Drug reference

Cidofovir

Antiviral

AntiviralATC J05AB12

CDSCO approvedSchedule HATC J05AB12

EXCRETION

—

not curated

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Manufacturer advises effective contraception during and after treatment in women. Men should use barrier contraception during and for 3 months after treatment. May cause impaired fertility in males.

FDA category + note

Top interactionssee all 12 →

AminoglycosidesContraindicatedTextbookG&G 14e
AcyclovirSevereDatabaseDDInter
AldesleukinSevereDatabaseDDInter
AmikacinSevereDatabaseDDInter

Mechanism

Cidofovir is a selective inhibitor of human cytomegalovirus (HCMV) DNA polymerase. This inhibition blocks viral DNA synthesis, thereby suppressing HCMV replication.

Indications

Cytomegalovirus retinitis in patients with AIDS (in combination with probenecid) (specialist use only, only when other medicinal products are considered unsuitable)CMV retinitis in HIV-infected patientsacyclovir-resistant mucocutaneous HSV infectionadenovirus disease in transplant recipientsextensive molluscum contagiosum in HIV patientsBK virus nephropathy (reduced doses)anogenital warts (topical)cervical intraepithelial neoplasia (topical)respiratory papillomatosis (intralesional)cytomegalovirus retinitisCMV retinitis in AIDS patients (particularly those who have failed ganciclovir therapy)acyclovir-resistant mucocutaneous herpes simplex in immunosuppressed patientsCMV retinitisCMV CNS infections (alternative in patients failing ganciclovir and foscarnet, although data are limited)severe poxviral infections (can be given along with tecovirimat)orthopoxvirus infections (topical, with mixed results)MCV infections (topical, with mixed results)

Dosing

Adult: BY INTRAVENOUS INFUSION: Initially 5 mg/kg once weekly for 2 weeks, then maintenance 5 mg/kg every 2 weeks, maintenance treatment to be started 2 weeks after completion of induction treatment
Renal adjustment: Manufacturer advises intravenous sodium chloride 0.9% prehydration and concomitant oral probenecid for prevention of nephrotoxicity. Consider treatment interruption or discontinuation if changes in renal function occur.

Pharmacokinetics

Half-life

2.6 h (plasma terminal); ~87 h (intracellular phosphocholine metabolite)

Bioavailability

Very low (oral)

Protein binding

<6%

Excretion

Primarily via renal tubular secretion; it is a substrate of organic anion transporter 1 (OAT1).

Contraindications

Concomitant administration with potentially nephrotoxic drugs (discontinue potentially nephrotoxic drugs at least 7 days before starting cidofovir)
Patients unable to receive probenecid
concurrent nephrotoxic agents
prior exposure to aminoglycosides within 7 days
prior exposure to intravenous pentamidine within 7 days
prior exposure to amphotericin B within 7 days
prior exposure to foscarnet within 7 days
prior exposure to NSAIDs within 7 days
prior exposure to contrast dye within 7 days
combination at full doses with oral ganciclovir

Side effects

Common

Alopeciaastheniachillsdiarrhoeadyspnoeaeye inflammationfeverheadachenauseaproteinuriarashvomitingproteinuria (up to 50%)elevated serum creatinine (10% to 15%)neutropenia (15% to 20%)anterior uveitislow intraocular pressureburning (topical application site reactions)pain (topical application site reactions)pruritus (topical application site reactions)decreased intraocular pressureuveitisblindnesscataractconjunctivitiscorneal lesiondiplopiagastric disturbancesconstitutional symptomshypersensitivity reactionsmucocutaneous ulcerations (topical)

Serious

Neutropenia
ocular hypotony
renal failure
Fanconi syndrome acquired
hearing impairment
nephrotoxicity
pancreatitis
nephrotoxicity (principal dose-limiting side effect)
ulceration (topical)
infertility (may cause)
potential human carcinogen
dose related kidney damage (primary toxicity)
nephrotoxicity (dose-dependent proximal tubular cell injury)

Pregnancy & lactation

Pregnancy

Manufacturer advises effective contraception during and after treatment in women. Men should use barrier contraception during and for 3 months after treatment. May cause impaired fertility in males.

Drug interactions

Aminoglycosides

Contraindicated

Textbook

Increased risk of nephrotoxicity.

Concurrent nephrotoxic agents are contraindicated, and at least 7 days should elapse before initiation of cidofovir treatment after prior exposure to aminoglycosides, intravenous pentamidine, amphotericin B, foscarnet, NSAID, or contrast dye.

Source: G&G 14e

Acyclovir

Severe

Database

Drug interaction classified as: synergy.

Source: DDInter

Aldesleukin

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Amikacin