Classifications: antiviral; Therapeutic: antiviral
Pregnancy Category: C
75 mg/mL injection
Cidofovir, a nucleotide analog, suppresses cytomegalovirus (CMV) replication by inhibiting CMV DNA polymerase.
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.
Treatment of CMV retinitis in patients with AIDS.
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.
Renal function impairment, history of diabetes, myelosuppression, previous hypersensitivity to other nucleoside analogs;
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.
If serum Cr increases by 0.30.4, lower dose to 3 mg/kg.
- Pretreatment: Prehydrate with IV of 1 L NS infused over 12 h immediately before cidofovir infusion. If able to tolerate
fluid load, infuse second liter over 13 h starting at beginning (or end) of cidofovir infusion.
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 acidosis. Hematologic: Neutropenia
. CNS: Fever, headache,
asthenia. Respiratory: Dyspnea
. Special Senses: Ocular
hypotony. Urogenital: Nephrotoxicity, proteinuria.
, amphotericin B, foscarnet, pentamidine
can increase risk of nephrotoxicity.
Probenecid increases serum
levels and area under concentrationtime curve. Elimination:
80100% in urine; probenecid
delays urinary excretion.
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)
- Closely monitor renal function.
- Women: Use effective contraception during and 1 mo after treatment.
- Men: Use barrier contraception during and 3 mo after treatment.