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Cidofovir
Cidofovir (Vistide)
Cidofovir
(sih-DOF-oh-veer)
Pregnancy Category: C Vistide (Rx)

Classification: Antiviral drug

See Also: See also Antiviral Drugs.

Action/Kinetics: A nucleotide analog that suppresses CMV replication by selective inhibition of viral DNA synthesis. The drug inhibits CMV DNA polymease. Must be administered with probenecid.

Uses: Treatment of CMV retinitis in clients with AIDS.

Contraindications: History of severe hypersensitivity to probenecid or other sulfa-containing drugs. Use by direct intraocular injection. Use in clients with a serum creatinine greater than 1. 5 mg/dL, a calculated C_CR of 55 mL/min or less, or a urine protein of 100 mg/dL or more (equivalent to 2+ proteinuria or more). Lactation.

Special Concerns: Safety and efficacy have not been determined for children or for treatment of other CMV infections, including pneumonitis, gastroenteritis, congenital or neonatal CMV disease, or CMV disease in non-HIV-infected clients. Increased risk of ocular hypotony in those with preexisting diabetes. Use caution in clients with risk factors for nephrotoxicity.

Side Effects: Renal/GU: Nephrotoxicity, Fanconi's syndrome and decreases in serum bicarbonate associated with renal tubular damage, proteinuria, elevated serum creatinine, glycosuria, hematuria, urinary incontinence, UTI, acute renal failure. GI: N&V;, diarrhea, anorexia, abdominal pain, colitis, constipation, tongue discoloration, dyspepsia, dysphagia, flatulence, gastritis, hepatomegaly, abnormal liver function tests, melena, oral candidiasis, rectal disorder, stomatitis, aphthous stomatitis, mouth ulceration, dry mouth. CNS: Headache, asthenia, amnesia, anxiety, confusion, convulsions depression, dizziness, abnormal gait, hallucinations, insomnia, neuropathy, paresthesia, somnolence. CV: Hypotension, postural hypotension, pallor, syncope, tachycardia, vasodilation. Hematologic: Neutropenia, granulocytopenia, thrombocytopenia, anemia. Respiratory: Asthma, bronchitis, coughing, dyspnea, hiccup, increased sputum, lung disorder, pharyngitis, pneumonia, rhinitis, sinusitis. Dermatologic: Alopecia, rash, acne, skin discoloration, dry skin, herpes simplex, pruritus, rash, sweating, urticaria. Musculoskeletal: Arthralgia, myasthenia, myalgia. Metabolic: Edema, dehydration, weight loss. Ophthalmic: Ocular hypotony, amblyopia, conjunctivitis, eye disorder, iritis, retinal detachment, uveitis, abnormal vision. Miscellaneous: Allergic reactions, facial edema, malaise, back pain, chest pain, neck pain, sarcoma, sepsis fever, infections, chills, taste perversion.

Laboratory Test Alterations: AST, ALT, alkaline phosphatase. Hyperglycemia, hyperlipemia, hypocalcemia, hypokalemia.

Drug Interactions: Amphotericin B / Risk of nephrotoxicity Aminoglycosides / Risk of nephrotoxicity Foscarnet / Risk of nephrotoxicity Pentamidine, IV / Risk of nephrotoxicity Zidovudine / Zidovudine clearance

How Supplied: Injection: 75 mg/mL

Dosage
•IV Infusion CMV retinitis.
Induction: 5 mg/kg given once weekly for 2 consecutive weeks as an IV infusion at a constant rate over 1 hr. Maintenance: 5 mg/kg given once q 2 weeks as an IV infusion at a constant rate over 1 hr. With each dose of cidofovir, probenecid, 2 g PO, must be given 3 hr prior to the cidofovir dose and 1 g PO given at 2 hr and again at 8 hr after completion of the 1-hr cidofovir infusion. Also, with each dose of cidofovir, the client should receive a total of 1 L of 0.9% NaCl solution IV over a 1- to 2-hr period just before the cidofovir infusion. If the client can tolerate it, give a second liter of 0.9% NaCl solution either at the start of the cidofovir infusion or immediately afterward and infuse over a 1- to 3-hr period. If serum creatinine increases by 0.3 to 0.4 mg/dL, reduce the dose of cidofovir from 5 to 3 mg/kg. Discontinue cidofovir if the serum creatinine increases by 0.5 mg/dL or more or if there is development of 3 + or more proteinuria.