Cidofovir photo
KEY POINTS
- Cidofovir (Vistide) suppresses cytomegalovirus (CMV) replication by selective inhibition of viral DNA synthesis.
- The active intracellular metabolite of cidofovir is cidofovir diphospate, which selectively inhibits CMV DNA polymerase
- CMV that is resistant to ganciclovir with mutations in both the DNA polymerase and UL97 genes have been found to be cross resistant to CMV
- Cidofovir is active against some but not all CMV that is foscarnet resistant
- FDA-approved in June of 1996 for CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS)
- Not FDA-approved to treat other CMV infections
- May have a role in the treatment of monkeypox
- Has FDA boxed warnings for:
- Renal impairment (a major toxicity), including acute renal failure leading to dialysis and/or contributing to death
- Pre-dose hydration with normal saline and probenecid can reduce nephrotoxicity
- Probenecid is given as 4 grams total administered as 2 grams three hours pre-dose, 1 gram two hours pre-dose, and 1 gram eight hours post-d0se
- Package insert recommends normal saline dosed as 1 liter given over 1-2 hours just before the cidofovir dose, then if patients can tolerate it give a second liter over 1-3 hours just after the dose
- Renal function should be monitored during cidofovir therapy
- Pre-dose hydration with normal saline and probenecid can reduce nephrotoxicity
- Neutropenia
- Monitor neutrophil counts during therapy
- Carcinogenic, teratogenic, and can cause hypospermia
- Renal impairment (a major toxicity), including acute renal failure leading to dialysis and/or contributing to death
- Other adverse reactions can be:
- Decreased intraocular pressure/ ocular hypotony
- Anterior uveitis/ iritis
- Metabolic acidosis
- See package insert below for full list
- Dose based on mg/kg and adjust doses by renal function, given intravenously
- Not for intra-ocular administration
- Doses are infused over 1 hour
RESOURCES
- Cidofovir Package Insert or Here
- Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV
- The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation
- Interim Clinical Guidance for the Treatment of Monkeypox
- Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7)
- Maribavir, brincidofovir and letermovir: Efficacy and safety of new antiviral drugs for treating cytomegalovirus infections
- A review of topical and intralesional cidofovir