Cidofovir

CLINICAL USE

Treatment of CMV retinitis in patients with AIDS, if other agents are unsuitableTreatment of BK polyoma virus in transplant patients (unlicensed)

DOSE IN NORMAL RENAL FUNCTION

5 mg/kg weekly for 2 weeks then once every 2 weeks(See further information for BK polyoma virus treatment)

PHARMACOKINETICS

Molecular weight :279.2

%Protein binding :<6

%Excreted unchanged in urine : 80–100

Volume of distribution (L/kg) :0.3–0.8

half-life – normal/ESRD (hrs) :1.7–2.7/16–251

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

>55 Dose as in normal renal function<55 Avoid. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. 0.5 mg/kg/dose

HD :Dialysed. 0.5 mg/kg/dose

HDF/high flux :Dialysed. 0.5 mg/kg/dose

CAV/VVHD :Unknown dialysability. 0.5 mg/kg/dose

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsNone known

ADMINISTRATION

Reconstition

–

Route

IV infusion

Rate of Administration

Over 60 minutes

Comments

Dilute in 100 mL sodium chloride 0.9%

OTHER INFORMATION

Always administer with oral probenecid and intravenous sodium chloride 0.9%Administer 2 hours before dialysis session to benefit from peak concentration without having delayed clearance52–75% of dose dialysed out with high- flux haemodialysisInformation for the treatment of BK polyoma virus in transplant patients is from Pittsburgh. Starting dose was 0.25 mg/kg (if GFR<30 mL/min) in 100 mL sodium chloride 0.9% administered over 1 hour, given every 10–14 days. Hydration pre- and post-dose with 1 litre of sodium chloride 0.9% if tolerated. If no change within 10–14 days increase to 0.3–0.5 mg/kg; dose can be increased up to 1 mg/kg depending on response and side effects. Most patients would need a cumulative dose of 1–1.5 mg/kg. Initially use without probenecid. Monitor blood and urine samples for PCR measurement of viral load. The manufacturer advises to avoid in renal failure but theoretical doses, based on a 70 kg person, are suggested in the following paper

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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