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1 Adverse Reactions/Side Effects
CNS: SEIZURES, abnormal dreams, coma, confusion, dizziness, drowsiness, head- PDF Page #1
ganciclovir (gan-sye-kloe-vir) ache, malaise, nervousness. Resp: dyspnea. CV: arrhythmias, edema, hypertension,
Cytovene hypotension. GI: GI BLEEDING, abdominal pain,qliver enzymes, nausea, vomiting.
Classification GU: gonadal suppression, hematuria, renal toxicity. Derm: alopecia, photosensitiv-
Therapeutic: antivirals ity, pruritus, rash, urticaria. Endo: hypoglycemia. Hemat: neutropenia, thrombo-
cytopenia, anemia, eosinophilia. Local: pain/phlebitis at IV site. Neuro: ataxia,
Pregnancy Category C tremor. Misc: fever.
Indications Interactions
IV: Treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients,
Drug-Drug:qrisk of bone marrow depression with antineoplastics, radiation
therapy, or zidovudine. Toxicity may beqby probenecid.qrisk of seizures with
including HIV-infected patients (may be used with foscarnet). Prevention of CMV in-
imipenem/cilastatin. Concurrent use of other nephrotoxic drugs, cyclospor-
fection in transplant patients at risk. Congenital CMV infection in neonates.
ine, or amphotericin Bqrisk of nephrotoxicity.
Action
CMV converts ganciclovir to its active form (ganciclovir phosphate) inside the host
Route/Dosage
IV (Adults and Children ⬎3 mo): Induction— 5 mg/kg q 12 hr for 14– 21 days.
cell, where it inhibits viral DNA polymerase. Therapeutic Effects: Antiviral effect
Maintenance regimen— 5 mg/kg/day or 6 mg/kg for 5 days of each week. If pro-
directed preferentially against CMV-infected cells.
gression occurs,qto q 12 hr regimen. Prevention— 5 mg/kg q 12 hr for 7– 14
Pharmacokinetics days, then 5 mg/kg/day or 6 mg/kg for 5 days of each week.
Absorption: IV administration results in complete bioavailability. IV (Neonates): Congenital CMV infection— 12 mg/kg/day divided q 12 hr x 6
Distribution: Widely distributed; enters CSF. weeks.
Protein Binding: 1– 2%. Renal Impairment
Metabolism and Excretion: 90% excreted unchanged by the kidneys. IV (Adults and Children): Induction— CCr 50– 69 mL/min: 2.5 mg/kg/dose q 12
Half-life: Adults: 2.9 hr; Children 9 mo-12 yr: 2.4 ⫾ 0.7 hr; Neonates: 2.4 hr (qin hr; CCr 25– 49 mL/min: 2.5 mg/kg/dose q 24 hr; CCr 10– 24 mL/min: 1.25 mg/kg/
renal impairment). dose q 24 hr; CCr ⬍10 mL/min: 1.25 mg/kg 3 times/week after hemodialysis; Mainte-
TIME/ACTION PROFILE (antiviral levels) nance— CCr 50– 69 mL/min: 2.5 mg/kg/dose q 24 hr; CCr 25– 49 mL/min: 1.25
ROUTE ONSET PEAK DURATION
mg/kg/dose q 24 hr; CCr 10– 24 mL/min: 0.625 mg/kg/dose q 24 hr; CCr ⬍10 mL/
min: 0.625 mg/kg 3 times/week after hemodialysis.
IV rapid end of infusion 12–24 hr
NURSING IMPLICATIONS
Contraindications/Precautions Assessment
Contraindicated in: Hypersensitivity to ganciclovir or acyclovir; Bone marrow ● Diagnosis of CMV retinitis should be determined by ophthalmoscopy before treat-
depression or immunosuppression or thrombocytopenia (do not administer if ANC ment with ganciclovir.
⬍500/mm3 or platelet count ⬍25,000/mm3). ● Culture for CMV (urine, blood, throat) may be taken before administration. How-
Use Cautiously in: Renal impairment (doseprequired if CCr ⬍80 mL/min); ever, a negative CMV culture does not rule out CMV retinitis. If symptoms do not
Geri: Doseprecommended. respond after several weeks, resistance to ganciclovir may have occurred. Oph-
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 ● Diluent: Dilute in 100 mL of D5W, 0.9% NaCl, Ringer’s or LR. Once diluted for
infusion, solution should be used within 24 hr. Refrigerate but do not freeze. Con-
thalmologic exams should be performed weekly during induction and every 2 wk centration: 10 mg/mL. Rate: Administer slowly, via infusion pump, over 1 hr PDF Page #2
during maintenance or more frequently if the macula or optic nerve is threatened. using an in-line filter. Rapid administration may increase toxicity.
Progression of CMV retinitis may occur during or after ganciclovir treatment. ● Y-Site Compatibility: alemtuzumab, alfentanyl, allopurinol, amphotericin B
● Assess for signs of infection (fever, chills, cough, hoarseness, lower back or side cholesteryl, amphotericin B lipid complex, anidulafungin, argatroban, atropine,
pain, sore throat, difficult or painful urination). Notify health care professional if azithromycin, bivalirudin, bleomycin, calcium chloride, calcium gluconate, car-
these symptoms occur. boplatin, carmustine, caspofungin, cisplatin, cyanocobalamin, cyclophospha-
● Assess for bleeding (bleeding gums, bruising, petechiae; guaiac stools, urine, and mide, cyclosporine, dactinomycin, daptomycin, dexamethasone, dexmedetomi-
emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to ve- dine, digoxin, docetaxel, doxacurium, doxorubicin liposome, enalaprilat, epoetin
nipuncture sites for 10 min. alfa, eptifibatide, ertapenem, etoposide, etoposide phosphate, fentanyl, filgrastim,
● Lab Test Considerations: Monitor neutrophil and platelet count at least every fluconazole, fluorouracil, folic acid, furosemide, glycopyrrolate, granisetron,
2 days during bid therapy and weekly thereafter. Granulocytopenia usually occurs heparin, hetastarch, hydromorphone, ifosfamide, indomethacin, insulin, labeta-
during the first 2 wk of treatment but may occur anytime during therapy. Do not lol, leucovorin calcium, linezolid, lorazepam, mannitol, mechlorethamine, mel-
administer if neutrophil count ⬍500/mm3 or platelet count ⬍25,000/mm3. Re- phalan, methotrexate, metoprolol, milrinone, mitoxantrone, nafcillin, naloxone,
covery begins within 3– 7 days of discontinuation of therapy. nesiritide, nitroglycerin, nitroprusside, octreotide, oxytocin, paclitaxel, pancuro-
● Monitor BUN and serum creatinine at least once every 2 wk throughout therapy. nium, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phytonadione,
● Monitor liver function tests (AST, ALT, serum bilirubin, alkaline phosphatase) pe- potassium chloride, propofol, propranolol, protamine, ranitidine, remifentanil,
riodically during therapy. May causeqlevels. rituximab, rocuronium, sodium acetate, sufentanil, teniposide, thiotepa, tigecyc-
● May causepblood glucose. line, tirofiban, trastuzumab, vasopressin, vinblastine, vincristine, voriconazole,
zolendronic acid.
Potential Nursing Diagnoses ● Y-Site Incompatibility: aldesleukin, amifostine, amikacin, aminophylline, am-
Risk for infection (Indications) (Patient/Family Teaching) photericin B colloidal, ampicillin, ampicillin/sulbactam, amsacrine, ascorbic
Implementation acid, atracurium, azathioprine, aztreonam, benztropine, bumetanide, butor-
● Do not confuse Cytovene (ganciclovir) with Cytosar (cytarabine). phanol, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, cef-
● Prepare solution in a biologic cabinet. Wear gloves, gown, and mask while han- tazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, clindamy-
dling medication. Discard IV equipment in specially designated containers. cin, cytarabine, dantrolene, dexrazoxane, diazepam, diazoxide, diltiazem,
● Do not administer subcut or IM; severe tissue irritation may result. diphenhydramine, dobutamine, dolasetron, dopamine, doxorubicin, doxycycline,
● IV: Observe infusion site for phlebitis. Rotate infusion site to prevent phlebitis. ephedrine, epinephrine, epirubicin, erythromycin, esmolol, famotidine, fenoldo-
● Maintain adequate hydration throughout therapy. pam, fludarabine, foscarnet, gemcitabine, gentamicin, haloperidol, hydralazine,
hydrocortisone, hydroxyzine, idarubicin, imipenem/cilastatin, irinotecan, isopro-
IV Administration terenol, ketorolac, levofloxacin, lidocaine, magnesium sulfate, meperidine, me-
● Intermittent Infusion: Reconstitute 500 mg with 10 mL of sterile water for in- taraminol, methyldoapte, methylprednisolone, metoclopramide, metronidazole,
jection for a concentration of 50 mg/mL. Do not reconstitute with bacteriostatic midazolam, morphine, multivitamins, mycophenolate, nalbuphine, nicardipine,
water with parabens; precipitation will occur. Shake well to dissolve completely. norepinephrine, ondansetron, oxacillin, palonosetron, papaverine, penicillin G,
Discard vial if particulate matter or discoloration occurs. Reconstituted solution pentamidine, pentazocine, phentolamine, phenylephrine, phenytoin, piperacillin/
is stable for 12 hr at room temperature; do not refrigerate. tazobactam, potassium acetate, procainamide, prochlorperazine, promethazine,
䉷 2015 F.A. Davis Company CONTINUED
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3
PDF Page #3
CONTINUED
ganciclovir
pyridoxime, quinupristin/dalfopristin, sargramostim, sodium bicarbonate, strep-
tokinase, succinylcholine, tacrolimus, theophylline, thiamine, ticarcillin/clavulan-
ate, tobramycin, tolazoline, trimethoprim/sulfamethoxazone, vancomycin, vecu-
ronium, verapamil, vinorelbine.
Patient/Family Teaching
● Inform patient that ganciclovir is not a cure for CMV retinitis. Progression of retini-
tis may continue in immunocompromised patients during and after therapy. Ad-
vise patients to have regular ophthalmic exams at least every 6 wk. Duration of
therapy for CMV prevention is based on the duration and degree of immunosup-
pression.
● Advise patient to notify health care professional if fever; chills; sore
throat; other signs of infection; bleeding gums; bruising; petechiae; or
blood in urine, stool, or emesis occurs. Caution patient to avoid crowds
and persons with known infections. Instruct patient to use soft tooth-
brush and electric razor. Patient should be cautioned not to drink alco-
holic beverages or take products containing aspirin or NSAIDs.
● Advise patient that ganciclovir may have teratogenic effects. A nonhormonal
method of contraception should be used during and for at least 90 days after ther-
apy.
● Caution patient to use sunscreen and protective clothing to prevent photosensitiv-
ity reactions.
● Emphasize the importance of frequent follow-up exams to monitor blood counts.
Evaluation/Desired Outcomes
● Treatment of the symptoms of CMV retinitis in immunocompromised patients.
● Prevention of CMV retinitis in transplant patients at risk.
Why was this drug prescribed for your patient?
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
