Parenteral Manual

Cidofovir (SPECIAL ACCESS PROGRAM)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Vistide
Classification: 
Antiviral - NON-CYTOTOXIC HAZARDOUS
Original Date: 
March 2008
Revised Date: 
February 2026
Indications: 
  • Cytomegalovirus (CMV) retinitis in HIV-infected patients
  • Off-label:
    • Adenovirus infection post HSCT
    • CMV infections post HSCT
Reconstitution and Stability: 
  • Available as 75 mg/mL non-preserved solution in 5 mL vial
  • Diluted solutions stable 24 hours refrigerated or room temperature
Compatibility: 

-Solution Compatible:  NS, D5W

-Additives/Above Cassette Compatible: No information

-Y-site Compatible: No information

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES  Large Volume Pump only. Don't use a minibag smaller than 50 mL

Usual dilution: 3 mg/mL

Patient fluid restricted: 8 mg/mL

Infusion time: 60 minutes
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric and Adult dose:

  • Induction:  5 mg/kg/dose IV once weekly x 2
  • Maintenance: 5 mg/kg/dose IV every second week

Reduce dose in renal dysfunction (CrCl < 55 ml/min). Discontinue cidofovir if serum creatinine increases greater than 44 umol/L or > 3+ proteinuria.

Administration of  cidofovir must be accompanied by concomitant oral probenecid  &  IV  NS hydration:

Note: probenecid tablets are not in the hospital’s formulary. It is available via the special access program (SAP) and requires a separate approval from Health Canada

 1.  Probenecid orally   (Use multiple of 1/4 tab of 500 mg tab):

  • 3 hours pre-dose   - 25 mg/kg/dose up to 2 g.
  • 2 & 8 hours post-dose (after end of infusion)  - 12.5 mg/kg/dose up to 1 g

 2. IV Hydration:   NS 10 -15 mL/kg up to 1 L over 1-3 hours pre-dose

                          NS 10 -15 mL/kg up to 1 L over 1-2 hours post-dose (if tolerated)

Potential hazards of parenteral administration: 

Dose-limiting: renal toxicity

Increase in serum creatinine > 130 umol/L (18%), >1+ proteinuria (80%), decreased intraocular pressure (24%), anterior uveitis/iritis (11%), nausea and vomiting (65%), fever (57%), decreased wbc (ANC<0.75 31% ANC<0.5 20%), headache (27%), diarrhea (27%), alopecia (25%), infections (25%), chills (24%), dyspnea (22%), anemia (20%), abdominal pain (17%), metabolic acidosis (Fanconi's syndrome) (2%)

Probenecid: rash, dyspepsia, allergic phenomena (48%) (can be more serious than cidofovir's ADR

 (Caution with sulfonamide allergy)

Notes: 

Monitor:

Prior to each dose: creatinine, BUN, WBC with differential, and urine protein.

Periodically: electrolytes (calcium, magnesium, phosphorus), uric acid, SPOT/SGPT, Intraocular pressure, visual acuity, liver enzymes

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