II. Indications
- Cytomegalovirus Retinitis (HIV Infection or AIDS)
- Other non-FDA approved uses
- CMV pneumonitis or Gastroenteritis
- Resistant HSV and VZV Infections
- Invasive Adenovirus or BK Virus (transplant patients)
- In vitro activity against Vaccinia and Variola
III. Contraindications
- Serum Creatinine >1.5 mg/dl
- eGFR <55 ml/min
- Urine Protein > 100 mg/dl (2+ Urine Protein)
- Not FDA approved for children
IV. Mechanism
- Active against the Herpes Family of Viruses, especially Cytomegalovirus (CMV).
- Synthetic, acyclic, monophosphate Nucleotide analog of deoxycytidine (deoxyribonucleoside in DNA synthesis)
- Cidofovir is activated within infected host cells, via phosphorylation by pyruvate kinases to Cidofovir diphosphate
- Cidofovir diphosphate competes with deoxycytosine-5-triphosphate (dCTP) for viral DNA Polymerase
- When incorporated into DNA, it prevents further viral DNA polymerization, and block viral DNA Replication
V. Dosing: Cytomegalovirus Retinitis
- Cidofovir for Cytomegalovirus Retinitis
- Start: 5 mg/kg IV once weekly for 2 weeks
- Next: 5 mg/kg IV every othe week
- Medications typically administered with Cidofovir
- Probenacid 2 grams orally before and 1 gram orally at 2 and 8 hours after Cidofovir infusion
- Normal Saline during Cidofovir infusion
VI. Adverse Effects
- Granulocytopenia
- Metabolic Acidosis
- Ocular adverse effects
- Nephrotoxicity (severe)
- Similar to Fanconi Syndrome
- Stop all other Nephrotoxic Drugs at least 1 week before starting Cidofovir
VII. Safety
- Avoid in Lactation
- Avoid in Pregnancy due to Teratogenicity (Despite Pregnancy Category C)
- Avoid pregnancy for at least one month after taking Cidofovir
- Men should use barrier Contraception (Condoms) for at least 3 months after taking Cidofovir
VIII. Labs: Monitoring
- Periodic monitoring while on Cidofovir
- Neutrophil Count
- Intraocular Pressure for hypotony
- Renal Function before each Cidofovir dose
IX. Drug Interactions
- Nephrotoxic Drugs
-
Zidovudine
- Hold Zidovudine (or decrease its dose by 50%) on the day Cidofovir is given
X. Resources
XI. References
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A synthetic, acyclic, monophosphate nucleotide analog of deoxycytidine with antiviral activity, and mostly used against cytomegalovirus (CMV). After incorporation into the host cell, cidofovir is phosphorylated by pyruvate kinases to its active metabolite cidofovir diphosphate. Cidofovir diphosphate, bearing structural similarity to nucleotides, competes with deoxycytosine-5-triphosphate (dCTP) for viral DNA polymerase and gets incorporated into the growing viral DNA strands. As a result, it prevents further DNA polymerization and disrupts DNA replication of viruses. |
Definition (NCI_NCI-GLOSS) | A drug used to treat infection caused by viruses. |
Definition (CSP) | 1(3-hydroxy-2-phosphonomethoxypropyl) cytosine; potent selective inhibitor of human cytomegalovirus replication; used in CMV retinitis therapy. |
Definition (PDQ) | A synthetic, acyclic, monophosphate nucleotide analog of deoxycytidine with antiviral activity, and mostly used against cytomegalovirus (CMV). After incorporation into the host cell, cidofovir is phosphorylated by pyruvate kinases to its active metabolite cidofovir diphosphate. Cidofovir diphosphate, bearing structural similarity to nucleotides, competes with deoxycytosine-5-triphosphate (dCTP) for viral DNA polymerase and gets incorporated into the growing viral DNA strands. As a result, it prevents further DNA polymerization and disrupts DNA replication of viruses. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42545&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42545&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1600" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Nucleic Acid, Nucleoside, or Nucleotide (T114) |
MSH | C059262 |
SnomedCT | 108688007, 386894007 |
LNC | LP30899-6, MTHU015507 |
English | 1-((3-hydroxy-2-phosphonylmethoxy)propyl)cytosine, 1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine, HPMPC, cidofovir, 1(3-hydroxy-2-phosphonomethoxypropyl) Cytosine, Cidofovir, cidofovir (medication), Cidofovir Dihydrate, cidofovir [Chemical/Ingredient], hpmpc, cdv, CIDOFOVIR, Cidofovir (product), Cidofovir (substance), CDV |
Spanish | cidofovir (producto), cidofovir (sustancia), cidofovir |