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Ganciclovir
General information
Ganciclovir (dihydroxypropoxymethylguanine) is a nucleoside analogue with antiviral activity in vitro against herpesviruses. Intracellular phosphorylation of ganciclovir to its triphosphate derivative, which acts as a competitive inhibitor of deoxyguanosine triphosphate, leads to the inhibition of viral DNA synthesis. Because its toxicity profile is more favorable than those of foscarnet and cidofovir, it should be considered first-line treatment of life-threatening or sight-threatening cytomegalovirus (CMV) infections in immunocompromised patients. Ganciclovir is administered by infusion or by intravitreal injection [ ]. Oral ganciclovir as maintenance therapy for CMV retinitis in patients with AIDS has been reviewed [ ]. Oral ganciclovir has also been the subject of a pilot study in hepatitis B infection [ ].
General adverse effects and adverse reactions
The proportion of patients in whom ganciclovir therapy is subsequently interrupted or withdrawn because of adverse reactions is estimated at 32% [ ].
Fever, rash, and abnormal liver function values are each reported to occur in about 2% of ganciclovir recipients [ ]. Other infrequently reported adverse reactions, which may or may not be associated with ganciclovir, include chills, edema, malaise, vomiting, anorexia, diarrhea, dyspnea, reduced blood glucose, alopecia, impaired renal function, inflammation, pain, or phlebitis at the infusion site [ ]. These reactions may also be due to the underlying illness in such patients.
Drug studies
Observational studies
In 261 patients with CMV retinitis given oral ganciclovir 3–6 g/day or intravenous ganciclovir 5 mg/kg/day the most common adverse reactions were on the gastrointestinal tract (nausea in 29–43%, vomiting in 17–23%, diarrhea in 33–52%, and flatulence in 2–18%) [ ]. There were rashes in 9–32%, a low neutrophil count (below 0.5 × 10 9 /l) in 12–16%, a low hemoglobin concentration (below 8 g/dl) in 8–15%, a low platelet count (below 25 × 10 9 /l) in 0–3%, and a raised serum creatinine in 17–27%.
Organs and systems
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