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Last updated: Lupus Nephritis…
on 26 Aug 2016

Valganciclovir



Indication
  • Prevention of cytomegalovirus (CMV) disease in CMV-negative patients who have received a solid organ transplant from a CMV-positive donor, and induction and maintenance treatment of CMV
  • Protocols vary between transplant centres for exactly which patients are given valganciclovir and the duration of prophylaxis
Preparations
  • Valganciclovir is a prodrug of ganciclovir
  • 450 mg tablets, 50 mg/ml oral solution
Contraindications
  • Hypersensitivity to valganciclovir, ganciclovir or to any of the excipients
  • Also contraindicated during lactation
Cautions
  • Monitor creatinine. Nephrotoxic: in patients with impaired renal function, dosage adjustments based on creatinine clearance are required. In severe renal impairment there is an increased risk of bone marrow suppression
  • Monitor FBC
  • Monitor LFTs
  • Valganciclovir is a potential teratogen and carcinogen in humans with the potential to cause birth defects and cancers. It is also considered likely that it causes temporary or permanent inhibition of spermatogenesis
  • Women of child bearing potential must be advised to use effective contraception during treatment
  • Men should be advised to practise barrier contraception during treatment, and for at least 90 days thereafter
  • Caution is advised for handling broken tablets. If broken tablets come into contact with skin or mucosa, wash immediately with water
Side-effects
  • Bone marrow suppression, diarrhoea, hepatic dysfunction, nephrotoxicity
Dose
  • Prevention of CMV disease in solid organ transplantation: 900 mg once daily comencing 10 days after transplantation and continuing for 100-200 days
  • Transplant centres have their own prophylaxis protocols with variable durations of therapy
  • Treatment of CMV: induction: 900 mg BD; maintenance 900 mg OD
  • 900 mg valganciclovir is equivalent to 5 mg/kg ganciclovir IV
  • About 50% is removed by HD
Dose in renal impairment
CrCl (ml/min) Induction dose of valganciclovir Maintenance/Prevention dose of valganciclovir
≥ 60 900 mg (2 tablets) twice daily 900 mg (2 tablets) once daily
40 – 59 450 mg (1 tablet) twice daily 450 mg (1 tablet) once daily
25 – 39 450 mg (1 tablet) once daily 450 mg (1 tablet) every 2 days
10 – 24 450 mg (1 tablet) every 2 days 450 mg (1 tablet) twice weekly
< 10 Not recommended: 450mg 2-3x/wk has been used Not recommended: 450mg 1-2x/wk has been used

 

Interactions
  • Imipenum-cilastin – fits with concomitant use
  • Care with other agents that can cause neutropenia
  • Increased levels with mycophenolate
How to Prescribe View Details
Patient comment
  • Take with food
  • Do not crush or chew tablets
  • Caution is advised for handling broken tablets. If broken tablets come into contact with skin or mucosa, wash immediately with water

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