cidofovir (Vistide)
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Introduction
Tradename: Vistide.
Indications
- CMV retinitis in AIDS patients
- most common antiviral used for adenovirus infection[4]
Dosage
- 5 mg/kg weekly for 2 consecutive weeks, then 5 mg/kg every other week
- pre hydration: 1 liter of normal saline
- probenecid: 2 g must be administered orally 3 hours prior to each dose of cidofovir, then 1 g at 2 & at 8 hours after completion of the infusion
Dosage adjustment in renal failure
Table
| Creatinine clearance | induction | maintenance |
|---|---|---|
| 41-45 mL/min | 2.0 mg/kg | 2.0 mg/kg |
| 30-40 mL/min | 1.5 mg/kg | 1.5 mg/kg |
| 20-29 mL/min | 1.0 mg/kg | 1.0 mg/kg |
| <19 mL/min | 0.5 mg/kg | 0.5 mg/kg |
Pharmacokinetics
- does NOT require intracellular phosphorylation for activity
elimination via kidney
Monitor
serum creatinine, urine protein, WBC with each dose, intraocular pressure, visual acuity, ocular symptoms
Adverse effects
- common (>10%)
- dose-dependent nephrotoxicity infection, fever/chills, headache, amnesia, anxiety, confusion, seizures, insomnia, alopecia, rash, acne, skin discoloration, nausea/vomiting, diarrhea, anorexia, abdominal pain, constipation, dyspepsia, gastritis, thrombocytopenia, neutropenia, anemia, weakness, paresthesia, conjunctivitis, ocular hypotony, renal tubular damage, proteinuria, creatinine elevation, asthma, bronchitis, cough, dyspnea, pharyngitis
- less common (1-10%)
- hypotension, pallor, syncope, tachycardia, dizziness, hallucinations, depression, somnolence, malaise, pruritus, urticaria, hyperglycemia, hyperlipidemia, hypocalcemia, hypokalemia, dehydration, abnormal taste, stomatitis, urinary incontinence, urinary tract infection, skeletal pain, retinal detachment, iritis, uveitis, abnormal vision, hematuria, glycosuria, pneumonia, rhinitis, sinusitis, diaphoresis
More general terms
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Deprecated Reference
- ↑ 4.0 4.1 Hibbert KA, Shepard JAO, Lane RJ, Azar MM. Case 1-2018 - A 39-Year-Old Woman with Rapidly Progressive Respiratory Failure. N Engl J Med 2018; 378:182-190. January 11, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29320657 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcpc1712222
- ↑ Department of Veterans Affairs, VA National Formulary