Ganciclovir

• Guanosine nucleoside analogue similar to acyclovir
• Inhibits all human herpesviruses by inhibiting DNA polymerase
• Major toxicity is cytopenias
• 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
• Oral bioavailability 6-8%
• Indications: CMV after hematopoietic stem cell transplantation, CMV after solid organ transplantation, Congenital CMV, Cytomegalovirus, Herpesviridae, Macacine alphaherpesvirus 1, Post-transplant acute limbic encephalitis