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Pharmacologic class: Purine nucleotide cytosine analog
Therapeutic class: Antiviral
Pregnancy risk category C
Exerts antiviral effect by interfering with DNA synthesis of CMV, thereby inhibiting viral replication
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
• Renal impairment
• 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
Use cautiously in:
• renal impairment
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 12 (safety and efficacy not established).
☞ 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.
CNS: headache, seizures, coma
EENT: decreased intraocular pressure
GI: nausea, vomiting, diarrhea, anorexia, oral candidiasis
GU: proteinuria, nephrotoxicity
Metabolic: metabolic acidosis
Musculoskeletal: muscle contractions
Respiratory: dyspnea, increased cough
Skin: rash, alopecia
Other: pain, fever, chills, infection, pain at I.V. site
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
• 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.
☞ 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.