II. Indications

  1. Cytomegalovirus Retinitis
  2. CMV Prophylaxis after Transplant
  3. Congenital CMV (off-label use)

III. Contraindications

  1. Absolute Neutrophil Count <500/mm3
  2. Hemoglobin <8 mg/dl
  3. Platelet Count <25,000/mm3
  4. Hemodialysis
    1. Use Ganciclovir instead

IV. Mechanism

  1. Valganciclovir is a synthetic prodrug of Ganciclovir
    1. Valganciclovir has good oral Bioavailability compared with Ganciclovir, allowing for its oral dosing
  2. Like Ganciclovir, Valganciclovir is Nucleoside analogue of 2'-deoxyguanosine
    1. When incorporated into DNA, Valganciclovir blocks DNA Polymerase and further DNA elongation and DNA Replication

V. Dosing: Adult

  1. Cytomegalovirus Retinitis
    1. Induction: Take 900 mg orally twice daily for 21 days, then
    2. Maintenance: 900 mg orally daily
  2. CMV Prophylaxis after Transplant
    1. Take 900 orally daily
    2. Start within 10 days of transplant
    3. Continue for 100 days following heart, Kidney-Pancreas transplant (200 days after Kidney Transplant)
  3. Renal Dosing
    1. Adjust dose for eGFR <60 ml/min

VI. Dosing: Child

  1. CMV Prophylaxis after Kidney or Heart Transplant (age >4 months)
    1. Daily dose 7 mg x BSA x CrCl (via modified Schwartz, max 900 mg/day)
    2. Start within 10 days of transplant
    3. Continue for 100 days following Heart Transplant (200 days after Kidney Transplant)
  2. Symptomatic Congenital CMV (off-label for age <1 month old)
    1. Give 16 mg/kg orally with food twice daily for 6 months
    2. Dose adjusted for weight on monthly basis
    3. Monitor Absolute Neutrophil Count weekly for first 6 weeks, then at 8 weeks, and again monthly
    4. Monitor AST and ALT monthly

VII. Adverse Effects

  1. Myelosuppression (similar to Ganciclovir)
  2. Nephrotoxicity (increased Serum Creatinine)
    1. Monitor Serum Creatinine
  3. Possibly carcinogenic (as with Ganciclovir)

VIII. Safety

  1. Avoid in Lactation
  2. Avoid in Pregnancy (Teratogenic)
    1. Women should avoid pregnancy for at least 1 month after last dose
    2. Men should use barrier Contraception (Condoms) for at least 3 months after Ganciclovir

IX. Drug Interactions

  1. Didanosine
  2. Mycophenylate
  3. Zidovudine

XI. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2013) Med Lett Drugs Ther 11(127): 19-30 [PubMed]

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Related Studies

Cost: Medications

valganciclovir (on 9/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VALGANCICLOVIR 450 MG TABLET Generic $2.55 each
VALGANCICLOVIR HCL 50 MG/ML Generic $4.93 per ml