Valganciclovir

C. diff Risk

None

Oral Bioavailability

Excellent

Approximate Cost

$$$$

Spectrum Of Activity

Dosing

Induction
900 mg PO BID

Maintenance
900 mg PO daily

CrCl 40-59 mL/minCrCl 25-39 mL/minCrCl 10-24 mL/min450 mg BID450 mg daily450 mg q48h

CrCl 40-59 mL/minCrCl 25-39 mL/minCrCl 10-24 mL/minCrCl < 10 ml/min450 mg daily450 mg q48h450 mg twice weeklyNOT RECOMMENDED

No hepatic dose adjustment

General Information

Common

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

  • ¬†Carcinogenic/teratogenic

Rare

  • Anemia

  • Rash

  • CNS toxicity (headache, seizure, confusion)

  • ¬†GI intolerance

  • Hepatotoxicity

Laboratory

  • BMP & CBC weekly

Clinical

  • Mental status changes/seizures

  • Hematuria reported in cases of overdose

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.

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

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

Treatment and prophylaxis of CMV disease in immunocompromised hosts