Formulary
Letermovir: Indications, Dosing, Side Effects and Interactions
Letermovir is a cytomegalovirus DNA terminase complex inhibitor that interferes with cytomegalovirus genome formation and virion maturation.
MedNext Academy | 3 min read
Letermovir: Indications, Dosing, Side Effects and Interactions
Letermovir is a cytomegalovirus DNA terminase complex inhibitor that interferes with cytomegalovirus genome formation and virion maturation.
Drug action
Letermovir is a cytomegalovirus DNA terminase complex inhibitor that interferes with cytomegalovirus genome formation and virion maturation.
Indications and dose
**Prevention of cytomegalovirus reactivation and disease [in recipients of an allogeneic haematopoietic stem cell transplant who are seropositive**
- **Adult** (By Mouth): for the human cytomegalovirus] (initiated by a specialist) 480 mg once daily for 100 days post-transplant, start within 28 days post-transplant, treatment beyond 100 days may be considered in some patients-consult product literature.
Side effects
Common or very common Diarrhoea; nausea; vomiting Uncommon Abdominal pain; appetite decreased; fatigue; headache; muscle spasms; peripheral oedema; taste altered; vertigo
Interactions
**Severe interactions:**
- Medicinal products metabolised by CYP2C9 and/or CYP2C19 Co-administration of PREVYMIS with voriconazole (a CYP2C19 substrate) results in significantly decreased voriconazole plasma concentrations,...
- Administration of PREVYMIS may result in a clinically relevant decrease in plasma concentrations of co-administered medicinal products that are significantly transported by P-gp in the intestine...
**Other interactions (118):**
- General information about differences in exposure between different letermovir treatment regimens -The estimated letermovir plasma exposure is different depending on the dose regimen used (see table...
- Therefore, the clinical consequences of drug interactions for letermovir will be dependent on which letermovir regimen is used and whether or not letermovir is combined with ciclosporin.
- Effect of other medicinal products on letermovir The elimination pathways of letermovir in vivo are biliary excretion and glucuronidation.
- After uptake, glucuronidation of letermovir is mediated by UGT1A1 and 3.
- Letermovir also appears to be subject to P-gp and BCRP mediated efflux in the liver and intestine (see section 5.2).
- Inducers of drug metabolising enzymes or transporters Co-administration of PREVYMIS (with or without ciclosporin) with strong and moderate inducers of transporters (e.g., P-gp) and/or enzymes (e.g.,...
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises avoid in moderate impairment in those with co-existing moderate or severe renal impairment, and in severe impairment (risk of increased exposure).
Medicinal forms
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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