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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIVIRALS FOR SYSTEMIC USE › DIRECT ACTING ANTIVIRALS › Nucleosides and nucleotides excl. reverse transcriptase inhibitors
cidofovir
J05AB12
Forms & Strengths
- Intravenous injection: 75 mg/mL in 5 mL vials
Adult Dosing
- Induction: 5 mg/kg IV once weekly for 2 consecutive weeks
- Maintenance: 5 mg/kg IV once every 2 weeks
- Administer with probenecid and intravenous saline hydration to reduce nephrotoxicity
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- If used off-label, adult weight-based dosing (5 mg/kg) is typically adapted with strict renal monitoring
Indications
- Treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS)
Mechanism of Action
- Nucleotide analog of cytosine that inhibits viral DNA polymerase
- Suppresses CMV replication through intracellular metabolism to cidofovir diphosphate
- Inhibits viral DNA synthesis by both competitive inhibition and incorporation into viral DNA
Contraindications
- History of severe hypersensitivity to cidofovir
- Patients receiving other nephrotoxic agents (e.g., aminoglycosides, amphotericin B, foscarnet, pentamidine, vancomycin)
- Direct intraocular injection
- Patients unable to receive probenecid
Adverse Reactions
- Nephrotoxicity and renal impairment
- Neutropenia
- Metabolic acidosis
- Iritis, uveitis, and ocular hypotony
- Nausea, vomiting, diarrhea, and fever
Drug Interactions
- Probenecid decreases renal clearance of cidofovir
- Increased risk of nephrotoxicity with concomitant administration of other nephrotoxic drugs
- Potential risk of Fanconi syndrome with concurrent tenofovir or other proximal tubule toxins
Curated Content: Needs Vetting Before Put to Clinical Use