Formulary
Ganciclovir: Indications, Dosing, Side Effects and Interactions
Ganciclovir clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Ganciclovir: Indications, Dosing, Side Effects and Interactions
Ganciclovir clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Acute herpetic keratitis**
- **Adult** (To The Eye): Apply 5 times a day until healing complete, then apply 3 times a day for a further 7 days, treatment does not usually exceed 21 days.
**Prevention of cytomegalovirus disease [pre-emptive therapy in patients with drug-induced immunosuppression]**
- **Adult** (By Intravenous Infusion): Initially 5 mg/kg every 12 hours for 7-14 days, then maintenance 6 mg/kg once daily, on 5 days of the week, alternatively maintenance 5 mg/kg once daily.
**Prevention of cytomegalovirus disease [universal prophylaxis in patients with drug-induced immunosuppression]**
- **Adult** (By Intravenous Infusion): 6 mg/kg once daily, on 5 days of the week, alternatively 5 mg/kg once daily.
**Treatment of cytomegalovirus disease [in immunocompromised patients]**
- **Adult** (By Intravenous Infusion): Initially 5 mg/kg every 12 hours for 14-21 days, then maintenance 6 mg/kg once daily, on 5 days of the week, alternatively maintenance 5 mg/kg once daily, maintenance only for patients at risk of relapse; if disease progresses initial induction treatment may be repeated.
**Prevention of cytomegalovirus disease [pre-emptive therapy in patients with drug-induced immunosuppression] for ganciclovir**
- **Child 12-17 years** (By intravenous infusion): Initially 5 mg/kg every 12 hours for 7-14 days, then maintenance 6 mg/kg once daily, on 5 days of the week, alternatively maintenance 5 mg/kg once daily.
**Prevention of cytomegalovirus disease [universal prophylaxis in patients with drug-induced immunosuppression] for ganciclovir**
- **Neonate** (By intravenous infusion): (consult product literature).
- **Child 1 month-16 years** (By intravenous infusion): (consult product literature).
- **Child 17 years** (By intravenous infusion): 6 mg/kg once daily, on 5 days of the week, alternatively 5 mg/kg once daily.
**Treatment of cytomegalovirus disease [in immunocompromised patients] for ganciclovir**
- **Child** (By intravenous infusion): Initially 5 mg/kg every 12 hours for 14-21 days, then maintenance 6 mg/kg once daily, on 5 days of the week, alternatively maintenance 5 mg/kg once daily, maintenance only for patients at risk of relapse; if disease progresses initial induction treatment may be repeated.
**Congenital cytomegalovirus infection of the CNS for ganciclovir**
- **Neonate** (By intravenous infusion): 6 mg/kg every 12 hours for 6 weeks.
Cautions
With intravenous use History of cytopenia; potential carcinogen (including long-term carcinogenicity); potential teratogen (including long-term teratogenicity); radiotherapy
Contraindications
With intravenous use Abnormally low haemoglobin count (consult product literature); abnormally low neutrophil count (consult product literature); abnormally low platelet count (consult product literature)
Side effects
Common or very common When used by eye (topical) Eye stinging; punctate keratitis With intravenous use Anaemia; anxiety; appetite decreased; arthralgia; asthenia; bone marrow disorders; chest pain; chills; confusion; constipation; cough; depression; diarrhoea; dizziness; dysphagia; dyspnoea; ear pain; eye disorders; eye inflammation; eye pain; fever; flatulence; gastrointestinal discomfort; headache; hepatic function abnormal; increased risk of infection; insomnia; leucopenia; malaise; muscle complaints; nausea; neutropenia; night sweats; pain; peripheral neuropathy; renal impairment; seizure; sensation abnormal; sepsis; skin reactions; taste altered; thinking abnormal; thrombocytopenia; vomiting; weight decreased Uncommon With intravenous use Alopecia; arrhythmia; deafness; haematuria; hypotension; infertility male; oral ulceration; pancreatitis; psychotic disorder; tremor; visual impairment Rare or very rare With intravenous use Agranulocytosis; hallucination
Interactions
**Severe interactions:**
- Pharmacokinetic interactions Probenecid Probenecid given with oral ganciclovir resulted in statistically decreased renal clearance of ganciclovir, and led to clinically significant increased exposure.
- There was no clinically significant effect on ganciclovir concentrations.
**Other interactions (9):**
- Such an effect is also anticipated during concomitant administration of intravenous ganciclovir and probenecid.
- Therefore, patients taking probenecid and ganciclovir should be closely monitored for ganciclovir toxicity.
- Didanosine Didanosine plasma concentrations were found to be consistently raised when given with ganciclovir.
- Other antiretrovirals Cytochrome P450 isoenzymes play no role in ganciclovir pharmacokinetics.
- Pharmacodynamic interactions Imipenem cilastatin Seizures have been reported in patients taking ganciclovir and imipenemcilastatin concomitantly.
- Zidovudine Both zidovudine and ganciclovir have the potential to cause neutropenia and anaemia.
Pregnancy
With intravenous use: Manufacturer advises avoid unless potential benefit outweighs risk-teratogenicity in animal studies. When used by eye: Manufacturer advises avoid unless no suitable alternative-limited information available.
Breast feeding
With intravenous use: Manufacturer advises avoid-present in milk in animal studies. When used by eye: Manufacturer advises avoid unless no suitable alternative-limited information available.
Renal impairment
Dose adjustments With intravenous use: Manufacturer advises reduce dose for patients receiving mg/kg dosing if creatinine clearance less than 70 mL/minute-consult product literature. See Prescribing in renal impairment .
Medicinal forms
Solution,Gel
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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