Valganciclovir

C. diff Risk

None

Oral Bioavailability

Excellent

Approximate Cost

$$$$

Dosing

Adult

Induction
900 mg PO BID

Maintenance
900 mg PO daily

Hepatic

No hepatic dose adjustment

General Information

Common Usage

Treatment and prophylaxis of CMV disease in immunocompromised hosts

Drug Monitoring

Laboratory

  • BMP & CBC weekly

Clinical

  • Mental status changes/seizures

  • Hematuria reported in cases of overdose

Adverse Effects

Common

  • ¬†Hematologic toxicity (neutropenia > thrombocytopenia) - reversible

  • ¬†Carcinogenic/teratogenic

Rare

  • Anemia

  • Rash

  • CNS toxicity (headache, seizure, confusion)

  • ¬†GI intolerance

  • Hepatotoxicity

Major Interactions

Imipenem/cilastatin: increase risk of seizure when given with ganciclovir/valganciclovir;

Cyclosporine and Amphotericin B: enhanced nephrotoxic effects of cyclosporine and amphotericin B when co administered with ganciclovir/valganciclovir;

Mycophenolate: increased serum concentration of ganciclovir/valganciclovir when co-adminstered.

Additional Information

Teratogenic/carcinogenic - do not crush the valganciclovir tablets and avoid direct skin and/or mucous membrane contact with broken or crushed tablets

Valganciclovir should be taken with food to optimize absorption

Pharmacology

Antimicrobial class: Antiviral - Synthetic Guanine Analog

Pregnancy category: C

Average serum half life: 4 hours

Biliary penetration: Moderate

CSF penetration: Moderate/High

Lung penetration: Moderate

Urine penetration: High