Antimicrobials

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Ganciclovir

Guidelines for use

*Prescribing of Ganciclovir is restricted to the Infectious Diseases Service*

Please click on the titles below to read more:

1. Spectrum of Activity

Active against:

  • Cytomegalovirus (CMV)
  • Herpes simplex virus type 1 and 2 (HSV-1, HSV-2), varicella-zoster virus (VZV), human herpesvirus-6 (HHV-6) (uncommonly used to treat these viruses)

2. Clinical Use

Appropriate Uses:

  • Treatment of CMV syndrome and CMV end-organ disease (retinitis, infections of the GI tract, pneumonia or infections of the nervous system) in immunocompromised patients
  • Prevention of CMV in immunosuppressed patients who’ve undergone hematopoietic stem cell transplant or solid organ transplant

    3. Precautions

    • Hazardous drug

    4. Pregnancy and breastfeeding

    5. Adverse Effects

    • Neutropenia, thrombocytopenia, anemia, pancytopenia
    • Acute kidney injury
    • Phlebitis and/or pain at the IV site
    • Central nervous system adverse events including, but not limited to, confusion, seizures, abnormal thought patterns, psychosis, hallucinations, changes in mental status, headaches, nightmares

    6. Dosage

    Treatment of CMV infection:
    Induction Maintenance
    CrCl > 70 mL/min 5 mg/kg IV q12h 5 mg/kg IV q24h
    CrCl 50-69 mL/min 2.5 mg/kg IV q12h 2.5 mg/kg q24h
    CrCl 25-49 mL/min 2.5 mg/kg q24h 1.25 mg/kg q24h
    CrCl 10-24 mL/min 1.25 mg/kg q24h 0.625 mg/kg q24h
    CrCl < 10 mL/min 1.25 mg/kg 3 days per week

    0.625 mg/kg 3 days per week
    Peritoneal Dialysis 1.25 mg/kg 3 days per week 0.625 mg /kg 3 days per week
    Intermittent Hemodialysis

    1.25 mg/kg 3 days per week

    Give dose after HD session

    0.625 mg/kg 3 days per week

    Give dose after HD session
    CRRT

    CVVHDF: 2.5 mg/kg q24h3

    Little data, but consider: 2.5 mg/kg q48h
    SLED No data No data

    7. Monitoring drug therapy

    • CBC, platelets
    • Renal function

    References

    1. Product Monograph: Ganciclovir for Injection. Fresenius Kabi Canada Ltd, Toronto, ON, 2018.
    2. Markham A, Faulds D. Ganciclovir: An Update of its Therapeutic Use in Cytomegalovirus Infection. Drugs 1994; 48(3):455-484.
    3. Horvatits T, Kitzberger R, Drolz A, et al. Pharmacokinetics of ganciclovir during continuous venovenous hemodiafiltration in critically ill patients. Antimicrob Agents Chemother. 2014;58(1):94-101.

    Page updated: September 2020