cidofovir

Contraindicated in:

Hypersensitivity to cidofovir, probenecid, or sulfonamides;
Serum creatinine >1.5 mg/dL, CCr ≤55 mL/min, or urine protein ≥100 mg/dL (≥2+ proteinuria)
;
OB:
Pregnancy
;
Lactation: Breastfeeding not recommended for women with HIV.

Use Cautiously in:

Pedi: Safety and effectiveness not established in children.

Exercise Extreme Caution in:

Any condition or medication that ↑ the risk of dehydration
.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: alopecia, rash

EENT: ↓intraocular pressure, hearing loss, iritis, ocular hypotony, uveitis

F and E: ↓serum bicarbonate

GI: abdominal pain, nausea, vomiting, anorexia, diarrhea, HEPATOTOXICITY, PANCREATITIS

GU: proteinuria, RENAL FAILURE

Hemat:

neutropenia

, anemia

Metab: METABOLIC ACIDOSIS

Neuro: headache, weakness

Resp: dyspnea, pneumonia

Misc: chills, fever, infection

Interactions ⬆ ⬇

Drug-drug:

↑risk of nephrotoxicity with aminoglycosides, amphotericin B, foscarnet, and pentamidine; avoid concurrent use and wait 7 days after giving other nephrotoxic agents.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 75 mg/mL

Route/Dosage ⬆ ⬇

IV (Adults ): 5 mg/kg once weekly for 2 wk, followed by 5 mg/kg every 2 wk.

Renal Impairment

IV (Adults ):
↑in serum creatinine of 0.3–0.4 mg/dL: ↓dose to 3 mg/kg; discontinue if serum creatinine ↑≥0.5 mg/dL over baseline.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Suppresses replication of CMV by inhibiting viral DNA synthesis.

Therapeutic effects:

Slows progression of CMV retinitis; may not be curative.

Classifications ⬆ ⬇

Therapeutic Classification: antivirals

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Excreted mostly unchanged by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	unknown

Patient/Family Teaching ⬆ ⬇

Inform patient that cidofovir is not a cure for CMV retinitis and that retinitis may continue to progress during and after therapy.
Inform patient that concurrent antiretroviral therapy may be continued. However, zidovudine therapy should be temporarily discontinued or ↓ by 50% on the days of cidofovir therapy because of the effects of probenicid on zidovudine.
Advise patient of the possibility of renal toxicity from cidofovir. Emphasize the importance of routine lab tests to monitor renal function.
Discuss with patient the possibility of hair loss. Explore coping strategies.
Advise patients to have routine ophthalmologic exams after cidofovir therapy.
Rep:
May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding during therapy. Advise women of reproductive potential to use contraception during and for 1 mo after therapy. Men should use barrier contraception during and for 3 mo after therapy.

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇