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
