Ganciclovir

Indications
 Intravenous
Cytomegaloviral infections
Adult: Induction: 5 mg/kg every 12 hr for 14-21 days. Maintenance: 5 mg/kg once daily for 7 days per wk or 6 mg/kg once daily for 5 days per wk. Dose to be given by IV infusion.
Renal impairment: For dialysis patients: 1.25 mg/kg for induction or 0.625 mg/kg for maintenance, to be given postdialysis on days when dialysis is performed.
CrCl (ml/min)Dosage Recommendation
≥705 mg/kg every 12 hr for induction, then 5 mg/kg every 24 hr for maintenance.
50-692.5 mg/kg every 12 hr for induction, then 2.5 mg/kg every 24 hr for maintenance.
25-492.5 mg/kg every 24 hr for induction, then 1.25 mg/kg every 24 hr for maintenance.
10-241.25 mg/kg every 24 hr for induction, then 0.625 mg/kg every 24 hr for maintenance .

Intravenous
Prophylaxis of cytomegaloviral infections in immunocompromised patients
Adult: For patients receiving immunosuppressants after organ transplant: Initially, 5 mg/kg every 12 hr for 7-14 days followed by maintenance therapy: 5 mg/kg/day as a single dose for 7 days per wk or 6 mg/kg/day for 5 days per wk. Dose to be given as IV infusion.
Renal impairment: For dialysis patients: 1.25 mg/kg for induction or 0.625 mg/kg for maintenance, to be given postdialysis on days when dialysis is performed.
CrCl (ml/min)Dosage Recommendation
≥705 mg/kg every 12 hr for induction, then 5 mg/kg every 24 hr for maintenance.
50-692.5 mg/kg every 12 hr for induction, then 2.5 mg/kg every 24 hr for maintenance.
25-492.5 mg/kg every 24 hr for induction, then 1.25 mg/kg every 24 hr for maintenance .
10-241.25 mg/kg every 24 hr for induction, then 0.625 mg/kg every 24 hr for maintenance .

Ophthalmic
Cytomegaloviral retinitis
Adult: Intravitreal implant: Each implant can last for 5-8 mth; implant may be removed and replaced upon depletion of ganciclovir as evidenced by disease progression.
Renal impairment: Dose reduction may be needed.

Special Populations: In renal impairment (IV admin): CrCl >70 ml/min: 5 mg/kg every 12 hr (induction); 5 mg/kg every 24 hr (maintenance) 50-69 ml/min: 2.5 mg/kg every 12 hr (induction); 2.5 mg/kg every 24 hr (maintenance); 25-49 ml/min: 2.5 mg/kg every 24 hr (induction);1.25 mg/kg every 24 hr (maintenance); 10-24 mL/min: 1.25 mg/kg every 24 hr (induction);0.625 mg/kg every 24 hr (maintenance); Dialysis patient: 1.25 mg/kg (induction); 0.625 mg/kg (maintenance), 3 times wkly after haemodialysis In renal impairment (oral admin): CrCl >70 mL/min: 3 g daily in 3 or 6 divided doses; 50-69 mL/min: 1.5 g once daily or 500 mg tid; 25-49 mL/min: 1 g once daily or 500 mg bid; 10-24 mL/min: 500 mg once daily; <10 mL/min: 500 mg 3 times wkly after haemodialysis.
Contraindications
 Hypersensitivity; absolute neutrophil count <500 cells/mm3; platelet count <25,000/mm3; pregnancy, lactation. Not to be used as a bolus inj.
Warnings / Precautions
 Renal impairment; preexisting cytopenias or history of cytopenic reactions to drugs; child; contraceptive precautions to be followed during and at least 90 days thereafter; care in administering only into veins with good blood flow. Avoid contact with the skin and eyes. Maintain adequate hydration during infusion. Monitor WBC and platelet counts regularly during treatment. Eye examinations should be conducted at least once every 4-6 wk during treatment for CMV retinitis.
Adverse Reactions
 Haematolgical disturbances; marrow depression; GI disturbances; fever, rash and abnormal LFTs; irritation and phlebitis at inj site. Less frequent: CV, CNS, metabolic, musculoskeletal, respiratory, urogenital, ocular effects, cutaneous symptoms and increased serum-creatinine and BUN concentration. Potential risk of testicular effects and female fertility.
Drug Interactions
 Renal clearance reduced by probenecid; imipenem cilastatin (generalised seizures); zidovudine; didanosine; additive toxic effects with myelosuppressants; oral mycophenolate mofetil.
See Below for More ganciclovir Drug Interactions
Mechanism of Actions
 Ganciclovir is a synthetic guanine nucleoside analogue with activity against cytomegalovirus (CMV). It competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase, thus inhibiting viral DNA synthesis.
Absorption: Poor absorption after oral admin.
Distribution: Widely distributed to body tissues and fluids after IV admin.
Excretion: Excreted unchanged in the urine mainly via glomerular filtration and active tubular secretion. Elimination half-life: 2.5-4.5 hr after IV admin; increased in renal impairment.
Administration
 Should be taken with food.
Storage Conditions
 Intravenous: Store at 15-25°C. Ophthalmic: Store at 15-25°C.
ATC Classification
 J05AB06 - ganciclovir ; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. Used in the systemic treatment of viral infections.
S01AD09 - ganciclovir ; Belongs to the class of antiinfectives, antivirals. Used in the treatment of eye infections.
Storage
 Intravenous: Store at 15-25°C. Ophthalmic: Store at 15-25°C.
Available As
  • Ganciclovir 250 mg
  • Ganciclovir 500 mg

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