II. Indications
- Cytomegalovirus Retinitis
- CMV Prophylaxis after Transplant
- Congenital CMV (off-label use)
III. Contraindications
- Absolute Neutrophil Count <500/mm3
- Hemoglobin <8 mg/dl
- Platelet Count <25,000/mm3
-
Hemodialysis
- Use Ganciclovir instead
IV. Mechanism
- Valganciclovir is a synthetic prodrug of Ganciclovir
- Valganciclovir has good oral Bioavailability compared with Ganciclovir, allowing for its oral dosing
- Like Ganciclovir, Valganciclovir is Nucleoside analogue of 2'-deoxyguanosine
- When incorporated into DNA, Valganciclovir blocks DNA Polymerase and further DNA elongation and DNA Replication
V. Dosing: Adult
-
Cytomegalovirus Retinitis
- Induction: Take 900 mg orally twice daily for 21 days, then
- Maintenance: 900 mg orally daily
- CMV Prophylaxis after Transplant
- Take 900 orally daily
- Start within 10 days of transplant
- Continue for 100 days following heart, Kidney-Pancreas transplant (200 days after Kidney Transplant)
-
Renal Dosing
- Adjust dose for eGFR <60 ml/min
VI. Dosing: Child
- CMV Prophylaxis after Kidney or Heart Transplant (age >4 months)
- Daily dose 7 mg x BSA x CrCl (via modified Schwartz, max 900 mg/day)
- Start within 10 days of transplant
- Continue for 100 days following Heart Transplant (200 days after Kidney Transplant)
- Symptomatic Congenital CMV (off-label for age <1 month old)
- Give 16 mg/kg orally with food twice daily for 6 months
- Dose adjusted for weight on monthly basis
- Monitor Absolute Neutrophil Count weekly for first 6 weeks, then at 8 weeks, and again monthly
- Monitor AST and ALT monthly
VII. Adverse Effects
- Myelosuppression (similar to Ganciclovir)
- Nephrotoxicity (increased Serum Creatinine)
- Monitor Serum Creatinine
- Possibly carcinogenic (as with Ganciclovir)
VIII. Safety
- Avoid in Lactation
- Avoid in Pregnancy (Teratogenic)
- Women should avoid pregnancy for at least 1 month after last dose
- Men should use barrier Contraception (Condoms) for at least 3 months after Ganciclovir
IX. Drug Interactions
- Didanosine
- Mycophenylate
- Zidovudine
X. Resources
- Valganciclovir Tablet (DailyMed)
XI. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2013) Med Lett Drugs Ther 11(127): 19-30 [PubMed]
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Related Studies
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 |
Ontology: valganciclovir (C0909381)
Definition (NCI) | A synthetic prodrug of ganciclovir, a nucleoside analogue of 2'-deoxyguanosine, with antiviral activity. After phosphorylation, valganciclovir is incorporated into DNA, resulting in inhibition of viral DNA polymerase, viral DNA synthesis, and viral replication. (NCI04) |
Definition (NCI_NCI-GLOSS) | An antiviral agent that is being studied as a treatment for AIDS-related cytomegalovirus. It is changed in the body to ganciclovir. |
Definition (PDQ) | A synthetic prodrug of ganciclovir, a nucleoside analogue of 2'-deoxyguanosine, with antiviral activity. After phosphorylation, valganciclovir is incorporated into DNA, resulting in inhibition of viral DNA polymerase, viral DNA synthesis, and viral replication. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38289&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=38289&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C2629" NCI Thesaurus) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C121677 |
SnomedCT | 395266000, 129476000 |
LNC | LP157730-5, MTHU047892 |
English | valganciclovir (medication), valganciclovir [Chemical/Ingredient], valGANciclovir, ganciclovir L-valyl ester, valganciclovir, L-Valine, 2-((2-amino-1,6-dihydro-6-oxo-9H-purin-9-yl)methoxy)-3-hydroxypropyl Ester, Valganciclovir (product), Valganciclovir (substance), Valganciclovir, VGCV, VALGANCICLOVIR |
Spanish | valganciclovir (producto), valganciclovir (sustancia), valganciclovir |