Foscarnet: Difference between revisions

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*Active against all [[human herpesviruses]]
 
*Active against all [[human herpesviruses]]
   
  +
===Mechanism of Action===
=== Pharmacokinetics and Pharmacodynamics ===
 
   
  +
*Acts as a pyrophosphate analogue that competitively and reversibly inhibits herpesvirus DNA polymerase, causing premature chain termination of DNA
* CSF penetration 66% of serum levels
 
   
 
===Pharmacokinetics and Pharmacodynamics===
== Dosing ==
 
   
 
*CSF penetration 66% of serum levels
=== Pediatric Dosing ===
 
   
 
==Dosing==
* Induction: foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h
 
* Maintenance: foscarnet 90 to 120 mg/kg IV q24h
 
   
== Safety ==
+
=== Adult Dosing ===
   
  +
* [[CMV esophagitis]] and [[CMV colitis]]: 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours
* Nephrotoxic
 
  +
* [[CMV retinitis]]: induction with 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours, for 14 to 21 days, followed by maintenance with 90 to 120 mg/kg/dose once daily for 3 to 6 months or longer
* Causes electrolyte abnormalities, including [[hypocalcemia]], [[hypophosphatemia]], [[hyperphosphatemia]], [[hypomagnesemia]], and [[hypokalemia]]
 
  +
* Acyclovir-resistant mucocutaneous [[Herpes simplex virus|herpes simplex]]: 40 mg/kg/dose every 8 to 12 hours
  +
 
===Pediatric Dosing===
  +
 
*Induction: foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h
 
*Maintenance: foscarnet 90 to 120 mg/kg IV q24h
  +
  +
=== Administration ===
  +
  +
* Infusion rate not to exceed 1 mg/kg/min, with adult doses of 60 mg/kg typically infused over 1 hour, and doses of 90 to 120 mg/kg infused over 2 hours
  +
  +
==Safety==
  +
  +
===Adverse Events===
  +
  +
*Most common AEs include infusion-related [[nausea]], electrolyte abnormalities, and [[acute kidney injury]]
  +
**Renal tubular nephrotoxicity is common, dose-dependent, and usually reversible if drug is stopped early
  +
**Crystal glomerular nephropathy also occurs
 
**Electrolyte abnormalities, including [[hypocalcemia]], [[hypophosphatemia]], [[hyperphosphatemia]], [[hypomagnesemia]], and [[hypokalemia]]
  +
**Nausea is very common, and can be debilitating
  +
***Minimize with concurrent IV and oral hydration, antiemetics, and slowing the infusion rate[[CiteRef::jayaweera1997mi]]
  +
*Other AEs include:
  +
**[[Seizure]], usually in patients with concurrent CNS pathology
  +
**[[Genital ulcers]], which slowly heal once the drug is stopped
  +
**[[Anemia]]
  +
**[[Nephrogenic diabetes insipidus]]
  +
  +
===Monitoring===
  +
  +
*Close monitoring of electrolytes and creatinine is required
   
 
[[Category:Antivirals]]
 
[[Category:Antivirals]]

Latest revision as of 08:55, 18 October 2023

Background

Spectrum of Activity

Mechanism of Action

  • Acts as a pyrophosphate analogue that competitively and reversibly inhibits herpesvirus DNA polymerase, causing premature chain termination of DNA

Pharmacokinetics and Pharmacodynamics

  • CSF penetration 66% of serum levels

Dosing

Adult Dosing

  • CMV esophagitis and CMV colitis: 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours
  • CMV retinitis: induction with 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours, for 14 to 21 days, followed by maintenance with 90 to 120 mg/kg/dose once daily for 3 to 6 months or longer
  • Acyclovir-resistant mucocutaneous herpes simplex: 40 mg/kg/dose every 8 to 12 hours

Pediatric Dosing

  • Induction: foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h
  • Maintenance: foscarnet 90 to 120 mg/kg IV q24h

Administration

  • Infusion rate not to exceed 1 mg/kg/min, with adult doses of 60 mg/kg typically infused over 1 hour, and doses of 90 to 120 mg/kg infused over 2 hours

Safety

Adverse Events

Monitoring

  • Close monitoring of electrolytes and creatinine is required

References

  1. ^  Dushyantha T. Jayaweera. Minimising the Dosage-Limiting Toxicities of Foscarnet Induction Therapy. Drug Safety. 1997;16(4):258-266. doi:10.2165/00002018-199716040-00003.