNA

References

    Epocrates, UpToDate

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