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Ganciclovir (CYTOVENE) - renal dosing

Usual Dosing (Adults)

CMV retinitis:  
(IV) Induction: 5 mg/kg q12h x 14-21 days. Maintenance: 5 mg/kg q24h. 
(Oral) 1 gram q8h or 500mg q3h (6x/day). Take with food.

DOSAGE AND ADMINISTRATION
CAUTION - DO NOT ADMINISTER CYTOVENE-IV SOLUTION BY RAPID OR BOLUS INTRAVENOUS INJECTION. THE TOXICITY OF CYTOVENE-IV MAY BE INCREASED AS A RESULT OF EXCESSIVE PLASMA LEVELS.

CAUTION - INTRAMUSCULAR OR SUBCUTANEOUS INJECTION OF RECONSTITUTED CYTOVENE-IV SOLUTION MAY RESULT IN SEVERE TISSUE IRRITATION DUE TO HIGH pH (11).

Dosage------------------------
THE RECOMMENDED DOSE FOR CYTOVENE-IV SOLUTION SHOULD NOT BE EXCEEDED. THE RECOMMENDED INFUSION RATE FOR CYTOVENE-IV SOLUTION SHOULD NOT BE EXCEEDED.

For Treatment of CMV Retinitis in Patients With Normal Renal Function
Induction Treatment
The recommended initial dosage for patients with normal renal function is 5 mg/kg (given intravenously at a constant rate over 1 hour) every 12 hours for 14 to 21 days.

Maintenance Treatment
Following induction treatment, the recommended maintenance dosage of CYTOVENE-IV solution is 5 mg/kg given as a constant-rate intravenous infusion over 1 hour once daily, 7 days per week, or 6 mg/kg once daily, 5 days per week.

For patients who experience progression of CMV retinitis while receiving maintenance treatment with CYTOVENE-IV, reinduction treatment is recommended.

For the Prevention of CMV Disease in Transplant Recipients With Normal Renal Function
The recommended initial dosage of CYTOVENE-IV solution for patients with normal renal function is 5 mg/kg (given intravenously at a constant rate over 1 hour) every 12 hours for 7 to 14 days, followed by 5 mg/kg once daily, 7 days per week or 6 mg/kg once daily, 5 days per week.

The duration of treatment with CYTOVENE-IV solution in transplant recipients is dependent upon the duration and degree of immunosuppression. In controlled clinical trials in bone marrow allograft recipients, treatment with CYTOVENE-IV was continued until day 100 to 120 posttransplantation. CMV disease occurred in several patients who discontinued treatment with CYTOVENE-IV solution prematurely. In heart allograft recipients, the onset of newly diagnosed CMV disease occurred after treatment with CYTOVENE-IV was stopped at day 28 posttransplant, suggesting that continued dosing may be necessary to prevent late occurrence of CMV disease in this patient population (see INDICATIONS AND USAGE above section for a more detailed discussion).

Renal Dosing

dialysis [CRCL > 70]: No change

[50-69]: IV: (Induction): 2.5mg/kg q12h. (Maint): 2.5mg/kg q24h. 
Oral: 1500mg qd or 500mg tid.

[25-49]: IV: (Induction): 2.5mg/kg q24h. (Maint): 1.25 mg/kg q24h. 
Oral: 1000mg qd or 500mg bid.

[10-24]: IV: (Induction): 1.25 mg/kg q24h. (Maint): 0.625 mg/kg q24h. 
Oral: 500mg qd.

[<10]: IV: (Induction): 1.25 mg/kg 3x/week following dialysis. (Maint): 0.625 mg/kg 3x/week following dialysis. 
Oral: 500mg 3x/week following dialysis.

Hemodialysis

dialysis Hemodialysis & peritoneal dialysis:
IV: (Induction): 1.25 mg/kg 3x/week following dialysis. 
(Maint): 0.625 mg/kg 3x/week following dialysis. 
Oral: 500mg 3x/week following dialysis.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the 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.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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