11D Viral infections
INFECTIONS & INFESTATIONS
CrCl ;10mL/min: 500mg every 24 hours; all for
10 days. Treatment of recurrent genital herpes:
500mg every 12 hours; CrCl ;29mL/min: 500mg
every 24 hours; both for 3 days. Suppression
of recurrent genital herpes if immunocompetent
(;
9 episodes/year; reevaluate annually): 1g every
24 hours; CrCl ;29mL/min: 500mg every 24 hours;
(;
9 episodes/year): 500mg every 24 hours;
CrCl ;29mL/min: 500mg every 48 hours; Reduction
of genital herpes transmission risk (;
9 episodes/
year): 500mg every 24 hours for source partner
(and use safer sex practices); CrCl ;29mL/min:
500mg every 48 hours; Suppression of recurrent
genital herpes if HIV-infected: 500mg every 12
hours; CrCl ;29mL/min: 500mg every 24 hours.
;12yrs: Herpes labialis (treat for 1 day): 2g every
12 hours; CrCl 30–49mL/min: 1g every 12 hours;
CrCl 10–29mL/min: 500mg every 12 hours; CrCl
;10mL/min: 500mg once.
Children: Herpes labialis: ;12yrs: not
recommended. Herpes zoster or genital herpes
;18yrs: not recommended. Chickenpox: ;2yrs or
;18yrs: not recommended. Begin at onset of signs/
symptoms. 2–18yrs: 20mg/kg three times daily for 5
days; max 1g three times daily. CrCl;50mL/min: not
recommended.
Warnings/Precautions: Renal impairment.
Maintain adequate hydration. Elderly. Pregnancy
(Cat.B). Nursing mothers.
Interactions: Renal or CNS toxicity with nephrotoxic
drugs.
Adverse reactions: Headache, nausea, abdominal
pain, dizziness, fatigue, rash, lab abnormalities
(CBC, AST, serum creatinine), CNS disturbances
(esp. elderly). Thrombotic thrombocytopenic purpura/
hemolytic uremic syndrome (in advanced HIV or
transplant recipients on 8g/day).
How supplied: Caplets– 30, 90
;VALGANCICLOVIR
VALCYTE Roche
Nucleoside analogue. Valganciclovir (as HCl) (prodrug
of ganciclovir) 450mg; tabs.
Indications: Treatment of AIDS-related
cytomegalovirus (CMV) retinitis. Prevention of
CMV disease in kidney, heart, or kidney-pancreas
transplant adult patients at high risk. Prevention of
CMV disease in kidney and heart transplant pediatric
patients ( 4 months to 16 years old) at high risk.
Adults: Take with food. ;16yrs: Treatment:
induction: 900mg twice daily for 21 days;
maintenance: 900mg once daily. Prevention (heart or
kidney-pancreas): 900mg once daily starting within
10 days of transplantation until 100 days post-op.
Prevention (kidney): 900mg once daily starting within
10 days of transplantation until 200 days post-op.
Renal impairment (CrCl ;60mL/min): reduce dose;
see literature. Hemodialysis (CrCl ;10mL/min): not
recommended (use ganciclovir).
Children: ;4months: not recommended. Take
with food. ;4months: Dose (mg); 7 ; BSA ;
Creatinine Clearance (if calculated Schwartz CrCl
;150mL/min/1.73m2, then use max value of
150mL/min/1.73m2 in equation). Round calculated
dose to the nearest 25mg increment; max 900mg. If
calculated dose within 10% of tablet strength, tablets
may be used.
Also: Valganciclovir
VALCY TE FOR ORAL SOLUTION
Valganciclovir (as HCl) (prodrug of ganciclovir)
50mg/mL; pwd for reconstitution; tutti-frutti flavor.
Indications: Prevention of CMV disease in kidney
and heart transplant pediatric patients ( 4 months to
16 years old) at high risk.
Adults: Use tablet form.
Children: ;4months: not recommended. Take
with food. ;4months: Dose (mg); 7 ; BSA ;
Creatinine Clearance (if calculated Schwartz CrCl
;150mL/min/1.73m2, then use max value of
150mL/min/1.73m2 in equation). Round calculated
dose to the nearest 25mg increment; max 900mg.
Contraindications: Acyclovir or ganciclovir allergy.
Warnings/Precautions: Do not substitute on
a mg-per-mg basis for ganciclovir. Avoid handling
broken tabs. Withhold dose if absolute neutrophil
count ;500 cells/microliter, platelet count
;
25,000/microliter, or hemoglobin ;
8 g/dL.
Reduce dose or discontinue if blood dyscrasias
occur. Renal impairment. Cytopenia or cytopenic
reactions to drugs, chemicals, irradiation. Monitor
CBC with differential, platelets, ophthalmic, and
renal function. Maintain adequate hydration. Use
effective contraception during (men and women)
and for at least 90 days after treatment (men).
Elderly. Pregnancy (Cat.C: teratogenic, embryotoxic,
carcinogenic, aspermatogenesis in animals), nursing
mothers: see literature.
Interactions: Zidovudine increases anemia/
neutropenia risk. Probenecid increases levels. May
potentiate mycophenolate mofetil (MMF) metabolites
or be potentiated by MMF in patients with renal
impairment (monitor). Caution with nephrotoxic or
myelosuppressive drugs. Monitor for toxicity with
didanosine.
Adverse reactions: GI upset, pyrexia, tremor,
neutropenia, anemia, thrombocytopenia, graft
rejection; children: also hypertension, upper
respiratory tract infection, constipation, cough.
How supplied: Tabs– 60; Soln–100mL (after
constitution)
;
;ZANAMIVIR
RELENZA GlaxoSmithKline
Neuraminidase inhibitor. Zanamivir 5mg/blister; dry
pwd for oral inhalation; contains lactose.
Indications: Treatment of uncomplicated acute
illness due to influenza A and B virus in patients ;
7
years of age who have been symptomatic for no more
than two days. Prophylaxis of influenza in patients
;
5 years of age.
Adults and Children: Use supplied Diskhaler
inhalation device. Complete course of treatment.
