Ganciclovir

Active against the Herpesvirus family including Cytomegalovirus (CMV)
Ganciclovir is a synthetic, Nucleoside analogue of 2'-deoxyguanosine
Ganciclovir is metabolized to the active Ganciclovir-5-triphosphate (Ganciclovir-TP) by thymidine kinase
1. Some CMV strains lack thymidine kinase, rendering them resistant to Ganciclovir
Ganciclovir-TP inhibits viral DNA synthesis by being substituted into DNA in place of deoxyguanosine
1. Competitively inhibits viral DNA Polymerases
2. Prevents viral DNA elongation

Cytomegalovirus Retinitis
1. Induction: 5 mg/kg IV over 1 hour every 12 hours for 14 to 21 days, then
2. Maintenance: 6 mg/kg IV over 1 hour daily for 5 days per week OR 5 mg/kg IV daily
CMV Prophylaxis after Transplant
1. Induction: 5 mg/kg IV over 1 hour every 12 hours for 7 to 14 days, then
2. Maintenance: 6 mg/kg IV over 1 hour daily for 5 days per week
Renal Dosing
1. eGFR 50 to 69 ml/min
  1. Induction: 2.5 mg/kg IV every 12 hours, then
  2. Maintenance: 2.5 mg/kg IV every 24 hours
2. eGFR 25 to 49 ml/min
  1. Induction: 2.5 mg/kg IV every 24 hours, then
  2. Maintenance: 1.25 mg/kg IV every 24 hours
3. eGFR 10 to 24 ml/min
  1. Induction: 1.25 mg/kg IV every 24 hours, then
  2. Maintenance: 0.625 mg/kg IV every 24 hours
4. eGFR <10 ml/min or Hemodialysis
  1. Induction: 1.25 mg/kg IV three times weekly (after Hemodialysis)
  2. Maintenance: 0.625 mg/kg IV three times weekly (after Hemodialysis)

Not FDA approved for use in children
1. Use Informed Consent regarding potential adverse effects including carcinogenicity
Child (age >3 months old)
1. See adult dosing above
Symptomatic Congenital CMV
1. Give 6 mg/kg IV every 12 hours for 6 weeks

Avoid in Lactation
Avoid in Pregnancy (Teratogenic)
1. Men should use barrier Contraception (Condoms) for at least 3 months after Ganciclovir