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What is Valganciclovir
Valganciclovir is the L-valyl ester of ganciclovir (i.e., a prodrug), which exists as a mixture of two diastereomers.
After oral administration, both diastereomers are rapidly converted to ganciclovir. Ganciclovir is a synthetic analog of guanine and is effective against human cytomegalovirus (CMV) infections. The advantage of valganciclovir is the ability to attain in vivo exposure similar to IV ganciclovir and higher than oral ganciclovir capsules.
During induction therapy of CMV retinitis, similar outcomes were noted in patients treated with valganciclovir or IV ganciclovir. Valganciclovir is approved for use as induction treatment of CMV retinitis in patients with AIDS, as maintenance therapy after induction, or in patients with inactive CMV retinitis.
Valganciclovir is also approved for prophylaxis against CMV after heart, kidney, or kidney-pancreas transplantation.
Valganciclovir received initial FDA-approval for use in adults in March 2001.
Approval was extended to children 4 months and older for the prevention of CMV disease in kidney and heart transplant patients in August 2009, and in April 2015, valganciclovir was approved for use in infants as young as 1 month of age after heart transplant.
Brand Name
Valcyte
Indications
- congenital cytomegalovirus (CMV) disease
- cytomegalovirus (CMV)
- cytomegalovirus (CMV) disease prophylaxis
- cytomegalovirus (CMV) retinitis
- cytomegalovirus (CMV) retinitis prophylaxis
- cytomegalovirus (CMV)-associated gastrointestinal disease
- encephalitis
- Epstein-Barr virus
- herpes simplex virus type 1
- herpes simplex virus type 2
- human herpesvirus 6 (HHV-6)
- human herpesvirus 6 (HHV-6) infection
- human herpesvirus 8 (HHV-8)
- human herpesvirus 8 (HHV-8) infection
- multicentric Castleman disease
- varicella-zoster virus
Side Effects
- abdominal pain
- agitation
- agranulocytosis
- anaphylactic shock
- anemia
- anxiety
- aplastic anemia
- arthralgia
- asthenia
- back pain
- bleeding
- bone marrow suppression
- candidiasis
- chills
- clastogenesis
- confusion
- constipation
- cough
- depression
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- fatigue
- fever
- hallucinations
- headache
- hearing loss
- hematuria
- hyperkalemia
- hypophosphatemia
- hypotension
- infection
- infertility
- influenza
- insomnia
- leukopenia
- macular edema
- malaise
- muscle cramps
- myalgia
- nausea
- neutropenia
- new primary malignancy
- night sweats
- ocular pain
- oral ulceration
- pancreatitis
- pancytopenia
- paresthesias
- peripheral edema
- peripheral neuropathy
- pharyngitis
- pruritus
- psychosis
- renal failure (unspecified)
- retinal detachment
- seizures
- spermatogenesis inhibition
- teratogenesis
- thrombocytopenia
- tremor
- vomiting
- weight loss
- wound dehiscence
Monitoring Parameters
- CBC with differential
- ophthalmologic exam
- pregnancy testing
- serum creatinine/BUN
Contraindications
- accidental exposure
- acyclovir hypersensitivity
- anemia
- antimicrobial resistance
- aplastic anemia
- bone marrow suppression
- breast-feeding
- children
- contraception requirements
- dehydration
- dialysis
- famciclovir hypersensitivity
- ganciclovir hypersensitivity
- geriatric
- infants
- infertility
- male-mediated teratogenicity
- neonates
- neutropenia
- new primary malignancy
- ocular exposure
- penciclovir hypersensitivity
- pregnancy
- pregnancy testing
- radiation therapy
- renal failure
- renal impairment
- reproductive risk
- thrombocytopenia
- valacyclovir hypersensitivity
- valganciclovir hypersensitivity
Interactions
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Amikacin
- Aminoglycosides
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Aprotinin
- Bacitracin
- Bictegravir; Emtricitabine; Tenofovir Alafenamide
- Cisplatin
- Colchicine; Probenecid
- Cyclosporine
- Dapsone
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Didanosine, ddI
- 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
- Flucytosine
- Gentamicin
- Hyaluronidase, Recombinant; Immune Globulin
- Hydroxyurea
- Imipenem; Cilastatin
- Imipenem; Cilastatin; Relebactam
- Immune Globulin IV, IVIG, IGIV
- Kanamycin
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamivudine; Tenofovir Disoproxil Fumarate
- Mycophenolate
- Nonsteroidal antiinflammatory drugs
- Paromomycin
- Pentamidine
- Plazomicin
- Polymyxin B
- Probenecid
- Streptomycin
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Tacrolimus
- Talimogene Laherparepvec
- Telbivudine
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Tobramycin
- Trimethoprim
- Vancomycin
- Vinblastine
- Vinca alkaloids
- Vincristine
- Vincristine Liposomal
- Vinorelbine
- Zidovudine, ZDV
