- Prevention of cytomegalovirus (CMV) disease in CMV-negative patients who have received a solid organ transplant from a CMV-positive donor, and induction and maintenance treatment of CMV
- Protocols vary between transplant centres for exactly which patients are given valganciclovir and the duration of prophylaxis
- Valganciclovir is a prodrug of ganciclovir
- 450 mg tablets, 50 mg/ml oral solution
- Hypersensitivity to valganciclovir, ganciclovir or to any of the excipients
- Also contraindicated during lactation
- Monitor creatinine. Nephrotoxic: in patients with impaired renal function, dosage adjustments based on creatinine clearance are required. In severe renal impairment there is an increased risk of bone marrow suppression
- Monitor FBC
- Monitor LFTs
- Valganciclovir is a potential teratogen and carcinogen in humans with the potential to cause birth defects and cancers. It is also considered likely that it causes temporary or permanent inhibition of spermatogenesis
- Women of child bearing potential must be advised to use effective contraception during treatment
- Men should be advised to practise barrier contraception during treatment, and for at least 90 days thereafter
- Caution is advised for handling broken tablets. If broken tablets come into contact with skin or mucosa, wash immediately with water
- Bone marrow suppression, diarrhoea, hepatic dysfunction, nephrotoxicity
- Prevention of CMV disease in solid organ transplantation: 900 mg once daily comencing 10 days after transplantation and continuing for 100-200 days
- Transplant centres have their own prophylaxis protocols with variable durations of therapy
- Treatment of CMV: induction: 900 mg BD; maintenance 900 mg OD
- 900 mg Valganciclovir is equivalent to 5 mg/kg ganciclovir IV
- About 50% is removed by HD
CrCl (ml/min) | Induction dose of valganciclovir | Maintenance/Prevention dose of valganciclovir |
≥ 60 | 900 mg (2 tablets) twice daily | 900 mg (2 tablets) once daily |
40 – 59 | 450 mg (1 tablet) twice daily | 450 mg (1 tablet) once daily |
25 – 39 | 450 mg (1 tablet) once daily | 450 mg (1 tablet) every 2 days |
10 – 24 | 450 mg (1 tablet) every 2 days | 450 mg (1 tablet) twice weekly |
< 10 | Not recommended: 450mg 2-3x/wk has been used | Not recommended: 450mg 1-2x/wk has been used |
- Imipenum-cilastin – fits with concomitant use
- Care with other agents that can cause neutropenia
- Increased levels with mycophenolate