Ganciclovir

Ganciclovir

[IV approximately $20 per dose]

ADMINISTRATION ROUTES:

• IV

ALTERNATIVE NAMES:

• Cymevene

ICU INDICATIONS:

1. Treatment of life threatening or sigh tthreatening CMV infection

PRESENTATION AND ADMINISTRATION:

• IV Use:
  Warning: Gancicolovir is a cytotoxic drug. Cytotoxic precautions apply.
  Each vial contains 500mg of powder
  Reconstitute each vial with 10ml of water for injection (giving a concentration of 50mg/ ml). Shake well to dissolve powder. Add to 50-100ml of compatible IV fluid and administer over at least 1 hour. Prepare immediately before use; reconstituted solution is stable at room temperature for 12 hours
  Store at room temperature. Do not refrigerate.
  Compatible with the following IV fluids:
  Normal saline, Hartmanns, 5% glucose
  Do not mix with other medications

DOSAGE:

• 5mg/kg every 12 hours for 14 to 21 days followed by 5mg/kg daily

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]
  <10: 1.25mg/kg 24 hourly
  10-25: 1.25mg/kg 24 hourly
  >25-50: 2.5mg/kg 24 hourly
  >50-69: 2.5mg/kg 12 hourly
• Dose in renal replacement therapy
  CAPD: 1.25mg/kg 24 hourly
  HD: 1.25mg/kg post dialysis
  CVVHDF: 2.5mg/kg 24 hourly

DOSAGE IN PAEDIATRICS:

• 5mg/kg every 12 hours for 14 to 21 days followed by 5mg/kg daily.

CLINICAL PHARMACOLOGY:

• Ganciclovir is a synthetic guanine derivative active against cytomegalovirus (CMV).

CONTRAINDICATIONS:

1. hypersensitivity to ganciclovir, valganciclovir, acyclovir or valacyclovir

WARNINGS

• Hematological:
  Ganciclovir should not be administered if the absolute neutrophil count is less than 500 or the platelet count is less than 25,000. Granulocytopenia (neutropenia), anemia and thrombocytopenia have been observed in patients treated with ganciclovir. The frequency and severity of these events vary widely in different patient populations.

PRECAUTIONS

• General:
  See WARNINGS
• Laboratory Tests:
  No tests are required in addition to routine ICU blood tests.
  
• Drug/Laboratory Test Interactions:
  None reported

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• Since both zidovudine and ganciclovir have the potential to cause neutropenia and anemia, some patients may not tolerate concomitant therapy with these drugs at full dosage. Generalized seizures have been reported in patients who received ganciclovir and imipenem-cilastatin. These drugs should not be used concomitantly; use meropenem instead of imipenem in this situation.

ADVERSE REACTIONS

• Body as a Whole:
  Fever, Infection, Chills, Sepsis
• Digestive System:
  Diarrhoea, anorexia, vomiting
• Haematological System:
  Leukopenia, anaemia, thrombocytopenia
• Nervous System:
  Neuropathy
• Other:
  Sweating, Pruritus