Ganciclovir (Cymevene)

Ganciclovir - is related to aciclovir but is more active against cytomegalovirus (CMV).It is also more toxic. It causes profound myelosuppression when given with zidovudine; the two should not be given together particularly during initial ganciclovir therapy.

Uses
CMV infections in immunocompromised patients
Prevention of CMV infection during immunosuppression following
organ transplantation

Contraindications
Hypersensitivity to ganciclovir and aciclovir
Abnormally low neutrophil counts

Administration
• IV infusion: 5 mg/kg 12 hourly, given over 1 h through filter provided

Though not cytotoxic, this product should preferably be made up aseptically as it is myelosuppressive. Reconstitute the 500mg powder with 10 ml WFI, then dilute with 50–100 ml sodium chloride 0.9% or glucose 5%

Wear polythene gloves and safety glasses when preparing solution
Duration of treatment: 7–14 days for prevention and 14–21 days for
treatment
Ensure adequate hydration
Monitor: FBC
U&E
LFT

In renal impairment:

CC (ml/min)	Dose (mg/kg)	Interval (h)
> 70	5.0	12
50–69	2.5	12
25–49	2.5	24
0–24	1.25	24

Adverse effects
Leucopenia
Thrombocytopenia
Anaemia
Fever
Rash
Abnormal LFT

Cautions
History of cytopenia, low platelet count
Concurrent use of myelosuppressants
Renal impairment

Renal replacement therapy
The major route of clearance of ganciclovir is by glomerular filtration of the unchanged drug. CVVH dialysed 2.5 mg/kg IV once daily. HD dialysed, 1.25 mg/kg every day post-dialysis on dialysis days. PD dialysable, 1.25 mg/kg IV every 24 hours.