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Cidofovir

    Brands

    DEA Class; Rx

    Common Brand Names; Vistide (DSC)

    • Antivirals, CMV

    Antiviral; acyclic phosphonate nucleotide analog; structurally similar to acyclovir; not dependent upon intracellular activation
    Used for the treatment of cytomegalovirus (CMV), herpes virus infections, and adenovirus infections
    Associated with renal toxicity; use with probenecid and IV hydration to reduce toxicity

    Indicated for the treatment of cytomegalovirus (CMV) retinitis in persons with HIV.

    For secondary cytomegalovirus (CMV) disease prophylaxis† or cytomegalovirus (CMV) retinitis prophylaxis (i.e., long-term suppressive therapy) in persons living with HIV.

    Hypersensitivity to cidofovir or probenecid

    SCr >1.5 mg/dL, CrCl <55 mL/min, urine protein >100 mg/dL (2+ proteinuria)

    Direct intraocular injection

    Concomitant nephrotoxic drugs

    • Infection
    • Chills
    • Fever
    • Headache
    • Amnesia
    • Anxiety
    • Confusion
    • Seizures
    • Insomnia
    • Weakness
    • Paresthesia
    • Alopecia
    • Rash
    • Acne
    • Skin discoloration
    • Nausea
    • Vomiting
    • Diarrhea
    • Anorexia
    • Abdominal pain
    • Constipation
    • Dyspepsia
    • Gastritis
    • Thrombocytopenia
    • Neutropenia
    • Anemia
    • Amblyopia
    • Conjunctivitis
    • Ocular hypotony
    • Tubular damage
    • Proteinuria
    • Elevated creatinine

    Risk of nephrotoxicity (dose-limiting)

    Risk of neutropenia

    Probenecid must be administered w/each dose: 2 g PO 3 hr before cidofovir, 1 g at 2 hr & 8 hr after completion of cidofovir infusion

    1 L saline IV with each cidofovir infusion; 1 add’l liter if pt can tolerate

    Pregnancy Category: C

    Lactation: It is not known whether cidofovir is excreted in milk. It should not be administered to nursing mothers. The CDC advises HIV-infected women not to breast-feed to avoid postnatal transmission of HIV.

    Adults

    5 mg/kg/week IV.

    Geriatric

    5 mg/kg/week IV.

    Adolescents

    Safety and efficacy have not been established; however, doses up to 5 mg/kg/week IV have been used off-label.

    Children

    Safety and efficacy have not been established; however, doses up to 5 mg/kg/week IV have been used off-label.

    Infants

    Safety and efficacy have not been established; however, doses up to 5 mg/kg/week IV have been used off-label.

    Neonates

    Safety and efficacy have not been established.

    Cidofovir

    injectable solution

    • 75mg/mL (375mg/5mL vial); generic