cidofovir


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cidofovir

 [si-dof´ah-vir]
an antiviral nucleoside analogue used in treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome; administered by intravenous infusion.

cidofovir

Vistide

Pharmacologic class: Purine nucleotide cytosine analog

Therapeutic class: Antiviral

Pregnancy risk category C

Action

Exerts antiviral effect by interfering with DNA synthesis of CMV, thereby inhibiting viral replication

Availability

Solution for injection: 75 mg/ml in 5-ml, single-use vials

Indications and dosages

CMV retinitis in AIDS patients

Adults: 5 mg/kg I.V. infused over 1 hour q week for 2 continuous weeks; then 5 mg/kg I.V. once q 2 weeks as a maintenance dose

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug, probenecid, or other sulfa-containing agents
• Creatinine level above 1.5 mg/dl, calculated creatinine clearance of 55 ml/minute or less, or urine protein level of 100 mg/dl or higher
• Concurrent use of nephrotoxic drugs

Precautions

Use cautiously in:
• renal impairment
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 12 (safety and efficacy not established).

Administration

Be aware that drug carries a high risk of nephrotoxicity. Follow administration instructions carefully, including preinfusion and postinfusion hydration with I.V. normal saline solution.
• Premedicate with probenecid 2 g P.O., as prescribed, 3 hours before starting cidofovir infusion.
• Before starting infusion, give 1 L of normal saline solution over 1 to 2 hours.
• Mix I.V. dose in 100 ml of normal saline solution and infuse over 1 hour using infusion pump.
• Give 1 L of normal saline solution during or immediately after cidofovir infusion (unless contraindicated).
• Administer probenecid 1 g 2 hours and 8 hours after infusion ends, as prescribed.

If drug touches skin, flush thoroughly with water.

Adverse reactions

CNS: headache, seizures, coma

EENT: decreased intraocular pressure

GI: nausea, vomiting, diarrhea, anorexia, oral candidiasis

GU: proteinuria, nephrotoxicity

Hematologic: neutropenia

Hepatic: hepatomegaly

Metabolic: metabolic acidosis

Musculoskeletal: muscle contractions

Respiratory: dyspnea, increased cough

Skin: rash, alopecia

Other: pain, fever, chills, infection, pain at I.V. site

Interactions

Drug-drug.Nephrotoxic drugs: increased risk of nephrotoxicity

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydrogenase: increased values

Bicarbonate, creatinine clearance, hemoglobin, neutrophils, platelets: decreased values

Patient monitoring

• Assess white blood cell count and creatinine and urine protein levels within 48 hours of each dose.
• Closely monitor intraocular pressure and visual acuity.
• Monitor hepatic enzyme levels in patients with hepatic disease.

Patient teaching

Tell patient to immediately report fever, vision changes, nausea, vomiting, rash, or urinary output changes.
• Instruct patient to take probenecid, as prescribed, before each dose and to have regular eye examinations.
• Urge female patient of childbearing age to use effective contraception during and for 1 month after therapy.
• Instruct male patients to use barrier contraception during and for 3 months after therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

cidofovir

/ci·dof·o·vir/ (sĭ-dof´o-vir) an antiviral nucleoside analogue used in the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome.

cidofovir

an antiviral.
indication It is used to treat cytomegalovirus retinitis in patients with AIDS.
contraindications Known hypersensitivity to acyclovir or this drug prohibits its use.
adverse effects Life-threatening effects include coma, hemorrhage, hematuria, granulocytopenia, thrombocytopenia, irreversible neutropenia, anemia, and eosinophilia. Other serious adverse effects include confusion, psychosis, tremors, somnolence, arrhythmias, hypertension/hypotension, retinal detachment in cytomegalovirus retinitis, abnormal liver function tests, increased creatinine, increased blood urea nitrogen, and phlebitis.

cidofovir

Forvade, GS-504, HPMPC, Vistide AIDS A nucleotide analogue effective against a broad spectrum of herpesviruses Indications CMV retinitis, CMV-induced blindness, genital warts Adverse effect Nephrotoxicity

cidofovir

A DNA POLYMERASE INHIBITOR drug. A brand name is Viside.
References in periodicals archive ?
Cidofovir is currently approved by the FDA for the treatment of cytomegalovirus retinitis in the AIDS population.
In this situation, the combined action of cidofovir and CMVIG was associated with a slow decrease in viral replication which may have eventually allowed induction of CMV-specific cellular immunity, which in turn may have contributed to control of viremia after stopping therapy.
CMX001 is superior to cidofovir in that it is orally delivered, longer lasting, less toxic, and has a much stronger inhibitory effect on BK virus replication (Bennett et al.
Sterile product development company InnoPharma Inc stated on Friday that it has introduced the cidofovir injection (generic equivalent of Vistide) in 5mL single-use vials in the US market.
He required treatment with cidofovir, which, at that time, was not available at St Mary's.
When tenofovir was developed there were concerns that it would be nephrotoxic because other nucleotide reverse transcriptase inhibitors (adefovir used to treat hepatitis B and cidofovir used to treat herpes virus infections) are nephrotoxic.
Cidofovir (10) (1%-3%) cream or ointment, electron beam therapy, and photodynamic therapy have also been used with variable success rates (6) (SOR: C).
Other marketed drugs similar in class to tenofovir, such as cidofovir and adefovir, have activity against HSV, so it was worth checking if tenofovir gel did too, said Dr.
Patients with acyclovir-resistant HSV have been described and need treatment with foscarnet or topical cidofovir gel.
Army Medical Research Institute of Infectious Diseases, Chimerix is developing CMXO01 as an orally available version of cidofovir, shown to be an effective antiviral therapeutic effective for the treatment of smallpox as well as complications resulting from the smallpox vaccine.
Mutations in the UL54 DNA polymerase gene have been associated with resistance to the medications ganciclovir, foscarnet, and cidofovir.