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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

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

Free Antibiotic Cheat Sheet

Study Guide

  • Pharmacotherapy Study Guide
  • Acyclovir (Zovirax)
  • Albendazole (Albenza)
  • Amikacin
  • Aminoglycosides
  • Amphotericin B (Fungizone, Abelcet, Ambisome)
  • Amoxicillin (Amoxil)
  • Amoxicillin-Clavulanic Acid (Augmentin)
  • Ampicillin
  • Ampicillin-sulbactam (Unasyn)
  • Anidulafungin (Eraxis)
  • Artesunate
  • Atovaquone (Mepron)
  • Azithromycin (Zithromax, Zmax)
  • Aztreonam (Azactam, Cayston)
  • Aztreonam-avibactam (Emblaveo)
  • Bacitracin
  • Baloxavir marboxyl (Xofluza)
  • Bamlanivimab
  • Baricitinib (Olumiant)
  • Bebtelovimab
  • Bezlotoxumab (Zinplava)
  • Brincidofovir (Tembexa)
  • Cantharidin (Ycanth)
  • Casirivimab and Imdevimab (REGEN-COV)
  • Caspofungin (Cancidas)
  • Cefazolin (Ancef)
  • Cefepime (Maxipime)
  • Cefepime-enmetazobactam (Exblifep)
  • Cefepime-Taniborbactam
  • Cefiderocol (Fetroja)
  • Ceftaroline (Teflaro)
  • Ceftazidime (Fortaz, Tazicef)
  • Ceftazidime-avibactam (Avycaz)
  • Ceftobiprole medocaril (Zevtera)
  • Ceftolozane-Tazobactam (Zerbaxa)
  • Ceftriaxone (Rocephin)
  • Cefoxitin (Mefoxin)
  • Cephalexin (Keflex)
  • Cidofovir (Vistide)
  • Ciprofloxacin (Cipro)
  • Clarithromycin (Biaxin)
  • Clindamycin (Cleocin)
  • Colistin (colistimethate)
  • Cycloserine (Seromycin)
  • Dalbavancin (Dalvance)
  • Daptomycin (Cubicin)
  • Delafloxacin (Baxdela)
  • Dicloxacillin
  • Doripenem (Doribax)
  • Doxycycline (Doryx)
  • Elbasvir/ grazoprevir (Zepatier)
  • Eravacycline (Xerava)
  • Ertapenem (Invanz)
  • Erythromycin
  • Famciclovir (Famvir)
  • Fecal Microbiota Spores, Live-brpk (Vowst, SER-109)
  • Fidaxomicin (Dificid)
  • Fluconazole (Diflucan)
  • Flucytosine (Ancobon)
  • Foscarnet (Foscavir)
  • Fosfomycin (Monurol)
  • Ganciclovir (Cytovene)
  • Gentamicin (Garamycin)
  • Gepotidacin (Blujepa)
  • Glecaprevir/ Pibrentasvir (Mavyret)
  • Ibrexafungerp (Brexafemme)
  • Imipenem-cilastatin (Primaxin)
  • Imipenem-cilastatin-relebactam (Recarbrio)
  • Isavuconazole (Cresemba)
  • Itraconazole (Sporanox)
  • Ivermectin (Stromectol)
  • Ledipasvir/sofosbuvir (Harvoni)
  • Lefamulin (Xenleta)
  • Letermovir (Prevymis)
  • Levofloxacin (Levaquin)
  • Linezolid (Zyvox)
  • Maribavir (Livtencity)
  • Meropenem (Merrem)
  • Meropenem-vaborbactam (Vabomere)
  • Metronidazole (Flagyl)
  • Methenamine (Hiprex, Urex)
  • Micafungin (Mycamine)
  • Minocycline (Minocin)
  • Molnupiravir (Lagevrio)
  • Moxifloxacin (Avelox)
  • Nafcillin
  • Nitrofurantoin (Macrobid, Macrodantin)
  • Omadacycline (Nuzyra)
  • Oritavancin (Orbactiv, Kimyrsa)
  • Oseltamivir (Tamiflu)
  • Oteseconazole (Vivjoa)
  • Oxacillin
  • Nirmatrelvir/ ritonavir (Paxlovid)
  • Penicillin
  • Penicillin Skin Test
  • Phenazopyridine (AZO)
  • Piperacillin-tazobactam (Zosyn)
  • Pivmecillinam (Pivya)
  • Plazomicin (Zemdri)
  • Polymyxin B
  • Posaconazole (Noxafil)
  • Quinupristin-dalfopristin (Synercid)
  • Remdesivir (Veklury)
  • Rezafungin (Rezzayo)
  • Ribavirin
  • Rifabutin (Mycobutin)
  • Rifampin (Rifadin)
  • Secnidazole (Solosec)
  • Sofosbuvir/ velpatasvir/ voxilaprevir (Vosevi)
  • Sulopenem etzadroxil and Probenecid (Orlynvah)
  • Sotrovimab (Xevudy)
  • Sulbactam-durlobactam (Xacduro)
  • Sulfadiazine
  • Sulfamethoxazole-Trimethoprim (Bactrim)
  • Tecovirimat (TPOXX)
  • Tedizolid (Sivextro)
  • Telavancin (Vibativ)
  • Tigecycline (Tygacil)
  • Tobramycin
  • Tocilizumab (Actemra)
  • Valacyclovir (Valtrex)
  • Valganciclovir (Valcyte)
  • Vancomycin
  • Voriconazole (VFend)
  • Zidovudine (Retrovir)
  • Zoster vaccine recombinant, adjuvanted (Shingrix)

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