Parenteral Manual

Ganciclovir

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): 
CYTOVENE®
Classification: 
Antiviral agent - CYTOTOXIC
Original Date: 
August 2005
Revised Date: 
December 2015
Indications: 
  • Treatment of cytomegalovirus (CMV) infections in immunocompromised  patients
Reconstitution and Stability: 

VIAL SIZE

STERILE WATER for INJECTION  REQUIRED

FINAL CONCENTRATION

500 mg

10 mL

50 mg/mL
  • Reconstituted solution stable 12 hrs at room temperature and should not be refrigerated
  • Diluted solutions 5 mg/mL in D5W  stable 9 days refrigerated
  • Prepare in biological safety cabinet, handle and dispose of cytotoxic waste carefully
Compatibility: 

- Solutions Compatible: D5W, 0.9 % NaCl, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: KCl, fluconazole

- Incompatible: injections that contain parabens as preservatives (e.g., bacteriostatic water, gentamicin), morphine, ondansetron, piperacillin/tazobactam , TPN

 

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, into a large vein
Usual dilution: 5 mg/mL
Infusion time: 1 hour
IV Continuous Infusion NO
Dosage: 

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

- Prevention of CMV disease in transplant recipients:

  • Initial therapy: 10 mg/kg/day divided Q 12 hours x 1-2 weeks
  • Maintenance therapy: 5 mg/kg/day as a single dose for 7 days/week or 6 mg/kg/day for 5 days/week         

- Lung/heart transplant patient (CMV +ve donor and CMV +ve recipient)

  • 6 mg/kg/dose once daily  

- Congenital CMV Disease:

  • 15 mg/kg/day IV divided Q 12 hours      

- Other CMV infections

  • 10 mg/kg divided Q12H x 14-21 days, then
  • 5 mg/kg/day as a single dose x 7 days/week or 6 mg/kg/day for 5 days/week

 DOSAGE REDUCTION IN IMPAIRED RENAL FUNCTION IS RECOMMENDED:

Creatinine Clearance
(mL/min/1.73 m2)

Dose
(mg/kg)

Induction Interval
(hours)

Maintenance Interval
(hours)

50-69

2.5

12

24

25-49

2.5

24

48

10-24

1.25

24

48

<10

1.25-Induction

0.625-Maintenance

3 times/week

after hemodialysis

3 times/week

after hemodialysis

             

Potential hazards of parenteral administration: 
  • Phlebitis (infuse via central vein or large peripheral vein to minimize risk)
  • Neutropenia, thrombocytopenia, leukopenia, anemia, eosinophilia
  • Headache, confusion, seizures, dizziness,               
  • Elevation of liver function tests
  • Increase in serum creatinine, BUN  
  • Fever, chills, nausea, vomiting, diarrhea, anorexia, rash, edema reported occasionally
  • Arrhythmias, hypertension
  • Abnormal vision, loss of vision

 

Notes: 
  • Ganciclovir has exhibited mutagenic and carcinogenic potential in animals (use chemotherapy precautions when handling or reconstituting ganciclovir)
  • Monitor CBC with differential, platelets, urine output, serum creatinine, ophthalmologic exams, liver enzyme tests, BP, urinalysis
  • Ensure adequate hydration during treatment

 

DRUG INTERACTIONS:                               

  • Reports of generalized seizures with concurrent imipenem/cilastatin use - weigh potential risks and benefits in patients in whom this combination is proposed
  • Zidovudine: added hematologic toxicity - avoid combination where possible, or monitor hematologic parameters at least twice weekly
  • Caution advised with concomitant administration of potentially nephrotoxic or myelosuppressive agents 

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.