Pharm

Valganciclovir

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Valganciclovir, Valcyte

  • See Also
  1. Cytomegalovirus Retinitis
  2. Cidofovir
  3. Foscarnet
  4. Ganciclovir
  5. Letermovir
  6. Maribavir
  • Indications
  1. Cytomegalovirus Retinitis
  2. CMV Prophylaxis after Transplant
  3. Congenital CMV (off-label use)
  • Contraindications
  1. Absolute Neutrophil Count <500/mm3
  2. Hemoglobin <8 mg/dl
  3. Platelet Count <25,000/mm3
  4. Hemodialysis
    1. Use Ganciclovir instead
  • Mechanism
  1. Valganciclovir is a synthetic prodrug of Ganciclovir
    1. Valganciclovir has good oral Bioavailability compared with Ganciclovir, allowing for its oral dosing
  2. Like Ganciclovir, Valganciclovir is Nucleoside analogue of 2'-deoxyguanosine
    1. When incorporated into DNA, Valganciclovir blocks DNA Polymerase and further DNA elongation and DNA Replication
  • Dosing
  • Adult
  1. Cytomegalovirus Retinitis
    1. Induction: Take 900 mg orally twice daily for 21 days, then
    2. Maintenance: 900 mg orally daily
  2. CMV Prophylaxis after Transplant
    1. Take 900 orally daily
    2. Start within 10 days of transplant
    3. Continue for 100 days following heart, Kidney-Pancreas transplant (200 days after Kidney Transplant)
  3. Renal Dosing
    1. Adjust dose for eGFR <60 ml/min
  • Dosing
  • Child
  1. CMV Prophylaxis after Kidney or Heart Transplant (age >4 months)
    1. Daily dose 7 mg x BSA x CrCl (via modified Schwartz, max 900 mg/day)
    2. Start within 10 days of transplant
    3. Continue for 100 days following Heart Transplant (200 days after Kidney Transplant)
  2. Symptomatic Congenital CMV (off-label for age <1 month old)
    1. Give 16 mg/kg orally with food twice daily for 6 months
    2. Dose adjusted for weight on monthly basis
    3. Monitor Absolute Neutrophil Count weekly for first 6 weeks, then at 8 weeks, and again monthly
    4. Monitor AST and ALT monthly
  • Adverse Effects
  1. Myelosuppression (similar to Ganciclovir)
  2. Nephrotoxicity (increased Serum Creatinine)
    1. Monitor Serum Creatinine
  3. Possibly carcinogenic (as with Ganciclovir)
  • Safety
  1. Avoid in Lactation
  2. Avoid in Pregnancy (Teratogenic)
    1. Women should avoid pregnancy for at least 1 month after last dose
    2. Men should use barrier Contraception (Condoms) for at least 3 months after Ganciclovir
  • Drug Interactions
  1. Didanosine
  2. Mycophenylate
  3. Zidovudine
  • Resources
  1. Valganciclovir Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=37b7a5d8-9a2c-40b1-a414-71ecc47e567d
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2013) Med Lett Drugs Ther 11(127): 19-30 [PubMed]