Treatment of cytomegalovirus (CMV) retinitis: (Patient must meet the following
criteria first: serum creatinine 1.5, CRCL >55ml/min and urine protein < 100
Induction: 5 mg/kg qweek x 2.
Maintenance: 5 mg/kg q2weeks.
Note: Probenecid must be administered orally with each dose of cidofovir. DOSAGE AND ADMINISTRATION
VISTIDE MUST NOT BE ADMINISTERED BY INTRAOCULAR INJECTION.
THE RECOMMENDED DOSAGE, FREQUENCY, OR INFUSION RATE MUST NOT BE EXCEEDED.
VISTIDE MUST BE DILUTED IN 100 MILLILITERS 0.9% (NORMAL) SALINE PRIOR TO
ADMINISTRATION. TO MINIMIZE POTENTIAL NEPHROTOXICITY, PROBENECID AND INTRAVENOUS
SALINE PREHYDRATION MUST BE ADMINISTERED WITH EACH VISTIDE INFUSION.
The recommended induction dose of VISTIDE for patients with a serum creatinine
of 1.5 mg/dL, a calculated creatinine clearance > 55 mL/min, and a urine
protein < 100 mg/dL (equivalent to < 2+ proteinuria) is 5 mg/kg body weight
(given as an intravenous infusion at a constant rate over 1 hr) administered
once weekly for two consecutive weeks. Because serum creatinine in patients with
advanced AIDS and CMV retinitis may not provide a complete picture of the
patient's underlying renal status, it is important to utilize the Cockcroft-Gault
formula to more precisely estimate creatinine clearance (CrCl). As creatinine
clearance is dependent on serum creatinine and patient weight, it is necessary
to calculate clearance prior to initiation of VISTIDE.
CrCl (mL/min) should be calculated according to the following formula:
The recommended maintenance dose of VISTIDE is 5 mg/kg body weight (given as an
intravenous infusion at a constant rate over 1 hr), administered once every 2
Changes in Renal Function During VISTIDE Therapy
The maintenance dose of VISTIDE must be reduced from 5 mg/kg to 3 mg/kg for an
increase in serum creatinine of 0.3 – 0.4 mg/dL above baseline. VISTIDE therapy
must be discontinued for an increase in serum creatinine of 0.5 mg/dL above
baseline or development of 3+ proteinuria.
Preexisting Renal Impairment
VISTIDE is contraindicated in patients with a serum creatinine concentration >
1.5 mg/dL, a calculated creatinine clearance 55 mL/min, or a urine protein
100 mg/dL (equivalent to 2+ proteinuria).
Probenecid must be administered orally with each VISTIDE dose. Two grams must be
administered 3 hr prior to the VISTIDE dose and one gram administered at 2 and
again at 8 hr after completion of the 1 hr VISTIDE infusion (for a total of 4
Ingestion of food prior to each dose of probenecid may reduce drug-related
nausea and vomiting. Administration of an antiemetic may reduce the potential
for nausea associated with probenecid ingestion. In patients who develop
allergic or hypersensitivity symptoms to probenecid, the use of an appropriate
prophylactic or therapeutic antihistamine and/or acetaminophen should be
considered (see CONTRAINDICATIONS).
Patients must receive at least one liter of 0.9% (normal) saline solution
intravenously with each infusion of VISTIDE. The saline solution should be
infused over a 1–2 hr period immediately before the VISTIDE infusion. Patients
who can tolerate the additional fluid load should receive a second liter. If
administered, the second liter of saline should be initiated either at the start
of the VISTIDE infusion or immediately afterwards, and infused over a 1 to 3 hr
Cidofovir is contraindicated in patients with a serum creatinine
concentration > 1.5 mg/dL, a calculated creatinine clearance 55 mL/min,
or a urine protein 100 mg/dL (equivalent to 2 + proteinuria).
National Institutes of Health, U.S. National Library of Medicine,
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Food and Drug Administration (FDA). Please review the latest applicable package insert for
additional information and possible updates. A local search
option of this data can be found here.
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical
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