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Cidofovir Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for CMV Retinitis

Induction dose: 5 mg/kg via IV infusion once a week for 2 consecutive weeks
Maintenance dose: Following induction dose, 5 mg/kg via IV infusion once every 2 weeks

Probenecid 2 g orally must be given 3 hours prior to the cidofovir infusion. Probenecid 1 g orally must be given at 2 and 8 hours following completion of the cidofovir infusion (for a total probenecid dose of 4 g).

Usual Adult Dose for Smallpox Vaccine Reaction

(Not approved by FDA)

5 mg/kg via IV infusion once

A second dose 1 week later may be considered if clinically indicated.

Cidofovir is available under an IND protocol from the CDC as a second-line treatment of severe smallpox vaccine complications that have not responded to vaccinia immune globulin (VIG) treatment.

Renal Dose Adjustments

Preexisting renal impairment:
Calculated CrCl 55 mL/min or less, serum creatinine greater than 1.5 mg/dL, or urine protein 100 mg/dL or greater (equivalent to 2+ proteinuria or greater): Contraindicated

Changes in renal function during therapy:
For increase in serum creatinine of 0.3 to 0.4 mg/dL above baseline: Maintenance dose must be reduced to 3 mg/kg.
For increase in serum creatinine of 0.5 mg/dL or greater above baseline or development of 3+ proteinuria or greater: Therapy must be discontinued.

Renal function should be monitored closely in patients who develop 2+ proteinuria and dosage reduction or interruption of cidofovir therapy should be considered.

Liver Dose Adjustments

No adjustment recommended.

Precautions

The recommended dosage, frequency, or infusion rate must not be exceeded. Oral doses of probenecid and prehydration with IV normal saline must accompany each cidofovir infusion to minimize possible nephrotoxicity.

Direct intraocular injection of cidofovir is contraindicated; it has been associated with iritis, ocular hypotony, and permanent vision impairment.

Cidofovir is contraindicated in patients with a serum creatinine greater than 1.5 mg/dL, a calculated CrCl 55 mL/min or less, or a urine protein 100 mg/dL or greater (equivalent to 2+ proteinuria or greater). Cidofovir is contraindicated in patients who are receiving other nephrotoxic agents. Drugs with nephrotoxic potential must be stopped at least 7 days before initiating cidofovir therapy.

Because cidofovir is associated with renal toxicity, renal function, including serum creatinine concentration and urine protein, must be assessed during the 48 hour period immediately preceding each cidofovir dose. Dose modification, including reduction, interruption, and possibly discontinuation, may be required due to the major toxicity of cidofovir (i.e., renal impairment). Close monitoring of renal function (routine urinalysis and serum creatinine) during therapy should be emphasized.

Safety and effectiveness have not been studied in patients over the age of 60 years. Since elderly individuals frequently have reduced glomerular filtration, particular attention should be paid to assessing renal function before and during cidofovir administration.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age). The use of cidofovir in children with AIDS warrants extreme caution due to the risk of long-term carcinogenicity and reproductive toxicity. Administration of cidofovir to children should be undertaken only after careful evaluation and only if the potential benefits outweigh the risks.

Dialysis

Initiation of cidofovir is contraindicated in patients with calculated CrCl 55 mL/min or less, serum creatinine greater than 1.5 mg/dL, or urine protein 100 mg/dL or greater (equivalent to 2+ proteinuria or greater).

High-flux hemodialysis reduces serum levels of cidofovir by about 75%.

Other Comments

Cidofovir should be administered as an IV infusion at a constant rate over 1 hour.

Some patients may require longer periods of induction therapy. Generally, induction therapy should continue until the retinitis appears quiescent on fundoscopic examination. Because cidofovir therapy does not eradicate CMV infection, maintenance therapy is generally continued until progression of CMV retinitis, occurrence of treatment-limiting toxicity, or death of the patient.

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