CIDOFOVIR

CIDOFOVIR
(cye-do'fo-ver)
Vistide
Classifications: antiviral;
Therapeutic: antiviral

Prototype: Acyclovir
Pregnancy Category: C

Availability

75 mg/mL injection

Action

Cidofovir, a nucleotide analog, suppresses cytomegalovirus (CMV) replication by inhibiting CMV DNA polymerase.

Therapeutic Effect

Cidofovir reduces the rate of viral DNa synthesis of CMV. It is limited for use in treating CMV retinitis in patients with AIDS. Also effective against herpes viruses and other viruses.

Uses

Treatment of CMV retinitis in patients with AIDS.

Contraindications

Hypersensitivity to cidofovir, history of severe hypersensitivity to probenecid or other sulfa-containing medications; childbearing women and men without barrier contraception; pregnancy (category C); lactation; severe renal dysfunction. Safety and effectiveness in children not established.

Cautious Use

Renal function impairment, history of diabetes, myelosuppression, previous hypersensitivity to other nucleoside analogs; older adults.

Route & Dosage

CMV Retinitis: Induction & Maintenance
Adult: IV 5 mg/kg once weekly for 2 wk. Also give 2 g probenecid 3 h prior to infusion and 1 g 8 h after infusion (4 g total). Continue every 2 wk.

Renal Impairment
If serum Cr increases by 0.3–0.4, lower dose to 3 mg/kg.

Administration

  • Pretreatment: Prehydrate with IV of 1 L NS infused over 1–2 h immediately before cidofovir infusion. If able to tolerate fluid load, infuse second liter over 1–3 h starting at beginning (or end) of cidofovir infusion.
Intravenous

PREPARE: IV Infusion: Dilute the calculated dose in 100 mL of NS.  

ADMINISTER: IV Infusion: Give over 1 h at constant rate.  

  • Do not coadminister with other agents with significant nephrotoxic potential.
  • Store vials at 20°–25° C (68°–77° F); may store diluted IV solution at 2°–8° C (36°–46° F) for up to 24 h.

Adverse Effects (≥1%)

Body as a Whole: Infection, allergic reactions. GI: Nausea, vomiting, diarrhea. Metabolic: Metabolic acidosis. Hematologic: Neutropenia. CNS: Fever, headache, asthenia. Respiratory: Dyspnea, pneumonia. Special Senses: Ocular hypotony. Urogenital: Nephrotoxicity, proteinuria.

Interactions

Drug: aminoglycosides, amphotericin B, foscarnet, pentamidine can increase risk of nephrotoxicity.

Pharmacokinetics

Duration: Probenecid increases serum levels and area under concentration–time curve. Elimination: 80–100% in urine; probenecid delays urinary excretion.

Nursing Implications

Assessment & Drug Effects

  • Evaluate concurrent medications. Nephrotoxic drugs are usually discontinued 7 d prior to starting cidofovir.
  • Lab tests: Baseline and periodic serum creatinine, urine protein; periodic and WBC count with differential prior to each dose. Dose adjustments or discontinuation may be required.
  • In patients with proteinuria, administer IV hydration and repeat test.
  • Periodically monitor visual acuity and intraocular pressure.
  • Monitor for S&S of hypersensitivity (see Appendix F). Report their appearance promptly.

Patient & Family Education

  • Those taking zidovudine should discontinue or decrease dose to 50% on days of cidofovir administration.
  • Initiate or continue regular ophthalmologic exams.
  • Be alert to potential adverse reactions caused by probenecid (e.g., headache, nausea, vomiting, hypersensitivity reactions) and cidofovir.
  • Closely monitor renal function.
  • Women: Use effective contraception during and 1 mo after treatment.
  • Men: Use barrier contraception during and 3 mo after treatment.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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© 2006-2017 medpill.info Last Updated On: 07/21/2017 (0.01)
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