ganciclovir; DHPG (Cytovene, Vitrasert, Zirgan)
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Introduction
Tradenames: DHPG, Cytovene, Vitrasert. A virustatic agent.
Indications
- CMV retinitis:
- induction therapy
- maintenance therapy
- intravenous infusion
- 6 mg/kg/day for 5 days per week
- 5 mg/kg/day
- 1000 mg PO TID or 500 mg 6 times/day
- intravenous infusion
- herpetic keratitis (Zirgan)
Dosage
Tabs: 250 mg Powder for injection (lyophilized): 500 mg (10 mL)
Implant (intravitreal): 4.5 mg released gradually over 5-8 months
Ophthalmic gel: Zirgan
Dosage adjustment in renal failure
oral
| creatinine clearance | dosage |
|---|---|
| > 70 mL/min | 3000 mg/day divided TID-6X/day |
| 50-69 mL/min | 1500 mg/day divided QD-TID |
| 25-49 mL/min | 1000 mg/day divided QD-BID |
| 10-24 mL/min | 500 mg QD |
| < 10 mL/min | 500 mg 3X/week, following hemodialysis |
intravenous
| creatinine clearance | dosage |
|---|---|
| 50-79 mL/min/1.73 mm2 | 2.5 mg/kg every 12 hours |
| 25-49 mL/min/1.73 mm2 | 2.5 mg/kg every 24 hours |
| < 25 mL/min/1.73 mm2 | 1.25 mg/kg every 24 hours |
| creatinine clearance | dosage |
|---|---|
| 50-79 mL/min/1.73 mm2 | 2.5 mg/kg every 12 hours |
| 25-49 mL/min/1.73 mm2 | 2.5 mg/kg every 24 hours |
| < 25 mL/min/1.73 mm2 | 1.25 mg/kg every 24 hours |
Pharmacokinetics
elimination via kidney
Monitor
- serum creatinine, serum electrolytes serum calcium, serum magnesium within 180 days
Adverse effects
- common (> 10%)
- bone marrow suppression
- neutropenia
- thrombocytopenia
- reversible upon discontinuation of ganciclovir
- headache
- fever
- nausea/vomiting
- abdominal pain
- bone marrow suppression
- less common (1-10%)
- uncommon (< 1%)
- eosinophilia, arrhythmias, hypertension, hypotension, ataxia, coma, dizziness, nervousness, paresthesia, psychosis, tremor, alopecia, pruritus, urticaria, diarrhea, hemorrhage, inflammation & pain at site of injection, edema, malaise, dyspnea, retinal detachment, azoospermia
- intravitreal implant
- common (> 10%)
- less common (1-10%)
- cataracts, lens opacity, macular degeneration, intraocular pressure spikes, optic disc & nerve changes, hyphema, uveitis
Drug interactions
- zidovudine (AZT)
- bone marrow suppression may be severe
- few patients can tolerate concurrent administration of both agents
- didanosine (ddI)
- increased ddI levels
- increased risk of pancreatitis
- imipenem/cilastin
- immunosuppressive agents
More general terms
Additional terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 293-294
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Department of Veterans Affairs, VA National Formulary