the cmv hammer
A guanosine analogue that inhibits viral DNA polymerase. The mainstay of Cytomegalovirus (CMV) treatment.
agents
- Valganciclovir (PO): Prodrug with excellent bioavailability. Used for prophylaxis and treatment of mild-moderate disease.
- Ganciclovir (IV): Used for severe disease / high viral loads / GI absorption issues.
indications
- CMV Retinitis: HIV/AIDS.
- CMV Prophylaxis/Treatment: Solid organ and bone marrow transplant.
adverse effects
- Bone Marrow Suppression: Leukopenia/Neutropenia (dose-limiting).
- Interaction: Synergistic toxicity with Septra or Mycophenolate.
- Nephrotoxicity: Less than Foscarnet/Cidofovir, but requires renal adjustment.
- Teratogenic: Strict contraception required.