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cidofovir
generic
Black Box Warnings .
Appropriate Use
only indicated for CMV retinitis tx in AIDS pts
Renal Impairment
acute renal failure cases resulting in dialysis and/or contributing to death have occurred w/ as few as 1-2 doses; decr. nephrotoxicity risk w/ IV normal saline prehydration and probenecid w/ each cidofovir infusion; measure Cr and urine protein <48h prior to each dose, adjust dose based on renal fxn; contraindicated in combo w/ nephrotoxic agents
Neutropenia
neutropenia reported; monitor neutrophil count during tx
Carcinogen/Teratogen Risk
carcinogenic, teratogenic, and caused hypospermia in animal studies
Adult Dosing .
Dosage forms: INJ
CMV retinitis, AIDS-associated
- [induction tx]
- Dose: 5 mg/kg/dose IV qwk x2wk; Info: not 1st-line agent; hydrate and give w/ probenecid
- [maintenance tx]
- Dose: 5 mg/kg/dose IV q2wk; Info: not 1st-line agent; hydrate and give w/ probenecid; decr. dose to 3 mg/kg/dose if Cr incr. 0.3-0.4 mg/dL above baseline; D/C if Cr >0.5 mg/dL above baseline or 3+ proteinuria
mucocutaneous HSV infection, acyclovir-resistant (off-label)
- [5 mg/kg/dose IV qwk until healed]
- Alt: apply 1% gel bid-qid until healed; dose requires pharmacy compounding
mpox (off-label)
- [5 mg/kg/dose IV qwk x2wk]
- Info: not 1st-line agent; hydrate and give w/ probenecid and tecovirimat; decr. dose to 3 mg/kg/dose if Cr incr. 0.3-0.4 mg/dL above baseline; may extend duration based on clinical response; D/C if Cr >0.5 mg/dL above baseline or 3+ proteinuria
renal dosing
- [see below]
- CrCl <55, Cr >1.5, or proteinuria >100 mg/dL: contraindicated
- HD/PD: avoid use
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
CMV retinitis, AIDS-associated (off-label)
- [induction tx, 13 yo and older]
- Dose: 5 mg/kg/dose IV qwk x2wk; Info: not 1st-line agent; hydrate and give w/ probenecid
- [maintenance tx, 13 yo and older]
- Dose: 5 mg/kg/dose IV q2wk; Info: not 1st-line agent; hydrate and give w/ probenecid; decr. dose to 3 mg/kg/dose if Cr incr. 0.3-0.4 mg/dL above baseline; D/C if Cr >0.5 mg/dL above baseline or 3+ proteinuria
mucocutaneous HSV infection, acyclovir-resistant (off-label)
- [adolescents]
- Dose: 5 mg/kg/dose IV qwk until healed; Alt: apply 1% gel bid-qid until healed; dose requires pharmacy compounding
mpox (off-label)
- [5 mg/kg/dose IV qwk x2wk]
- Info: not 1st-line agent; hydrate and give w/ probenecid and tecovirimat; decr. dose to 3 mg/kg/dose if Cr incr. 0.3-0.4 mg/dL above baseline; may extend duration based on clinical response; D/C if Cr >0.5 mg/dL above baseline or 3+ proteinuria
renal dosing
- [see below]
- CrCl <55, Cr >1.5, or proteinuria >100 mg/dL: contraindicated
- HD/PD: avoid use
hepatic dosing
- [not defined]