Cidofovir

Treatment of CMV retinitis: first confirm serum creatinine <=1.5 mg/dL, calculated CrCl >55 mL/min and urine protein <100 mg/dL. Induction: 5 mg/kg once weekly for two consecutive weeks. Maintenance: 5 mg/kg every 2 weeks. Each dose is an IV infusion at a constant rate over 1 hour. Oral probenecid is required with each dose.

VISTIDE MUST NOT BE ADMINISTERED BY INTRAOCULAR INJECTION. Do not exceed recommended dosage, frequency, or infusion rate. Dilute in 100 mL 0.9% sodium chloride. Probenecid and IV saline prehydration must accompany every infusion to minimize nephrotoxicity.

Because serum creatinine in advanced AIDS and CMV retinitis may not fully reflect underlying renal status, calculate Cockcroft-Gault clearance before initiation:

Male CrCl (mL/min) = [(140 - age in years) x body weight in kg] / [72 x serum creatinine in mg/dL]. Female CrCl = male result x 0.85.

During maintenance, reduce 5 mg/kg to 3 mg/kg for a serum creatinine increase of 0.3 to 0.4 mg/dL above baseline. Discontinue for a rise >=0.5 mg/dL or development of >=3+ proteinuria.

Probenecid: 2 grams orally 3 hours before VISTIDE; 1 gram at 2 hours and again at 8 hours after completion of the 1-hour infusion (4 grams total). Food before each probenecid dose may reduce nausea/vomiting; an antiemetic may help. Appropriate prophylactic or therapeutic antihistamine and/or acetaminophen should be considered for allergic or hypersensitivity symptoms to probenecid, with the source directing attention to contraindications.

Hydration: at least 1 liter of 0.9% sodium chloride IV over 1 to 2 hours immediately before each VISTIDE infusion. Patients tolerating additional fluid should receive a second liter, begun at the start of the VISTIDE infusion or immediately afterward, over 1 to 3 hours.

Contraindicated if serum creatinine >1.5 mg/dL, calculated CrCl <=55 mL/min, or urine protein >=100 mg/dL (equivalent to >=2+ proteinuria).

Contraindicated.