Cidofovir

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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

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