Foscarnet sodium

CLINICAL USE

Antiviral agent:Treatment and maintenance therapy of cytomegalovirus retinitis (CMV)Mucocutaneous herpes simplex infection (HSI)

DOSE IN NORMAL RENAL FUNCTION

CMV: 60 mg/kg every 8 hours induction dose for 2–3 weeks, then 60 mg/kg daily, increase to 90–120 mg/kg if toleratedMucocutaneous herpes simplex infection: 40 mg/kg every 8 hours

PHARMACOKINETICS

  • Molecular weight                           :300
  • %Protein binding                           :14–17
  • %Excreted unchanged in urine     : 85
  • Volume of distribution (L/kg)       :0.4–0.6
  • half-life – normal/ESRD (hrs)      :2–4/>100

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : 28 mg/kg every 8 hours
  • 10 to 20     : 15 mg/kg every 8 hours
  • <10           : 6 mg/kg every 8 hours

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Dialysed. Dose as in GFR
  • <10           : mL/min. See ‘Other Information’
  • HD                     :Dialysed. Dose as in GFR
  • <10           : mL/min. See ‘Other Information’
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min. See ‘Other Information’
  • CAV/VVHD      :Dialysed. Dose as in GFR=10–20 mL/min.

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Antivirals: avoid with lamivudine
  • Ciclosporin: may cause acute renal failure in combination

    ADMINISTRATION

    Reconstition

    –

    Route

    Centrally (undiluted); peripherally (diluted)

    Rate of Administration

    Continuous infusion over 24 hours, or intermittent infusion over at least 60 minutes

    Comments

    If given peripherally dilute with glucose 5% or sodium chloride 0.9% to a concentration of 12 mg/mL or lessAlternatively, piggy-back the undiluted foscarnet dose to 1 litre of a glucose 5% or sodium chloride 0.9% infusionIf given centrally, can be administered undiluted but additional fluids should be given to reduce the risk of nephrotoxicity

    OTHER INFORMATION

    Maintain adequate hydration to prevent renal toxicityMonitor serum calcium and magnesium Some units use full-dose ganciclovir and half-dose foscarnet concomitantly for treatment of resistant CMV disease

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