Virsus active against:
Mode of action
• A synthetic analogue of 2'-
deoxyguanosine, which inhibits
replication of herpes viruses both in
vitro and in vivo.
The virustatic activity of ganciclovir is a
result of the inhibition of viral DNA
synthesis by:
1) Competitive inhibition of
incorporation of deoxyguanosine
triphosphate into DNA by DNA
polymerase.
2)incorporation of ganciclovir
triphosphate into viral DNA, causing
termination of, or very limited, viral DNA
elongation.
Black Box Warnings
Hematologic toxicity: Granulocytopenia, anemia,
thrombocytopenia, and pancytopenia reported
Impairment of fertility: Based on animal data and
limited human data, ganciclovir may cause temporary
or permanent inhibition of spermatogenesis in males
and suppression of fertility in females
Caution:
-Renal impairment
Dose
For the treatment of viral encephalitis:
for varicella-zoster (herpes zoster) encephalitis as an
alternative to acyclovir:
Intravenous dosage:
Adults: 5 mg/kg/dose IV every 12 hours is
recommended by the Infectious Diseases Society of
America (IDSA).
Duration:
10 to 15 days duration of therapy
Renal impairment (maintenance)
CrCl 70 mL/minute or more: no
dosage adjustment needed.
CrCl 50 to 69 mL/minute: 2.5
mg/kg/dose IV every 24 hours.
CrCl 25 to 49 mL/minute: 1.25
mg/kg/dose IV every 24 hours.
CrCl 10 to 24 mL/minute: 0.625
mg/kg/dose IV every 24 hours.
CrCl less than 10 mL/minute:
0.625 mg/kg/dose IV 3 times a
week after hemodialysis.
➢ Cytomegalovirus (HCMV)
➢ Herpes simplex virus 1 and 2
➢ Human herpesvirus 6, 7 and 8
➢ Epstein-Barr virus (EBV),
➢ Varicella zoster virus (VZV),
and hepatitis B virus.
Drug interactions overview
• Coadministration with imipenem-
cilastatin is not recommended
because generalized seizures
reported
• Monitor renal function when
coadministered with cyclosporine
or amphotericin B
• Based on increased risk, monitor
for hematological and renal
toxicity when concomitantly using
mycophenolate mofetil
Preparation for administration
Reconstitute 500mg vial with 10ml unpreserved
sterile water, shake well to dissolve, then dilute
in 100ml dextrose 5% or saline to conc. Less
than 10mg/ml. The diluted solution should then
be infused intravenously over 1 hour as
directed