Valganciclovir

Background

• Valine ester of ganciclovir with much higher oral bioavailability (70%)
• Indications: CMV after hematopoietic stem cell transplantation, CMV after solid organ transplantation, Congenital CMV, Cytomegalovirus, Herpesviridae

Dosing

• CMV prophylaxis in solid organ transplant: 900 mg p.o. daily
• Mild-to-moderate CMV disease in solid organ transplant: 900 mg p.o. twice daily
• CMV viremia in hematopoietic stem cell transplant: 900 mg p.o. twice daily for 7 to 14 days followed by once daily until negative PCR

Renal Dosing

CrCl	Induction or Treatment	Maintenance or Prophylaxis
≥60	900 mg twice daily	900 mg once daily
40 to 59	450 mg twice daily	450 mg once daily
25 to 39	450 mg once daily	450 mg every 2 days
10 to 24	450 mg every 2 days	450 mg twice weekly
<10	Not recommended; may consider using oral solution 200 mg 3 times weekly	Not recommended; may consider using oral solution 100 mg 3 times weekly

Safety

Adverse Effects

• Long list
• Anemia, thrombocytopenia, and neutropenia