IDStewardship

Cidofovir (Vistide)

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
    • Neutropenia
      • Monitor neutrophil counts during therapy
    • Carcinogenic, teratogenic, and can cause hypospermia
  • 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

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