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

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 ?
Compound 14c only gave a different value of [EC.sub.50] = 9.64 even though the [CC.sub.50] value was found >100 with a [SI.sub.50] = 1, while the cidofovir used as reference data gave [EC.sub.50] = 180, [CC.sub.50] > 200 with a [SI.sub.50] > 1.
In the US, the generic cidofovir will be marketed by Mylan Inc (NasdaqGS:MYL), according to InnoPharma Inc.
Current antiviral therapy with cidofovir is not always successful, although current available data on the new drug CMX001 seems promising.
Successful treatment of juvenile laryngeal papillomatosis-related multicystic lung disease with cidofovir: A case report and review of the literature.
Interim guidance for use of smallpox vaccine, cidofovir, and VIG for prevention and treatment in the setting of an outbreak of monkeypox infections.
The antiviral medication cidofovir was recently approved for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome.
Updated interim CDC guidance for use of smallpox vaccine, cidofovir, and vaccinia immunoglobulin (VIG) for prevention and treatment in the setting of an outbreak of monkeypox infections.
Yet another option is topical 1%-3% cidofovir, which has been shown to result in clearance within 4-6 weeks of twice-daily applications, with acute inflammation but either no or minimal recurrences.
Updated interim CDC guidance for use of smallpox vaccine, cidofovir, and vaccinia immune globulin (VIG) for prevention and treatment in the setting of an outbreak of monkeypox infections.
It is presumed that the only antiviral drug that is likely to have any activity against monkeypox is cidofovir, but research is still underway The agency advised physicians not to treat patients with cidofovir except in life-threatening situations.
The system also will be used to monitor the effectiveness of contraindication screening, identify new contraindications, and coordinate the distribution of vaccinia immune globulin (VIG) and cidofovir to the civilian population.
for a total of 10-14 days Q fever Oral tetracycline 500 mg every 6 hr for 5-7 days, continued for at least 2 days after patient is afebrile OR Oral doxycycline 100 mg every 12 hr for 5-7 days, continued for at least 2 days after patient is afebrile Smallpox No current treatment other than supportive care; cidofovir effective in vitro; animal studies ongoing Tularemia IM streptomycin 7.5-10 mg/kg b.i.d.