Antiviral dosing and efficacy for prophylaxis of cytomegalovirus disease in solid organ transplant recipients.
OBJECTIVE
The implications of the findings from clinical studies and pharmacokinetic analyses of the antiviral agent valganciclovir for dosing of the drug to prevent cytomegalovirus (CMV) disease in solid organ transplant recipients are reviewed.


CONCLUSIONS
Valganciclovir, an oral prodrug of ganciclovir, is as effective as oral ganciclovir for preventing CMV disease, although prophylaxis with either agent may delay CMV disease. Dosage reduction is required for both drugs in patients with renal impairment to prevent high plasma ganciclovir concentrations and toxicity. A valganciclovir dosage of 900 mg/day is required in patients with normal renal function, especially those at high risk for CMV disease, to provide adequate systemic ganciclovir exposure. Some studies suggest that a lower dosage might suffice for patients at a low risk for CMV disease.


CONCLUSIONS
Valganciclovir dosing should be based on renal function to avoid toxicity.
Cochrane
Adam B
AB
University of Chicago Hospitals, 5841 South Maryland Avenue, Mail Code 5026, Chicago, IL 60637, USA. adam.cochrane@uchospitals.edu
D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects; D016377:Organ Transplantation / Q000009:adverse effects*; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir