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ganciclovir; DHPG (Cytovene, Vitrasert, Zirgan)

Tradenames: DHPG, Cytovene, Vitrasert. A virustatic agent. Indications: 1) CMV retinitis: a) induction therapy - 5 mg/kg every 12-24 hours IV for 14-21 days infused over 1 hour b) maintenance therapy 1] intravenous infusion a] 6 mg/kg/day for 5 days per week b] 5 mg/kg/day 2] 1000 mg PO TID or 500 mg 6 times/day 2) 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 Pharmacokinetics: -> elimination 1/2life 2.9 hours (30 hours ESRD) Monitor: - serum creatinine, serum electrolytes serum calcium, serum magnesium within 180 days Adverse effects: 1) common (> 10%) - bone marrow suppression - neutropenia - thrombocytopenia - reversible upon discontinuation of ganciclovir - headache - fever - nausea/vomiting - abdominal pain 2) less common (1-10%) - anemia, sepsis, abnormal liver function tests, confusion, CNS abnormalities, rash 3) 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 4) intravitreal implant a) common (> 10%) - visual acuity loss, vitreous hemorrhage, retinal detachments b) less common (1-10%) - cataracts, lens opacity, macular degeneration, intraocular pressure spikes, optic disc & nerve changes, hyphema, uveitis Drug interactions: 1) zidovudine (AZT) a) bone marrow suppression may be severe b) few patients can tolerate concurrent administration of both agents 2) didanosine (ddI) a) increased ddI levels b) increased risk of pancreatitis 3) imipenem/cilastin 4) immunosuppressive agents

Interactions

drug interactions

Related

lobucavir (Cyclobut-G, Cygalovir) valganciclovir (Valcyte)

General

antiviral agent

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category C safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 293-294
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  5. Department of Veterans Affairs, VA National Formulary