CIDOFOVIR

Antibacterial activity

Active against CMV
Active against others herpes viruses (but not approved for their Tx)

Pregnancy Risk Factor

Class C

Contraindication/Precaution

Cidofovir is indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) only
IV prehydratation and administration of probenecid MUST be used with each cidofovir infusion
Hypersensitivity to cidofovir, or any component
Do not use with nursing mothers
Must monitor renal function and adjust dosage accordingly
Monitor neutrophil counts, could cause granulocytopenia
Safety and effectiveness in children have not been studied.
Use caution if renal dysfunction or if other nephrotoxic agents present

Mechanism of Action

Suppresses CMV replication by selective inhibition of viral DNA synthesis.

Pharmacodynamics

Metabolism: N/A
Half-life: ~3 hours, changes with renal function
Elimination: excreted in urine

Dosage

Cidofovir is indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) only
IV prehydratation and administration of probenecid MUST be used with each cidofovir infusion

Children and Adults:

Safety and effectiveness in children have not been studied.

Administration to children should be undertaken only after careful evaluation and only if the potential benefits of treatment outweigh the risks.

Administer with probenecid - 2 g PO 3 hours prior to each cidofovir dose and 1 g at 2 and 8 hours after completion of the infusion (total: 4 g)

Induction: 
(5 mg/kg IV (administer over 1 hrs) qwk with probenecid) for 2 weeks
Maintenance: 
5 mg/kg IV (administer over 1 hrs) q2wks with probenecid

Dose VS renal function

Induction, Cr. clearance (ml/min) :
<19: 0.5 mg/kg IV  qwk 20-29: 1 mg/kg IV qwk 30-40: 1.5 mg/kg IV qwk 41-55:  2 mg/kg IV  qwk >55: unchanged

Maintenance, Cr. clearance (ml/min) :
<19: 0.5 mg/kg IV  q2wk 20-29: 1 mg/kg IV q2wk 30-40: 1.5 mg/kg IV q2wk 41-55:  2 mg/kg IV  q2wk >55: unchanged

Dialysis
Hemo: N/A
CAPD: N/A