Ganciclovir

Ganciclovir Brand Names

Cytovene | Vitrasert | Zirgan

What is Ganciclovir

Ganciclovir is a synthetic, purine nucleoside analog used for the treatment and prevention of cytomegalovirus (CMV) infections. An ophthalmic gel is used for the treatment of herpetic keratitis

In addition, ganciclovir has been shown to be active against other viruses, including herpes simplex, varicella zoster, and human herpesvirus 6 and 8.

Hematologic toxicity is common with systemic ganciclovir administration; dosage adjustments for neutropenia or thrombocytopenia may be required.

he FDA originally approved intravenous ganciclovir in June 1989. Ganciclovir ophthalmic gel (Virgan) was given an orphan drug designation for acute herpetic keratitis in April 2007 and was granted full approval (Zirgan) in September of 2009.

Ganciclovir oral capsules and intraocular implant were withdrawn from the US market in 2013.

Indications

  1. acute retinal necrosis (ARN)
  2. B virus (cercopithecine herpesvirus)
  3. congenital cytomegalovirus (CMV) disease
  4. cytomegalovirus (CMV)
  5. cytomegalovirus (CMV) disease prophylaxis
  6. cytomegalovirus (CMV) pneumonitis
  7. cytomegalovirus (CMV) retinitis
  8. cytomegalovirus (CMV) retinitis prophylaxis
  9. cytomegalovirus (CMV)-associated gastrointestinal disease
  10. encephalitis
  11. Epstein-Barr virus
  12. herpes simplex keratitis (dendritic keratitis)
  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 6 (HHV-6) infection
  18. human herpesvirus 8 (HHV-8)
  19. human herpesvirus 8 (HHV-8) infection
  20. multicentric Castleman disease
  21. neonatal herpes simplex virus infection
  22. progressive outer retinal necrosis (PORN)
  23. varicella (chickenpox) infection
  24. varicella-zoster virus

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. anaphylactoid reactions
  5. anemia
  6. anorexia
  7. anosmia
  8. anxiety
  9. aphasia
  10. arrhythmia exacerbation
  11. arthralgia
  12. back pain
  13. bleeding
  14. blurred vision
  15. bone marrow suppression
  16. bronchospasm
  17. candidiasis
  18. cardiac arrest
  19. cataracts
  20. chest pain (unspecified)
  21. chills
  22. cholelithiasis
  23. cholestasis
  24. clastogenesis
  25. confusion
  26. conjunctival hyperemia
  27. conjunctivitis
  28. constipation
  29. cough
  30. cranial nerve palsies
  31. depression
  32. diaphoresis
  33. diarrhea
  34. dizziness
  35. drowsiness
  36. dysesthesia
  37. dysgeusia
  38. dyspepsia
  39. dysphagia
  40. dyspnea
  41. edema
  42. elevated hepatic enzymes
  43. eructation
  44. exfoliative dermatitis
  45. fatigue
  46. fever
  47. flatulence
  48. GI perforation
  49. hallucinations
  50. headache
  51. hearing loss
  52. hematuria
  53. hemolytic anemia
  54. hemolytic-uremic syndrome
  55. hepatic failure
  56. hepatitis
  57. hypercalcemia
  58. hypertension
  59. hypertriglyceridemia
  60. hypoesthesia
  61. hyponatremia
  62. hypotension
  63. increased intracranial pressure
  64. increased urinary frequency
  65. infection
  66. infertility
  67. influenza
  68. injection site reaction
  69. insomnia
  70. irritability
  71. keratitis
  72. leukopenia
  73. macular edema
  74. malaise
  75. memory impairment
  76. metabolic acidosis
  77. muscle cramps
  78. myalgia
  79. myasthenia
  80. nausea
  81. neutropenia
  82. new primary malignancy
  83. ocular irritation
  84. ocular pain
  85. otalgia
  86. pancreatitis
  87. pancytopenia
  88. paresthesias
  89. peripheral neuropathy
  90. peripheral vasodilation
  91. phlebitis
  92. pruritus
  93. pulmonary fibrosis
  94. rash
  95. renal failure (unspecified)
  96. retinal detachment
  97. rhabdomyolysis
  98. seizures
  99. SIADH
  100. spermatogenesis inhibition
  101. Stevens-Johnson syndrome
  102. stomatitis
  103. stroke
  104. teratogenesis
  105. testicular atrophy
  106. thrombocytopenia
  107. tinnitus
  108. torsade de pointes
  109. tremor
  110. urinary retention
  111. urticaria
  112. vasculitis
  113. ventricular tachycardia
  114. visual impairment
  115. vomiting
  116. weight loss
  117. xerophthalmia
  118. xerosis
  119. xerostomia

Monitoring Parameters

  • CBC with differential
  • LFTs
  • ophthalmologic exam
  • pregnancy testing
  • serum creatinine/BUN

Contraindications

  • accidental exposure
  • acyclovir hypersensitivity
  • anemia
  • antimicrobial resistance
  • bone marrow suppression
  • breast-feeding
  • chemotherapy
  • children
  • contact lenses
  • contraception requirements
  • dehydration
  • famciclovir hypersensitivity
  • ganciclovir hypersensitivity
  • geriatric
  • infants
  • infertility
  • intramuscular administration
  • leukopenia
  • male-mediated teratogenicity
  • neonates
  • neoplastic disease
  • neutropenia
  • ocular exposure
  • penciclovir hypersensitivity
  • pregnancy
  • pregnancy testing
  • radiation therapy
  • renal failure
  • renal impairment
  • reproductive risk
  • subcutaneous administration
  • thrombocytopenia
  • valacyclovir hypersensitivity
  • valganciclovir hypersensitivity

Interactions

  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Aldesleukin, IL-2
  • Aminoglycosides
  • Amlodipine; Celecoxib
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Aprotinin
  • Bacitracin
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Capreomycin
  • Celecoxib
  • Cidofovir
  • Cisplatin
  • Clofarabine
  • Colchicine; Probenecid
  • Colistimethate, Colistin, Polymyxin E
  • Cyclosporine
  • Dapsone
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dichlorphenamide
  • Diclofenac
  • Diclofenac; Misoprostol
  • Didanosine, ddI
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxorubicin
  • 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
  • Entecavir
  • Esomeprazole; Naproxen
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Flucytosine
  • Flurbiprofen
  • Gallium
  • Gallium Ga 68 Dotatate
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocodone; Ibuprofen
  • Hydroxyurea
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Imipenem; Cilastatin
  • Imipenem; Cilastatin; Relebactam
  • Immune Globulin IV, IVIG, IGIV
  • Indomethacin
  • Inotersen
  • Ketoprofen
  • Ketorolac
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Mycophenolate
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Nitisinone
  • Nonsteroidal antiinflammatory drugs
  • Oxaprozin
  • Pentamidine
  • Piroxicam
  • Polymyxin B
  • Polymyxins
  • Probenecid
  • Rofecoxib
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulindac
  • Tacrolimus
  • Talimogene Laherparepvec
  • Telavancin
  • Telbivudine
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Tolmetin
  • Trimethoprim
  • Valdecoxib
  • Vancomycin
  • Vinca alkaloids
  • Zidovudine, ZDV
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