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CIDOFOVIR
Generic Name: CIDOFOVIR
ABSTRACT -
Cidofovir (Vistide) is an FDA-approved acyclic nucleoside phosphonate antiviral active against a broad spectrum of DNA viruses including cytomegalovirus (CMV), herpes simplex virus, adenovirus, and poxviruses. Converted intracellularly to cidofovir diphosphate, it selectively inhibits viral DNA polymerase by competing with dCTP, incorporating into nascent viral DNA and causing chain termination. It is approved for CMV retinitis in HIV-infected patients and used off-label for adenovirus infections in immunocompromised hosts.
DOSAGE -
CMV retinitis induction: 5 mg/kg IV once weekly for 2 weeks; maintenance: 5 mg/kg IV every 2 weeks. Must be co-administered with oral probenecid 2 g (3 hours before) and 1 g (2 and 8 hours after) to reduce nephrotoxicity; IV saline hydration required.
SIDE EEFECTS -
- Nephrotoxicity (proximal tubular dysfunction, Fanconi syndrome)
- Neutropenia
- Proteinuria
- Nausea and vomiting
- Ocular hypotony (intraocular pressure reduction)
ALLERGIC REACTIONS -
These symptoms may indicate an allergic reaction and require immediate medical attention.
- Probenecid-associated hypersensitivity reactions (rash, fever — from co-administered probenecid)
- Drug hypersensitivity
- Urticaria
- Anaphylaxis (rare)
DRUG INTERACTIONS-
- Nephrotoxic agents (aminoglycosides, amphotericin B, foscarnet, NSAIDs) — severe additive nephrotoxicity — avoid co-administration or stop nephrotoxic drugs ≥7 days before cidofovir
- Probenecid affects renal secretion of many drugs — review full medication list
- Zidovudine: reduce AZT dose by 50% on days of cidofovir administration (probenecid effect)
PREAUTONS–
- Serum creatinine, urine protein (dipstick) and WBC before each dose — hold if creatinine rises >0.4 mg/dL from baseline or 2+ proteinuria
- Dose reduction to 3 mg/kg if mild renal deterioration
- Contraindicated if baseline serum creatinine >1.5 mg/dL, CrCl ≤55 mL/min, or urine protein ≥100 mg/dL (2+)
- Probenecid and IV hydration are mandatory co-medications — never administer cidofovir alone
WARNINGS –
- Severe irreversible nephrotoxicity — the most serious and dose-limiting toxicity; renal failure can be fatal
- Carcinogenicity and spermatotoxicity in animal studies — effective contraception required for ≥3 months after last dose
- Ocular hypotony including permanent vision loss reported — regular IOP monitoring
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