Ganciclovir: Difference between revisions
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==Background== |
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*Guanosine nucleoside analogue similar to acyclovir |
*Guanosine nucleoside analogue similar to acyclovir |
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*Indications: {{#ask: [[Is treated by::ganciclovir]] | default=none}} |
*Indications: {{#ask: [[Is treated by::ganciclovir]] | default=none}} |
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===Mechanism of Action=== |
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*Analog of deoxyguanosine, competes with deoxyguanosine to inhibit viral DNA polymerase |
*Analog of deoxyguanosine, competes with deoxyguanosine to inhibit viral DNA polymerase |
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===Mechanisms of Resistance=== |
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*Resistance in [[CMV]] |
*Resistance in [[CMV]] |
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**Can also develop through mutations in the target UL54 DNA polymerase |
**Can also develop through mutations in the target UL54 DNA polymerase |
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===Spectrum of Activity=== |
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* |
*Active against [[HSV-1]], [[HSV-2]], [[VZV]], [[CMV]], [[HHV-6]], and [[HHV-8]] |
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===Pharmacokinetics and Pharmacodynamics=== |
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*Oral bioavailability 6-8% |
*Oral bioavailability 6-8% |
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*CNS penetration 24-67% of serum levels |
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== Dosing == |
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=== Pediatric Dosing === |
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* Ganciclovir 5-6 mg/kg IV q12h |
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==Safety== |
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**Usually develops in first one to two weeks of treatment |
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**Contraindicated when neutrophils <0.5 cells/mL or platelets <25 cells/mL |
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=== Drug-Drug Interactions === |
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* [[Zidovudine]], [[didanosine]], [[probenecid]], and [[imipenem-cilastatin]] (increases risk of seizures) |
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[[Category:Antivirals]] |
[[Category:Antivirals]] |
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Revision as of 01:17, 12 September 2020
Background
- Guanosine nucleoside analogue similar to acyclovir
- Indications: CMV after hematopoietic stem cell transplantation, CMV after solid organ transplantation, Congenital CMV, Cytomegalovirus, Herpesviridae, Macacine alphaherpesvirus 1, Post-transplant acute limbic encephalitis
Mechanism of Action
- Analog of deoxyguanosine, competes with deoxyguanosine to inhibit viral DNA polymerase
Mechanisms of Resistance
- Resistance in CMV
- Most often conferred by mutations of UL97 kinase, which is required in order to phosphorylate ganciclovir into its active form
- Can also develop through mutations in the target UL54 DNA polymerase
Spectrum of Activity
Pharmacokinetics and Pharmacodynamics
- Oral bioavailability 6-8%
- CNS penetration 24-67% of serum levels
Dosing
Pediatric Dosing
- Ganciclovir 5-6 mg/kg IV q12h
Safety
- Major toxicity is cytopenias
- Usually develops in first one to two weeks of treatment
- Contraindicated when neutrophils <0.5 cells/mL or platelets <25 cells/mL
Drug-Drug Interactions
- Zidovudine, didanosine, probenecid, and imipenem-cilastatin (increases risk of seizures)
