Background
- Acyclic nucleoside phosphonate that competes with cytosine nucleotides to inhibit viral DNA polymerase
- Indications: Adenovirus, CMV after solid organ transplantation, Cytomegalovirus, Herpes simplex virus
Spectrum of Activity
- Active against essentially all DNA viruses, including polyomaviruses (BK virus, JC virus), human papillomavirus, adenovirus, all of the human herpesviruses, poxviruses (including monkeypox virus and variola virus)
- Not active against hepatitis B virus or RNA viruses
Pharmacokinetics and Pharmacodynamics
- Unlike ganciclovir, it does not need phosphorylation by UL97
- Does not penetrate CSF
Dosing
- Should be given with probenecid 2 g IV prior to each dose
Safety
- Major adverse effect is dose-dependent, irreversible renal tubular necrosis, which may be prevented by probenecid
- Contraindicated when creatinine >132 μmol/L, CrCl <55 mL/min, or urine protein ≥100 mg/dL (2+ proteinuria)
- Neutropenia
- Acute iritis
