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IDStewardship

Letermovir

[Letermovir photo]

KEY POINTS

  • Letermovir (Prevymis) is a terminase complex inhibitor antiviral drug with activity versus cytomegalovirus (CMV)
    • Inhibits the CMV DNA terminase complex (pUL51, pUL56, and pUL89) required for viral DNA processing and packaging
    • Does not have cross-resistance with other anti-CMV drugs
  • FDA-approved November 8th, 2017 for prophylaxis versus CMV infection and disease in adult patients who are CMV-seropositive recipients of an allogenic hematopoietic stem cell transplant
  • Available oral and injectable
    • Same dose oral or IV as 480mg daily through 100 days post-transplant
      • Package insert does not give dose adjustment for renal or mild-moderate hepatic function
        • Use not recommended in severe hepatic dysfunction (Child-Pugh Class C)
        • For the injectable product when creatinine clearance is below 50 mL/min the vehicle (hydroxypropyl betadex) can accumulate, so serum creatinine monitoring is recommended
    • Tablet comes as 240mg or 480mg
      • Package insert says swallow tablet whole
    • Injection comes as 240mg or 480 mg vial at 20mg/mL
      • Administered over 1 hour
  • Contraindicated with: pimozide; ergot alkaloids; pitavastatin and simvastatin when co-administered with cyclosporine
  • Letermovir interacts with numerous medications (e.g., tacrolimus, sirolimus, omeprazole, cyclosporine, atorvastatin)
  • Some adverse effects reported in clinical studies include: nausea, vomiting, diarrhea, peripheral edema, cough, headache, fatigue, and abdominal pain
    • Lacks myelosuppression seen with other anti-CMV medications (a benefit of letermovir)
  • Reportedly tablets will cost $195.00 per day and the injection will cost $270.00​ per day

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