Cidofovir

Cidofovir Brand Name– Vistide

What is Cidofovir

Cidofovir is an acyclic phosphonate nucleotide analog antiviral agent used for the treatment of cytomegalovirus (CMV) or herpes virus infections.

Nucleotides differ chemically and pharmacologically from nucleosides (e.g., zidovudine).

Nucleotides are combinations of purine or pyrimidine bases along with an attached sugar and phosphate moiety that is highly stable to serum esterase cleavage, and are the individual units that make up RNA and DNA.

Unlike nucleoside analogs, cidofovir is not dependent upon intracellular activation for its antiviral activity. Other advantages of cidofovir include once-weekly dosing and activity against certain ganciclovir, foscarnet, and acyclovir-resistant CMV strains.

Cidofovir exhibits other antiviral activity in vitro, including activity against poxviruses.

The National Institutes of Health’s National Institute of Allergy and Infectious Disease has proposed testing cidofovir in the treatment of smallpox.

Cidofovir is also available off-label via a treatment IND from the US CDC for the treatment of severe reactions to the vaccinia (smallpox) vaccine in selected circumstances.

Systemic cidofovir can cause serious adverse reactions, including renal toxicity, and close attention to administration protocols and clinical monitoring are recommended.

The FDA approved cidofovir injection (Vistide) in June 1996. An intravitreous formulation of cidofovir is being investigated for the treatment of CMV retinitis. Cidofovir gel (Forvade) has been shown effective in healing lesions in acyclovir-unresponsive mucocutaneous herpes simplex virus infection in patients with AIDS.

In May 1997, the FDA determined that data are not sufficient to support approval of cidofovir gel for refractory herpes simplex virus infection in patients with AIDS; no further studies to evaluate the use of cidofovir in herpes simplex infections are planned or in progress.

The gel is available through an expanded access program from the manufacturer in the United States.

Indications

1. adenovirus
2. adenovirus infection
3. African swine fever virus
4. condylomata acuminata
5. cytomegalovirus (CMV)
6. cytomegalovirus (CMV) retinitis
7. cytomegalovirus (CMV) retinitis prophylaxis
8. eczema vaccinatum
9. Epstein-Barr virus
10. generalized vaccinia
11. Hepadnavirus Family
12. herpes genitalis
13. herpes simplex virus infection
14. herpes simplex virus type 1
15. herpes simplex virus type 2
16. human herpesvirus 6 (HHV-6)
17. human herpesvirus 7 (HHV-7)
18. human herpesvirus 8 (HHV-8)
19. human papillomavirus (HPV)
20. human papillomavirus (HPV) infection
21. human polyomavirus, BK virus
22. human polyomavirus, JC virus
23. Iridovirus Family
24. molluscum contagiosum
25. molluscum contagiosum virus (MCV)
26. Papovavirus Family
27. Poxvirus Family
28. vaccinia necrosum (progressive vaccinia)
29. vaccinia virus
30. varicella-zoster virus
31. variola virus (smallpox)

Side Effects

1. abdominal pain
2. acne vulgaris
3. agitation
4. alopecia
5. amblyopia
6. amnesia
7. anemia
8. angioedema
9. anorexia
10. antimicrobial resistance
11. anxiety
12. arthralgia
13. asthenia
14. ataxia
15. back pain
16. bone fractures
17. bone pain
18. candidiasis
19. cardiomyopathy
20. cataracts
21. chest pain (unspecified)
22. chills
23. cholangitis
24. colitis
25. confusion
26. conjunctivitis
27. constipation
28. corneal opacification
29. cough
30. dehydration
31. delirium
32. dental caries
33. depression
34. diarrhea
35. diplopia
36. dizziness
37. drowsiness
38. dysgeusia
39. dyspepsia
40. dysphagia
41. dyspnea
42. dysuria
43. edema
44. elevated hepatic enzymes
45. encephalopathy
46. epistaxis
47. esophagitis
48. exfoliative dermatitis
49. Fanconi syndrome
50. fecal incontinence
51. fever
52. flatulence
53. furunculosis
54. gastritis
55. GI bleeding
56. gingivitis
57. glycosuria
58. hallucinations
59. headache
60. hearing loss
61. heart failure
62. hematuria
63. hemoptysis
64. hepatic necrosis
65. hepatitis
66. hepatomegaly
67. hiccups
68. hyperacusis
69. hypercalcemia
70. hyperesthesia
71. hyperglycemia
72. hyperkalemia
73. hyperlipidemia
74. hypertension
75. hypertonia
76. hyperventilation
77. hypocalcemia
78. hypoglycemia
79. hypokalemia
80. hypomagnesemia
81. hyponatremia
82. hypophosphatemia
83. hypotension
84. hypothermia
85. hypotonia
86. hypoxia
87. infection
88. infertility
89. injection site reaction
90. insomnia
91. iritis
92. jaundice
93. keratitis
94. laryngeal edema
95. leukocytosis
96. leukopenia
97. libido increase
98. lymphadenopathy
99. malaise
100. melena
101. metabolic acidosis
102. migraine
103. miosis
104. muscle cramps
105. myalgia
106. myasthenia
107. myoclonia
108. nausea
109. nephrolithiasis
110. nephrotoxicity
111. neutropenia
112. new primary malignancy
113. nocturia
114. ocular hypotonia
115. ocular hypotonia
116. ocular pain
117. oral ulceration
118. orthostatic hypotension
119. osteonecrosis
120. otalgia
121. pallor
122. pancreatitis
123. pancytopenia
124. paresthesias
125. peripheral edema
126. peripheral neuropathy
127. peripheral vasodilation
128. pharyngitis
129. phlebitis
130. phosphaturia
131. photosensitivity
132. pneumothorax
133. polyuria
134. proctitis
135. proteinuria
136. pruritus
137. rash
138. renal failure (unspecified)
139. renal tubular necrosis
140. retinal detachment
141. rhinitis
142. seborrhea
143. seizures
144. sinus tachycardia
145. sinusitis
146. skin discoloration
147. skin ulcer
148. splenomegaly
149. stomatitis
150. syncope
151. teratogenesis
152. thrombocytopenia
153. thrombotic thrombocytopenic purpura (TTP)
154. tinnitus
155. tongue discoloration
156. tremor
157. urinary incontinence
158. urinary retention
159. urticaria
160. uveitis
161. vertigo
162. visual impairment
163. vomiting
164. weight gain
165. weight loss
166. xerophthalmia
167. xerostomia

Monitoring Parameters

• CBC with differential
• serum creatinine
• urinalysis

Contraindications

• accidental exposure
• breast-feeding
• children
• dehydration
• diabetes mellitus
• diarrhea
• females
• foscarnet therapy
• geriatric
• infertility
• male-mediated teratogenicity
• nephrotoxicity
• neutropenia
• new primary malignancy
• ocular exposure
• pregnancy
• probenecid hypersensitivity
• proteinuria
• renal disease
• renal failure
• renal impairment
• sulfonamide hypersensitivity

Interactions

• Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acyclovir
• Adefovir
• Aldesleukin, IL-2
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Amikacin
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Aminoglycosides
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amphotericin B
• Amphotericin B cholesteryl sulfate complex (ABCD)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B liposomal (LAmB)
• Aprotinin
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atenolol; Chlorthalidone
• Azilsartan; Chlorthalidone
• Bacitracin
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Bictegravir; Emtricitabine; Tenofovir Alafenamide
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bumetanide
• Cabozantinib
• Candesartan; Hydrochlorothiazide, HCTZ
• Capreomycin
• Captopril; Hydrochlorothiazide, HCTZ
• Celecoxib
• Chlorothiazide
• Chlorthalidone
• Chlorthalidone; Clonidine
• Choline Salicylate; Magnesium Salicylate
• Cisplatin
• Clofarabine
• Colchicine; Probenecid
• Cyclosporine
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dichlorphenamide
• Diclofenac
• Diclofenac; Misoprostol
• Diflunisal
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diuretics
• Doravirine; Lamivudine; Tenofovir disoproxil fumarate
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Emtricitabine
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Emtricitabine; Tenofovir alafenamide
• Emtricitabine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Entecavir
• Eprosartan; Hydrochlorothiazide, HCTZ
• Esomeprazole; Naproxen
• Ethacrynic Acid
• Etodolac
• Famotidine; Ibuprofen
• Fenoprofen
• Flurbiprofen
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Furosemide
• Gallium Ga 68 Dotatate
• Ganciclovir
• Gentamicin
• Hyaluronidase, Recombinant; Immune Globulin
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Ibuprofen
• Ibuprofen
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Immune Globulin IV, IVIG, IGIV
• Indapamide
• Indomethacin
• Inotersen
• Kanamycin
• Ketoprofen
• Ketorolac
• Lamivudine, 3TC; Zidovudine, ZDV
• Lamivudine; Tenofovir Disoproxil Fumarate
• Lansoprazole; Naproxen
• Magnesium Salicylate
• Mannitol
• Maraviroc
• Meclofenamate Sodium
• Mefenamic Acid
• Meloxicam
• Methyclothiazide
• Metolazone
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nitisinone
• Nonsteroidal antiinflammatory drugs
• Oxaliplatin
• Oxaprozin
• Pamidronate
• Paromomycin
• Pentamidine
• Piroxicam
• Plazomicin
• Polymyxins
• Probenecid
• Protease inhibitors
• Rofecoxib
• Salsalate
• Spironolactone
• Streptomycin
• Sulindac
• Tacrolimus
• Talimogene Laherparepvec
• Telavancin
• Telbivudine
• Tenofovir Alafenamide
• Tenofovir Alafenamide
• Tenofovir, PMPA
• Tobramycin
• Tolmetin
• Torsemide
• Triamterene
• Valacyclovir
• Valdecoxib
• Vancomycin
• Zidovudine, ZDV
• Zoledronic Acid