foscarnet

REMS

Cytomegalovirus (CMV) retinitis in patients with HIV (alone or in combination with ganciclovir).
Acyclovir-resistant mucocutaneous herpes simplex virus (HSV) infections in immunocompromised patients.

Contraindicated in:

Hypersensitivity;
HF (due to sodium content);
Patients on sodium-restricted diets;
Hemodialysis;
Lactation: Lactation.

Use Cautiously in:

Renal impairment (dose ↓ required if CCr ≤1.4 mL/min/kg);
Seizure disorders;
QT interval prolongation or cardiovascular disease;
Hypokalemia or hypomagnesemia (must be corrected prior to therapy);
OB: Safety not established in pregnancy;
Pedi: Safety and effectiveness not established in children.

CV: chest pain, edema, palpitations, QT interval prolongation, TORSADES DE POINTES

Derm: ↑sweating, pruritus, rash, skin ulceration

EENT: conjunctivitis, eye pain, vision abnormalities

F and E: hypocalcemia, hypokalemia, hypomagnesemia, hyperphosphatemia, hypophosphatemia

GI: diarrhea, nausea, vomiting, abdominal pain, abnormal taste sensation, anorexia, constipation, dyspepsia

GU: RENAL FAILURE, albuminuria, dysuria, nocturia, polyuria, urinary retention

Hemat: anemia, leukopenia, neutropenia

Local: pain/inflammation at injection site

MS: arthralgia, myalgia, back pain, involuntary muscle contraction

Neuro: headache, anxiety, ataxia, confusion, depression, dizziness, fatigue, hypoesthesia, neuropathy, paresthesia, SEIZURES, tremor, weakness

Resp: cough, dyspnea

Misc: fever, chills, flu-like syndrome, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS, URTICARIA, AND ANGIOEDEMA), MALIGNANCY

Drug-drug:

QT interval prolonging medications, including quinidine, procainamide, amiodarone, sotalol, chlorpromazine, thioridazine, moxifloxacin, pentamidine, and methadone, may ↑ risk of QT interval prolongation; avoid concurrent use.
Parenteral pentamidine may result in severe, life-threatening hypocalcemia.
Risk of nephrotoxicity may be ↑ by nephrotoxic agents, including amphotericin B, aminoglycosides, cyclosporine, acyclovir, methotrexate, tacrolimus, and pentamidine (IV).

(Generic available)

Solution for injection: 24 mg/mL

Cytomegalovirus Retinitis

IV (Adults ): 60 mg/kg every 8 hr or 90 mg/kg every 12 hr for 2–3 wk as induction therapy; then 90–120 mg/kg once daily as maintenance therapy.

Renal Impairment

IV (Adults ): CCr >1–1.4 mL/min/kg: 45 mg/kg every 8 hr or 70 mg/kg every 12 hr for 2–3 wk as induction therapy; then 70–90 mg/kg once daily as maintenance therapy; CCr >0.8–1 mL/min/kg: 50 mg/kg every 12 hr for 2–3 wk as induction therapy; then 50–65 mg/kg once daily as maintenance therapy; CCr >0.6–0.8 mL/min/kg: 40 mg/kg every 12 hr or 80 mg/kg once daily for 2–3 wk as induction therapy; then 80–105 mg/kg every 48 hr as maintenance therapy; CCr >0.5–0.6 mL/min/kg: 60 mg/kg once daily for 2–3 wk as induction therapy; then 60–80 mg/kg every 48 hr as maintenance therapy; CCr >0.4–0.5 mL/min/kg: 50 mg/kg once daily for 2–3 wk as induction therapy; then 50–65 mg/kg every 48 hr as maintenance therapy; CCr <0.4 mL/min/kg: Not recommended.

Herpes Simplex Virus

IV (Adults ): 40 mg/kg every 8–12 hr for 2–3 wk or until healing occurs.

Renal Impairment

IV (Adults ): CCr >1–1.4 mL/min/kg: 30 mg/kg every 8–12 hr for 2–3 wk or until healing occurs; CCr >0.8–1 mL/min/kg: 20–35 mg/kg every 8–12 hr for 2–3 wk or until healing occurs; CCr >0.6–0.8 mL/min/kg: 25 mg/kg every 12 hr or 35 mg/kg once daily for 2–3 wk or until healing occurs; CCr >0.5–0.6 mL/min/kg: 25–40 mg/kg once daily for 2–3 wk or until healing occurs; CCr >0.4–0.5 mL/min/kg: 20–35 mg/kg once daily for 2–3 wk or until healing occurs; CCr <0.4 mL/min/kg: Not recommended.

Prevents viral replication by inhibiting viral DNA polymerase and reverse transcriptase.

Therapeutic effects:

Virustatic action against susceptible viruses, including CMV.

Therapeutic Classification: antivirals

Absorption: IV administration results in complete bioavailability.

Distribution: Variable penetration into CSF. May concentrate in and be slowly released from bone.

Metabolism/Excretion: 80–90% excreted unchanged in urine.

Half-Life: 3 hr (normal renal function); longer half-life of 90 hr may reflect release of drug from bone.

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	8–24 hr

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Inform patient that foscarnet is not a cure for CMV retinitis. Progression of retinitis may continue in immunocompromised patients during and after therapy. Advise patients to have regular ophthalmologic exams.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
May cause dizziness and seizures. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to notify health care provider immediately if perioral tingling or numbness in the extremities or paresthesia occurs during or after infusion. If these signs of electrolyte imbalance occur during administration, infusion should be stopped and lab samples for serum electrolyte concentrations obtained immediately.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding.

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9192- Foscarnet Sodium
  - 0143-9192-01- 10 CARTON in 1 CASE (0143-9192-01) / 1 BOTTLE in 1 CARTON / 250 mL in 1 BOTTLE

14593- Emcure Pharmaceuticals Limited
- 14593-925-
  - 14593-925-01- 50 kg in 1 DRUM (14593-925-01)

14593- Emcure Pharmaceuticals Limited
- 14593-925-
  - 14593-925-02- 15 kg in 1 DRUM (14593-925-02)

14593- Emcure Pharmaceuticals Limited
- 14593-925-
  - 14593-925-03- 1 kg in 1 POUCH (14593-925-03)

23155- Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.
- 23155-771- foscarnet sodium
  23155-771-31- 1 BOTTLE, GLASS in 1 CARTON (23155-771-31) / 250 mL in 1 BOTTLE, GLASS

25021- Sagent Pharmaceuticals
- 25021-189- Foscarnet Sodium
  - 25021-189-84- 10 BAG in 1 CARTON (25021-189-84) / 250 mL in 1 BAG

43066- Baxter Healthcare Corporation
- 43066-089- FOSCARNET SODIUM
  - 43066-089-10- 10 BAG in 1 CARTON (43066-089-10) / 250 mL in 1 BAG

59651- Aurobindo Pharma Limited
- 59651-476-
  - 59651-476-37- 50 kg in 1 DRUM (59651-476-37)

61662- Lianyungang Runzhong Pharmaceutical Co. Ltd.
- 61662-0001-
  61662-0001-1- 500 g in 1 BAG (61662-0001-1)

63323- Fresenius Kabi USA, LLC
- 63323-875- Foscarnet
  63323-875-50- 1 BOTTLE in 1 CARTON (63323-875-50) / 250 mL in 1 BOTTLE

68083- Gland Pharma Limited
- 68083-389- Foscarnet Sodium
  - 68083-389-01- 1 BAG in 1 CARTON (68083-389-01) / 250 mL in 1 BAG

70121- Amneal Pharmaceuticals LLC
- 70121-1744- Foscarnet Sodium
  - 70121-1744-2- 12 POUCH in 1 CARTON (70121-1744-2) / 1 BAG in 1 POUCH / 250 mL in 1 BAG

70121- Amneal Pharmaceuticals LLC
- 70121-1744- Foscarnet Sodium
  - 70121-1744-7- 10 POUCH in 1 CARTON (70121-1744-7) / 1 BAG in 1 POUCH / 250 mL in 1 BAG

70600- Maithri Drugs Private Limited
- 70600-020-
  - 70600-020-01- 50 kg in 1 DRUM (70600-020-01)

76310- Clinigen Limited
- 76310-024- Foscavir
  76310-024-01- 10 CARTON in 1 CARTON (76310-024-01) / 1 BOTTLE in 1 CARTON (76310-024-11) / 250 mL in 1 BOTTLE

76310- Clinigen Limited
- 76310-024- Foscavir
  - 76310-024-25- 10 CARTON in 1 CARTON (76310-024-25) / 1 BOTTLE in 1 CARTON (76310-024-15) / 250 mL in 1 BOTTLE

79290- Chongqing Bioland Pharmaceutical Ltd.
- 79290-0001-
  - 79290-0001-1- 25 kg in 1 DRUM (79290-0001-1)

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆ ⬇

Code ⬆