The use of ganciclovir is considered appropriate when all of the following circumstances exist:
1. The drug has been ordered by the Infectious Disease department OR the Renal or Bone Marrow Transplant Team.
2. The patient is immunocompromised.
3. The patient has a cytomegalovirus infection.
This drug is indicated only for cytomegalovirus retinitis. However, standard of practice in medicine calls for use of ganciclovir for cytomegalovirus infections when antiviral therapy is warranted. This includes gastrointestinal infections, pneumonitis hepatobiliary infection.
Dose:
CMV retinitis: induction therapy — 5 mg/kg q 12 hr I.V. for 14 - 21 days Maintenance therapy, 5 mg/kg/day I.V. daily or 6 mg/kg/day 5 days a week.
Other infections: usually as for retinitis. A dose of 2.5 mg/kg q 8 h I.V. has also been used.
Renal Impairment: if Ccr is 79 or less — give 2.5 mg/kg q 12 h
if Ccr is 49 or less — give 2.5 mg/kg/day
if Ccr is <25 — 1.25 mg/kg/day
Must administer by slow I.V. infusion over 1 hour in at least 100 ml of fluid but not to exceed 10 mg/ml.
Monitor:
1. Neutrophil must be > 500/mm3
2. Platelets must be > 25,000 mm3
3. AZT used with ganciclovir causes profound myelosuppression
4. Use of Imipenem-Cilastatin with ganciclovir may increase the risk of seizures.
5. Use with other drugs that inhibit replication of rapidly dividing cells may have additive toxicity.
6. Do not administer parenteral AZT and ganciclovir simultaneously.
Outcome:
Improvement in symptoms and functions of systems involved.
