| Indication |
- 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
|
| Preparations |
- Valganciclovir is a prodrug of ganciclovir
- 450 mg tablets, 50 mg/ml oral solution
|
| Contraindications |
- Hypersensitivity to valganciclovir, ganciclovir or to any of the excipients
- Also contraindicated during lactation
|
| Cautions |
- 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
|
| Side-effects |
- Bone marrow suppression, diarrhoea, hepatic dysfunction, nephrotoxicity
|
| Dose |
- 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
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| Dose in renal impairment |
| 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 |
|
| Interactions |
- Imipenum-cilastin – fits with concomitant use
- Care with other agents that can cause neutropenia
- Increased levels with mycophenolate
|
| How to Prescribe |
View Details |
| Patient comment |
- Take with food
- Do not crush or chew tablets
- Caution is advised for handling broken tablets. If broken tablets come into contact with skin or mucosa, wash immediately with water
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