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Indications and Dosage
Intravenous
Cytomegaloviral retinitis in AIDS patients Adult: In combination with probenecid and NaCl 0.9% solution: Induction therapy: 5 mg/kg once weekly for 2 consecutive weeks. Maintenance therapy: 5 mg/kg once every 2 weeks. Doses are given via IV infusion at a constant rate over 1 hour.
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Renal Impairment
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Reconstitution
Dilute with 100 mL of NaCl 0.9%.
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Contraindications
Hypersensitivity to cidofovir. Patients unable to take probenecid or history of hypersensitivity to other sulfa-containing drugs. Renal impairment (serum creatinine >1.5 mg/dL, CrCl ≤55 mL/min or ≥2+ proteinuria [≥100 mg/dL]). Direct intraocular injection. Concomitant use of or within 7 days of nephrotoxic agents. Lactation.
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Special Precautions
Patient with diabetes mellitus. Hepatic impairment. Pregnancy.
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Adverse Reactions
Significant: Neutropenia, hypospermia, decreased Na bicarbonate level with proximal tubule injury and renal wasting syndrome (including Fanconi syndrome); ocular complications (e.g. decreased IOP sometimes associated with uveitis, iritis, decreased visual acuity; ocular hypotony).
Gastrointestinal disorders: Nausea, vomiting, diarrhoea, pancreatitis. General disorders and administration site conditions: Asthenia, fever, chills. Nervous system disorders: Headache. Renal and urinary disorders: Proteinuria, increased blood creatinine. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Rash, alopecia. Potentially Fatal: Acute renal failure resulting in dialysis, metabolic acidosis with hepatic impairment and pancreatitis. |
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IV/Parenteral/Topical: C
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Patient Counseling Information
Women of childbearing potential should use effective contraceptive measures during and for 6 months after treatment. Men should use barrier contraceptive methods during and for 3 months after treatment.
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Monitoring Parameters
Monitor serum creatinine and urine protein levels (baseline and within 48 hours of each dose); WBC with differential (prior to each dose). Assess IOP, visual acuity; signs and symptoms of uveitis, iritis, and metabolic acidosis.
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Drug Interactions
Increased risk of nephrotoxicity with other nephrotoxic agents (e.g. IV aminoglycosides, IV pentamidine, amphotericin B, foscarnet, and NSAIDs). Increased risk of Fanconi syndrome with tenofovir.
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Action
Description:
Mechanism of Action: Cidofovir is a cytidine analogue that possesses in vitro and in vivo activity against human cytomegalovirus (HCMV). It is converted to its active metabolite, cidofovir diphosphate which selectively inhibits viral DNA synthesis thus supressing cytomegalovirus (CMV) replication. Additionally, cidofovir diphosphate incorporation into growing viral DNA chains causes a reduction of viral DNA synthesis rate. Pharmacokinetics: Distribution: Volume of distribution: 0.537 L/kg. Plasma protein binding: <6%. Metabolism: Metabolised via phosphorylation intracellularly into the active metabolite cidofovir diphosphate. Excretion: Via urine (approx 80-100% as unchanged drug). Elimination half-life: 2.4-3.2 hours (mean range); intracellular elimination half-life: 24-87 hours. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 60613, Cidofovir. https://pubchem.ncbi.nlm.nih.gov/compound/Cidofovir. Accessed Oct. 25, 2023. |
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Storage
Intact vials: Store below 25°C. Do not refrigerate or freeze. Diluted solutions: Store between 2-8°C for up to 24 hours. Do not freeze. Follow applicable procedures for receiving, handling, administration, and disposal.
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MIMS Class
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ATC Classification
J05AB12 - cidofovir ; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. Used in the systemic treatment of viral infections.
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References
Anon. Cidofovir. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/04/2023. Buckingham R (ed). Cidofovir. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/04/2023. Cidofovir Dihydrate Injection, Solution (Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 04/04/2023. Cidofovir Tillomed 75 mg/mL Concentrate for Solution for Infusion (Tillomed Laboratories Ltd). MHRA. https://products.mhra.gov.uk. Accessed 04/04/2023. Joint Formulary Committee. Cidofovir. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/04/2023.
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