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Cytovene

Generic Name: Ganciclovir Sodium
Class: Nucleosides and Nucleotides
VA Class: AM800
Chemical Name: 2-Amino-1,9-dihydro-9-[2-hydroxy-1-(hydroxymethyl)ethoxy]methyl]-6H-purin-6-one sodium salt
CAS Number: 84245-13-6

Warning(s)

  • Clinical toxicity of oral and IV ganciclovir includes granulocytopenia, anemia, and thrombocytopenia.1

  • In animal studies, ganciclovir was carcinogenic, teratogenic, and caused aspermatogenesis.1

  • The only FDA-approved indications for IV ganciclovir are treatment of CMV retinitis in immunocompromised patients and prevention of CMV disease in transplant recipients at risk.1

  • The only FDA-approved indications for oral ganciclovir are prevention of CMV disease in patients with advanced HIV infection, maintenance treatment of CMV retinitis in immunocompromised patients, and prevention of CMV disease in solid organ transplant recipients.1

  • Because oral ganciclovir is associated with a risk of more rapid progression of CMV retinitis, it should be used as maintenance treatment only in those for whom this risk is balanced by the benefits associated with avoiding daily IV infusions.1

Introduction

Antiviral; purine nucleoside analog of guanine.1 2 3 8 9 10 11 12

Uses for Cytovene

Cytomegalovirus (CMV) Infections

Treatment of CMV retinitis in immunocompromised patients, including HIV-infected patients.1 5 11 21 28 100 103 104 105 117 118 126 127 139 164 174 175 187 207 225 243 268 ganciclovir is not curative; stabilization or improvement of ocular manifestations may occur, but progression of retinitis is possible during or following treatment.1 4 5 8 9 11 13 21 27 28 63 65 77 94 100 120 126 128 139 167 168

Drugs of choice for initial induction and maintenance therapy of CMV retinitis are IV ganciclovir, IV foscarnet, IV cidofovir, oral valganciclovir, or intravitreal fomivirsen.268 319 322 331 A regimen of both ganciclovir and foscarnet is used for treatment of CMV retinitis in patients who have relapsed following monotherapy with either drug.268 319 322 331

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Primary prevention (primary prophylaxis) of CMV disease in HIV-infected patients at risk for the disease, including adults, adolescents, and children who are positive for CMV antibody and have CD4+ T-cell counts <50/mm3.317 320 321 322 USPHS/IDSA recommends oral ganciclovir as the drug of choice for primary CMV prophylaxis in these patients.317

Long-term suppressive or maintenance therapy (secondary prophylaxis) of recurrent CMV disease in HIV-infected adults, adolescents, or children.317 USPHS/IDSA recommends IV ganciclovir or IV foscarnet as drugs of choice for such prophylaxis.317

Prevention of CMV disease in solid organ transplant recipients and bone marrow transplant (BMT) recipients at risk for the disease.1 268 271 283 284 286 287 304 305 307 313 324

Has been used in immunocompromised patients for parenteral treatment of extraocular CMV infections, including GI infections,3 4 5 6 8 11 16 20 21 26 68 69 70 76 77 92 102 108 110 122 134 146 166 193 194 207 pneumonitis,3 4 5 8 10 11 15 16 17 18 19 20 21 33 43 64 72 73 74 106 107 108 109 110 111 121 122 137 140 145 146 147 149 151 154 159 180 188 193 198 199 200 201 202 207 219 220 225 nervous system,4 5 8 11 21 110 165 207 231 hepatobiliary,4 5 8 20 21 68 106 108 146 166 219 or cardiac110 171 220 CMV infections.3 5 8 15 19 108 140 Safety and efficacy have not been established for extraocular CMV infections;1 2 use in these infections should be limited to severe and/or potentially life-threatening infections when potential benefits outweigh risks.3 6 15 16 72 106 107 110 134 146 219 262

Safety and efficacy not established for treatment of congenital or neonatal CMV disease or for treatment of CMV infections in immunocompetent patients.1

Cytovene Dosage and Administration

General

  • Frequent monitoring of neutrophil and platelet counts is necessary during ganciclovir induction and maintenance therapy.1 2 20 191

  • Dosage adjustment and/or interruption of ganciclovir therapy may be necessary if hematologic abnormalities occur.1 2

  • Ganciclovir should be withheld if the ANC declines to <500/mm3 or the platelet count declines to <25,000/mm3 and should not be resumed until there is evidence of bone marrow recovery.1 2

Administration

Administer orally or by slow IV infusion.1 2

Do not administer by rapid IV infusion or direct IV injection since potentially toxic plasma ganciclovir concentrations may result.1 2 In addition, do not administer by IM or sub-Q injection.1 2

Can be administered via a commercially available intravitreal implant for treatment of CMV retinitis.323 340 Although ganciclovir has been administered by intravitreal injection for the treatment of ocular infections,4 5 8 67 84 117 129 135 170 209 safety and efficacy of intravitreal injection of solutions made from the powder for IV infusion have not been established.4 5 8 67 170

Oral Administration

Administer orally with food.1

Oral ganciclovir should be used only for prevention of CMV disease in HIV-infected patients or transplant recipients at risk for the disease or for maintenance treatment of CMV retinitis in patients in whom the disease is stable following initial IV induction therapy.1

IV Infusion

For solution and drug compatibility information see Compatibility under Stability.

Handle the powder and reconstituted and diluted solutions cautiously because of the high pH of the solutions and because of the mutagenic and/or carcinogenic potential of the drug.1 2 Use protective equipment (e.g., latex gloves, protective eyewear).1 2

Since ganciclovir shares some of the properties of cytotoxic drugs, consider consulting specialized references for procedures for proper handling and disposal of antineoplastics, although there is no general agreement that all of the procedures recommended in such guidelines are necessary or appropriate.1 2

Because of the high pH of ganciclovir solutions, a vein with adequate blood flow should be used to allow for rapid dilution and distribution of the drug, which may minimize risk of phlebitis.1 2

Reconstitution and Dilution

For intermittent IV infusion, reconstitute 500-mg vial by adding 10 mL of sterile water for injection to provide a solution containing 50 mg/mL.1 2 Bacteriostatic water for injection containing parabens should not be used.1 2 Shake vial well to ensure complete dissolution of the drug.1 2

The appropriate dose of reconstituted solution should then be withdrawn from the vial and diluted in 50–250 (usually 100) mL of a compatible IV infusion solution.1 2 8 For use in fluid-restricted patients, the appropriate dose of reconstituted solution may be diluted to a concentration ≤10 mg/mL; use of more concentrated solutions is not recommended.1 2 8 191

Rate of Administration

Administer by slow IV infusion over 1 hour, either via a large peripheral or central vein,4 190 at a constant rate of administration.1 2

For highly concentrated solutions (e.g., 5–10 mg/mL), a controlled-infusion device (e.g., pump) is recommended.8 262

Dosage

Available as ganciclovir and ganciclovir sodium; dosage expressed in terms of ganciclovir.1 2

Because the risk of toxicity may be increased with higher doses and/or more rapid infusion,1 2 recommended doses, frequencies of administration, and rate of IV infusion should not be exceeded.1 2

Pediatric Patients

Cytomegalovirus (CMV) Infections
Treatment of CMV Retinitis
Oral

Maintenance therapy in children >3 months of age: after an initial IV induction regimen, 1 g 3 times daily.1 191 Alternatively, 500 mg 6 times daily (every 3 hours while awake).1 191

IV

Initial induction therapy in children >3 months of age: 5 mg/kg every 12 hours for 14–21 days.1 191

Maintenance treatment in children >3 months of age: 5 mg/kg once daily.1 2 5 20 191 216 268 Alternatively, 6 mg/kg once daily 5 days weekly.1 2 71 106 191 262 268

Primary Prevention (Primary Prophylaxis) of CMV in HIV-infected Children and Adolescents
Oral

Infants and children: 30 mg/kg 3 times daily.317

Adolescents: 1 g 3 times daily.317

Prevention of Recurrence (Secondary Prophylaxis) of CMV in HIV-infected Children and Adolescents
Oral

1 g 3 times daily.317 Initiate secondary prophylaxis after initial induction treatment.317

IV

Infants and children: 5 mg/kg daily.317

Adolescents: 5–6 mg/kg once daily 5–7 days each week.317

Consideration can be given to discontinuing secondary CMV prophylaxis in adolescents with sustained (e.g., for ≥6 months) increase in CD4+ T-cell counts to >100–150/mm3 in response to potent antiretroviral therapy.317 This decision should be made in consultation with an ophthalmologist and factors such as the magnitude and duration of CD4+ T-cell increase, anatomic location of the retinal lesion, vision in the contralateral eye, and feasibility of regular ophthalmic monitoring should be considered.317 Relapse of CMV retinitis could occur following discontinuance of secondary prophylaxis, especially in those whose CD4+ T-cell count decreases to <50/mm3; relapse has been reported rarely in those with CD4+ T-cell counts >100/mm3.317

Reinitiate secondary CMV prophylaxis if CD4+ T-cell count decreases to <100–150/mm3.317

Adults

Cytomegalovirus (CMV) Infections
Treatment of CMV Retinitis
Oral

Maintenance therapy after an initial IV induction regimen: 1 g 3 times daily.1 Alternatively, 500 mg 6 times daily (every 3 hours while awake).1

IV

Initial induction therapy: 5 mg/kg every 12 hours for 14–21 days.1 191

Maintenance therapy: 5 mg/kg once daily.1 2 5 20 191 216 268 Alternatively, 6 mg/kg once daily 5 days weekly.1 2 71 106 191 262 268

Primary Prevention (Primary Prophylaxis) of CMV in HIV-infected Adults
Oral

1 g 3 times daily.1 317

Prevention of Recurrence (Secondary Prophylaxis) of CMV in HIV-infected Adults
Oral

1 g 3 times daily.317 Initiate secondary prophylaxis after initial induction treatment.317

IV

5–6 mg/kg once daily 5–7 days each week.317

Consideration can be given to discontinuing secondary CMV prophylaxis in adults with sustained (e.g., for ≥6 months) increase in CD4+ T-cell counts to >100–150/mm3 in response to potent antiretroviral therapy.317 This decision should be made in consultation with an ophthalmologist and factors such as the magnitude and duration of CD4+ T-cell increase, anatomic location of the retinal lesion, vision in the contralateral eye, and feasibility of regular ophthalmic monitoring should be considered.317 Relapse of CMV retinitis could occur following discontinuance of secondary prophylaxis, especially in those whose CD4+ T-cell count decreases to <50/mm3; relapse has been reported rarely in those with CD4+ T-cell counts >100/mm3.317

Reinitiate secondary CMV prophylaxis if CD4+ T-cell count decreases to <100–150/mm3.317

Prevention of CMV Disease in Transplant Recipients
Oral

1 g 3 times daily.1

IV

Initially, 5 mg/kg every 12 hours for 7–14 days, then 5 mg/kg once daily 7 days per week or 6 mg/kg once daily 5 days per week.1

Duration of ganciclovir maintenance in organ transplant recipients depends on several factors including the duration and degree of immunosuppression.1 283 302 303 Bone marrow allograft recipients have received IV ganciclovir for up to 100–120 days following transplantation.1 271 284 In cardiac allograft recipients, ganciclovir should be continued for >28 days in patients to prevent late development of CMV disease.1 283 Liver transplant recipients have received oral ganciclovir for up to 98 days following transplantation.1 325

Special Populations

Renal Impairment

In patients with impaired renal function, doses and/or frequency of administration of oral or IV ganciclovir must be modified in response to the degree of impairment.1 2 5 6 9 11 28 33 191 346 Dosage should be based on the patient’s measured or estimated Clcr.1 2

IV Dosage for Adults with Renal Impairment1

Clcr (mL/min)

Induction Dosage

Maintenance Dosage

50–69

2.5 mg/kg every 12 h

2.5 mg/kg every 24 h

25–49

2.5 mg/kg every 24 h

1.25 mg/kg every 24 h

10–24

1.25 mg/kg every 24 h

0.625 mg/kg every 24

<10

1.25 mg/kg 3 times weekly, following hemodialysis

0.625 mg/kg 3 times weekly, following hemodialysis

Oral Dosage for Adults with Renal Impairment1

Clcr (mL/min)

Dosage

50–69

1.5 g once daily or 500 mg 3 times daily

25–49

1 g once daily or 500 mg 2 times daily

10–24

500 mg once daily

<10

500 mg 3 times weekly, following hemodialysis

Geriatric Patients

Select dosage with caution because of age-related decreases in renal function.1 2 (See Renal Impairment under Dosage and Administration.)

Cautions for Cytovene

Contraindications

  • Known hypersensitivity to ganciclovir or acyclovir.1 2

Warnings/Precautions

Warnings

Hematologic Effects

Hematologic toxicity, principally neutropenia (ANC <1000/mm3) and/or thrombocytopenia (platelet count <50,000/mm3) frequently occurs.1 2 3 4 8 11 21 33 75 109 110 122 133 149 172 215 248 264 265 Anemia also reported.1

Neutropenia usually develops early in treatment (e.g., during the first or second week of induction therapy),1 2 3 5 20 23 74 122 but can occur at any time.1 2 5 20 23 74

In most cases, interruption of ganciclovir therapy1 2 3 4 8 23 74 92 122 149 190 248 or a decrease in dosage2 4 6 8 140 149 190 248 will result in increased neutrophil counts, usually evident within 3–7 days; however, prolonged or irreversible neutropenia has occurred.1 2 3 4 74 92 122 174 Bacterial or fungal sepsis and subsequent death have been reported occasionally in patients with ganciclovir-induced neutropenia.1 2 3 4 74 122 174 In addition, neutropenia has recurred following reinitiation of ganciclovir therapy,1 2 3 33 occasionally even at reduced dosage.3

CBCs should be monitored frequently.1 2 20 191 279 Neutrophil and platelet counts should be performed several times weekly (every other day or 2 or 3 times weekly) during IV induction therapy and at least weekly thereafter during maintenance therapy.1 2 279 More frequent monitoring is recommended for patients who have previously experienced leukopenia with ganciclovir or another nucleoside analog or in whom neutrophil counts are <1000/mm3 prior to initiating therapy with the drug.1 2 Manufacturer suggests that daily monitoring of neutrophil counts be considered in such patients;2 others suggest that less frequent monitoring (e.g., twice weekly) may be sufficient during maintenance therapy.262 Manufacturer also recommended that neutrophil and platelet counts be monitored daily in patients undergoing hemodialysis.1 2

If neutropenia and/or thrombocytopenia occur, dosage adjustment and/or interruption of ganciclovir therapy may be necessary.1 2 3 4 5 6 8 100 102 104 105 106 122 140 149 164 189 190 191 248

Do not use if ANC is <500/mm3 or if platelet count is <25,000/mm3.1

Use with caution in patients with preexisting cytopenias or a history of cytopenic reactions to other drugs, chemicals, or radiation therapy.1 2

Mutagenic, Carcinogenic, and Teratogenic Potential

Ganciclovir has mutagenic and teratogenic potential that should be considered when weighing the benefits and risks of therapy.1

Women of childbearing potential should use effective contraception during treatment.1 In addition, men should practice barrier contraception during and for ≥90 days after treatment.1

Potential carcinogen in humans.1

Effects on Fertility

Animal studies indicate ganciclovir causes inhibition of spermatogenesis and subsequent infertility; effects were reversible at lower doses and irreversible at higher doses.1 Suppression of fertility in female animals also noted.1

Human data not available; possibility that ganciclovir at recommended doses may cause temporary or permanent inhibition of spermatogenesis.1

General Precautions

Local Reactions

Initially reconstituted ganciclovir solutions have a high pH (pH 11).1 Despite further dilution in IV fluids, phlebitis and/or pain may occur at site of IV infusion.1

To avoid local irritation, care must be taken to infuse only into veins with adequate blood flow to permit rapid dilution and distribution of the drug.1

Sodium Content

Ganciclovir sodium contains approximately 4 mEq of sodium per gram of ganciclovir.1 2 191

Specific Populations

Pregnancy

Category C.1 (See Mutagenic, Carcinogenic, and Teratogenic Potential under Cautions.)

Lactation

Distributed into milk in animals;1 3 not known whether distributed into milk in humans.1 Discontinue nursing or the drug.1

Pediatric Use

Safety and efficacy of oral or IV ganciclovir not established in children.1

Only limited experience with IV ganciclovir in children younger than 12 years of age.1 2 157 217 Safety and efficacy in treatment of congenital or neonatal CMV infections, including retinitis, not established.1 2

Because of the drug’s potential for long-term carcinogenic and adverse reproductive effects, manufacturer warns that oral or IV ganciclovir should be used in children with extreme caution and only when potential benefits outweigh possible risks.1 2

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.1

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.1

Renal Impairment

Use with caution in patients with impaired renal function.1

Dosage adjustments necessary based on degree of renal impairment.1

Common Adverse Effects

Hematologic effects (neutropenia, thrombocytopenia, anemia);1 2 5 75 131 172 174 nervous system effects (headache, confusion);1 2 3 8 injection site reactions (inflammation, phlebitis, pain.1 2 21 122 133 215

Interactions for Cytovene

Nephrotoxic Drugs

Possible increased risk of adverse effects; use concomitantly with caution and closely monitor renal function.1

Specific Drugs

Drug

Interaction

Comments

Amphotericin B

Possible additive toxicity, including nephrotoxicity1

Use concomitantly only if potential benefits outweigh risks.1

Consider risk of nephrotoxicity in renal transplant patients.1

Antineoplastic agents (adriamycin, vinblastine, vincristine)

Possible additive toxicity1

Use concomitantly only if potential benefits outweigh risks1

Co-trimoxazole

Possible additive toxicity1

Use concomitantly only if potential benefits outweigh risks1

Dapsone

Possible additive toxicity1

Use concomitantly only if potential benefits outweigh risks1

Didanosine

Increased AUC of didanosine; no effect on ganciclovir pharmacokinetics1 347 b

Appropriate dosages for concomitant use with respect to safety and efficacy not established.b

If used concomitantly, monitor closely for didanosine toxicity.347

Flucytosine

Possible additive toxicity1

Use concomitantly only if potential benefits outweigh risks1

Foscarnet

In vitro evidence of additive or synergistic antiviral activity against CMV and HSV-2274 275 276 277 278

Imipenem

Seizures reported with concomitant use1 2 3 258

Use concomitantly only when potential benefits outweigh possible risks1 2 258

Immunosuppressive agents (azathioprine, corticosteroids, cyclosporine)

Possible increased risk of bone marrow suppression or increased risk of nephrotoxicity. No effect on cyclosporine clearance.15 19 140 188 193 202 219 262

Consider need for decreased dosage or temporary withdrawal of the immunosuppressive agent15 19 140 188 193 202 219 262

Interferons

In vitro evidence of synergistic antiviral effects against CMV, HSV-1 or -2, and varicella-zoster virus with interferons alfa and beta and, to a lesser extent, interferon gamma180 181 182 183 184 221

Pentamidine

Possible additive toxicity1

Use concomitantly only if potential benefits outweigh risks1

Probenecid

Possible increase in AUC and decrease in renal clearance of ganciclovir 1

Zidovudine

Possible pharmacokinetic interaction.1

Increased risk of hematologic toxicity.1 2 83 84 295

Concomitant use not recommended1 18 83 84 87 96 126 129 133 135 170 187 191 293 295

Cytovene Pharmacokinetics

Absorption

Bioavailability

Poorly absorbed from GI tract;3 4 8 26 58 235 peak plasma concentrations attained within 1 hour after a dose.58

Absolute bioavailability of oral ganciclovir is only 5 or 6–9% under fasting or nonfasting conditions, respectively.1

Distribution

Extent

Distribution into human body tissues and fluids has not been fully elucidated.5 9 64 262 Autopsy findings in patients who received IV ganciclovir suggest that the drug concentrates in the kidney, with substantially lower concentrations occurring in lung, liver, brain, and testes.5 9 64

Appears to have good ocular distribution following IV administration;2 5 93 104 117 distributed into aqueous and vitreous humor.3 104

Distributed into CSF following IV administration.1 2 3 4 5 9 28 59 64 68

Crosses the placenta in animals.3 Distributed into milk in animals;1 3 not known whether distributed into milk in humans.1

Plasma Protein Binding

1–2%.1

Elimination

Metabolism

With the exception of intracellular phosphorylation of the drug, ganciclovir does not appear to be metabolized appreciably in humans.1 2 4 5 11 28 59 61 64 124

Elimination Route

Following oral administration, 86% of the dose is recovered in feces and 5% is recovered in urine.1

Following IV administration, approximately 90–99% of the dose is excreted unchanged in urine.1 2 3 4 5 11 28 59 61 64 124 Renal excretion appears to occur principally via glomerular filtration,1 2 3 5 11 59 124 although limited renal tubular secretion also may occur.1 2 5 59

Removed by hemodialysis.1 2 3 5 60 108 124 151

Half-life

In adults with normal renal function: half-life in the initial distribution phase averages 0.23–0.76 hours and half-life in the terminal elimination phase averages 2.53–3.6 hours.1 2 3 4 5 8 9 11 59 61 64 124 132 205 Half-life following oral administration is 4.8 hours.1

Special Populations

Plasma concentrations may be higher and elimination half-life prolonged in patients with impaired renal function.1 2 3 5 9 11 20 59 60 61 64 124 In adults with moderate to severe renal impairment (Clcr <50 mL/minute per 1.73 m2), terminal half-life ranges from 4.4–30 hours, depending on degree of impairment.1 2 3 11 60 61 64 124

Stability

Storage

Oral

Capsules

5–25°C.1

Parenteral

Powder for IV Infusion

Room temperature <40°C.1

Following reconstitution with sterile water for injection, solutions containing 50 mg /mL are stable for 12 hours at 15–30°C and should not be refrigerated1 2 since a precipitate may form.263

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Ringer's injection

Ringer's injection, lactated

Sodium chloride 0.9%

Drug Compatibility
Y-Site CompatibilityHID

Compatible

Allopurinol sodium

Amphotericin B cholesteryl sulfate complex

Anidulafungin

Caspofungin acetate

Docetaxel

Doxorubicin HCl liposome injection

Enalaprilat

Etoposide phosphate

Filgrastim

Fluconazole

Granisetron HCl

Linezolid

Melphalan HCl

Paclitaxel

Pemetrexed disodium

Propofol

Remifentanil HCl

Teniposide

Thiotepa

Incompatible

Aldesleukin

Amifostine

Aztreonam

Fludarabine phosphate

Foscarnet sodium

Gemcitabine HCl

Ondansetron HCl

Piperacillin sodium–tazobactam sodium

Sargramostim

Tacrolimus

Vinorelbine tartrate

Variable

Cisatracurium besylate

Actions and Spectrum

  • Purine nucleoside analog structurally and pharmacologically related to acyclovir.1 2 3 5 23 52 54 112

  • Inactive until converted intracellularly to ganciclovir triphosphate.1 2 3 36 98 112 113

  • Ganciclovir triphosphate inhibits viral DNA synthesis and viral replication by incorporating into viral DNA chains1 2 8 9 57 58 99 113 133 206 209 and competitively inhibiting viral DNA polymerase.2 195

  • Active in vitro and in vivo against various Herpesviridae,1 2 3 21 152 209 221 232 including human cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1 and HSV-2),1 2 3 11 12 37 46 78 79 80 81 89 97 161 163 209 222 human herpesvirus type 6232 (the presumed causative agent of roseola),233 Epstein-Barr virus (EBV),1 2 3 11 12 37 89 97 161 169 209 222 and varicella-zoster virus (VZV).1 2 3 11 12 37 89 97 161 209 221

  • More active than acyclovir against CMV,4 8 16 22 57 112 210 but has activity similar to that of acyclovir against susceptible HSV.4 8 9 40 42 54 55 89 97 186

  • Some CMV with in vitro resistance to ganciclovir may be susceptible to foscarnet,290 291 but some strains may be resistant to both drugs.292

Advice to Patients

  • Advise patients being treated for CMV retinitis that ganciclovir is not a cure; they may continue to experience progression and/or recurrence, especially during periods of continued immunosuppression.1 2 Regular ophthalmologic examinations (minimum every 4–6 weeks) are necessary; some patients may require more frequent follow-up.1

  • Advise transplant recipients regarding the high frequency of impaired renal function reported in transplant recipients who receive ganciclovir, especially those receiving concomitant therapy with a nephrotoxic drug (e.g., cyclosporine, amphotericin B).1 2

  • All patients should be informed that the major toxicities of ganciclovir are granulocytopenia (neutropenia), thrombocytopenia, and anemia and of the need for frequent blood tests to closely monitor blood cell counts.1 2

  • Advise patients that ganciclovir causes tumors in animal and that the drug is considered a potential carcinogen in humans.1 2

  • Advise male patients that ganciclovir has caused decreased sperm production in animals and may cause infertility in humans.1 2 191 In addition, because of the mutagenic potential of ganciclovir, advise male patients to employ barrier contraceptive methods during and for ≥90 days after therapy with the drug.1 191 262

  • Advise female patients that ganciclovir causes birth defects in animals and should not be used during pregnancy.1 Because of the mutagenic potential of ganciclovir, advise female patients of childbearing potential to use effective contraception during treatment with the drug.1 2 191

  • Importance of taking capsules with food to maximize bioavailability.1

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Ganciclovir

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

250 mg*

Cytovene

Roche

Ganciclovir Capsules

500 mg*

Cytovene

Roche

Ganciclovir Capsules

Ganciclovir Sodium

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection, for iv infusion only

500 mg (of ganciclovir)

Cytovene-iv

Roche

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions July 9, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Roche. Cytovene-IV (ganciclovir sodium for injection) and Cytovene (ganciclovir capsules) prescribing information. Nutley, NJ; 2000 Sep.

2. Syntex Laboratories, Inc. Cytovene (ganciclovir sodium) product monograph. Palo Alto, CA; 1989 Jul.

3. Syntex Research. Investigator’s monograph: ganciclovir. 5th ed. Palo Alto, CA: 1987 Dec. (Syntex Document No. RS-21592)

4. Jacobson MA, Mills J. Serious cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1988; 108:585-94. [IDIS 240480] [PubMed 2831765]

5. Fletcher CV, Balfour HH Jr. Evaluation of ganciclovir for cytomegalovirus disease. DICP. 1989; 23:5-12. [IDIS 250386] [PubMed 2541566]

6. Chachoua A, Dieterich D, Krasinski K et al. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine (ganciclovir) in the treatment of cytomegalovirus gastrointestinal disease with the acquired immunodeficiency syndrome. Ann Intern Med. 1987; 107:133-7. [IDIS 233219] [PubMed 3037960]

7. Visor GC, Lin LH, Jackson SE et al. Stability of ganciclovir sodium (DHPG sodium) in 5% dextrose or 0.9% sodium chloride injections. Am J Hosp Pharm. 1986; 43:2810-2. [IDIS 222790] [PubMed 3492139]

8. Drew WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis. 1988; 158:449-56. [PubMed 2841381]

9. Weintraub M, Standish R. Ganciclovir: an antiviral agent for AIDS and other immunocompromised patients. Hosp Formul. 1987; 22:1011-6.

10. Weller IVD. ABC of AIDS: treatment of infections and antiviral agents. BMJ. 1987; 295:200-3. [IDIS 232733] [PubMed 3115376]

11. Laskin OL, Cederberg DM, Mills J et al. Ganciclovir for the treatment and suppression of serious infections caused by cytomegalovirus. Am J Med. 1987; 83:201-7. [IDIS 235332] [PubMed 3039841]

12. Tuazon CU, Labriola AM. Management of infectious and immunological complications of acquired immunodeficiency syndrome (AIDS)—current and future prospects. Drugs. 1987; 33:66-84. [IDIS 228653] [PubMed 3545766]

13. Bach MC, Bagwell SP, Knapp NP et al. 9-(1, 3-Dihydroxy-2-propoxymethyl)guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1985; 103:381-2. [IDIS 205821] [PubMed 2992335]

14. Glatt AE, Chirgwin K, Landesman SH. Treatment of infections associated with human immunodeficiency virus. N Engl J Med. 1988; 318:1439-48. [IDIS 241931] [PubMed 3285211]

15. Nicholson ML, Flower AJE, Simpson A et al. Ganciclovir for severe cytomegalovirus infection in transplant recipients. Lancet. 1988; 2:1501-2. [IDIS 249185] [PubMed 2904627]

16. Rostoker G, Ben Maadi A, Buisson C et al. Ganciclovir for severe cytomegalovirus infection in transplant recipients. Lancet. 1988; 2:1137-8. [IDIS 247832] [PubMed 2903346]

17. Frank I, Friedman HM. Progress in the treatment of cytomegalovirus pneumonia. Ann Intern Med. 1988; 109:769-71. [IDIS 248031] [PubMed 2847608]

18. Tindall B, Swanson C, Whyte BM et al. Fourth international conference on the acquired immunodeficiency syndrome. Med J Aust. 1989; 150: 87-92.

19. Hiesse C, Farquet C, Dussaix E et al. Ganciclovir for cytomegalovirus infection in renal transplant recipients. Lancet. 1989; 1:216-7.

20. Erice A, Jordan MC, Chace BA et al. Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA. 1987; 257:3082-7. [IDIS 230073] [PubMed 3035246]

21. Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(1,3-dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N Engl J Med. 1986; 314:801-5. [IDIS 213228] [PubMed 3005861]

22. Meyers JD. Management of cytomegalovirus infection. Am J Med. 1988; 85(Suppl 2A):102-6. [IDIS 247139] [PubMed 2841853]

23. Masur H, Lane HC, Palestine A et al. Effect of 9-(1,3-dihydroxy-2-propoxymethyl) guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men. Ann Intern Med. 1986; 104:41-4. [IDIS 209102] [PubMed 3000248]

24. Dorsky DI, Crumpacker CS. Drugs five years later: acyclovir. Ann Intern Med. 1987; 107:859-74. [IDIS 237470] [PubMed 3318610]

25. Whitley RJ. Ganciclovir—have we established clinical value in the treatment of cytomegalovirus infections? Ann Intern Med. 1988; 108:452-4. Editorial.

26. Mau S, Salamone FR, Muller RJ et al. Trimetrexate, ganciclovir, foscarnet, fluconazole—investigational drugs used in the management of AIDS. Hosp Pharm. 1989; 24:209-14.

27. Jordan MC. Ganciclovir for treatment of cytomegalovirus disease. DICP. 1989; 23:85-6. [IDIS 250407] [PubMed 2541567]

28. Laskin OL, Stahl-Bayliss CM, Kalman CM et al. Use of ganciclovir to treat serious cytomegalovirus infections in patients with AIDS. J Infect Dis. 1987; 155:323-7. [IDIS 225467] [PubMed 3027195]

29. Wood MJ, Geddes AM. Antiviral therapy. Lancet. 1987; 2:1189-93. [IDIS 235924] [PubMed 2890817]

30. Nahata MC. Clinical use of antiviral drugs. Drug Intell Clin Pharm. 1987; 21:399-405. [IDIS 228783] [PubMed 3556126]

31. Devita VT, Broder S, Fauci AS et al. Developmental therapeutics and the acquired immunodeficiency syndrome. Ann Intern Med. 1987; 106:568-81. [IDIS 227982] [PubMed 2435201]

32. Deeter RG, Khanderia U. Recent advances in antiviral therapy. Clin Pharm. 1986; 5:961-76. [IDIS 223482] [PubMed 3542344]

33. Keay S, Bissett J, Merigan TC. Ganciclovir treatment of cytomegalovirus infections in iatrogenically immunocompromised patients. J Infect Dis. 1987; 156:1016-21. [IDIS 243325] [PubMed 2824621]

34. Martin JC, Dvorak CA, Smee DF et al. 9-[(1, 3-dihydroxy-2-propoxy)methyl] guanine: a new potent and selective antiherpes agent. J Med Chem. 1983; 26:759-61. [PubMed 6302255]

35. Tyms AS, Davis JM, Jeffries DJ et al. BWB759U and an analogue of acyclovir, inhibits human cytomegalovirus in vitro. Lancet. 1984; 2:924-5. [PubMed 6148640]

36. St. Clair MH, Miller WH, Miller RL et al. Inhibition of cellular α DNA polymerase and herpes simplex virus-induced DNA polymerases by the triphosphate of BW759U. Antimicrob Agents Chemother. 1984; 25:191-4. [PubMed 6324666]

37. Mar EC, Cheng YC, Huang ES. Effect of 9-(1, 3-dihydroxy-2-propoxymethyl) guanine on human cytomegalovirus replication in vitro. Antimicrob Agents Chemother. 1983; 24:518-21. [PubMed 6316844]

38. Goring DR, DuBow MS. A cytotoxic effect associated with 9-(1,3-dihydroxy-2-propoxymethyl) guanine is observed during the selection for drug resistant human cells containing a single herpesvirus thymidine kinase gene. Biochem Biophys Res Commun. 1985; 133:195-201. [PubMed 3878145]

39. Smee DF. Interaction of 9-(1,3-dihydroxy-2 -propoxymethyl) guanine with cytosol and mitochondrial deoxyguanosine kinases: possible role in anti-cytomegalovirus activity. Mol Cell Biochem. 1985; 69:75-81. [PubMed 3001505]

40. Smee DF, Martin JC, Verheyden JPH et al. Anti-herpesvirus activity of the acyclic nucleoside 9-(1,3-dihydroxy-2-propoxymethyl) guanine. Antimicrob Agents Chemother. 1983; 23:676-82. [IDIS 170755] [PubMed 6307132]

41. Biron KK, Stanat SC, Sorrell JB et al. Metabolic activation of the nucleoside analog 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine in human diploid fibroblasts infected with human cytomegalovirus. Proc Natl Acad Sci USA. 1985; 82:2473-7. [PubMed 2986118]

42. Field AK, Davies ME, DeWitt C et al. 9-[2-Hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine: a selective inhibitor of herpes group virus replication. Proc Natl Acad Sci USA. 1983; 80:4139-43. [PubMed 6306664]

43. Cheng YC, Huang ES, Lin JC et al. Unique spectrum of activity of 9-[(1,3-dihydroxy-2 -propoxy)methyl]guanine against herpesviruses in vitro and its mode of action against herpes simplex virus type 1. Proc Natl Acad Sci, USA. 1983; 80: 2767-70.

44. Oberg B, Johansson NG. The relative merits and drawbacks of new nucleoside analogues with clinical potential. J Antimicrob Chemother. 1984; 14(Suppl A):5-26. [PubMed 6436227]

45. Cheng YC, Grill SP, Dutschman GE et al. Metabolism of 9-(1,3-dihydroxy-2-propoxymethyl) guanine and a new anti-herpes virus compound, in herpes simplex virus infected cells. J Biol Chem. 1983; 258:12460-4. [PubMed 6313660]

46. Smith KO, Galloway KS, Kennell WL et al. A new nucleoside analog, 9-[2-hydroxy-1 -(hydroxymethyl)ethoxy]methyl]guanine, highly active in vitro against herpes simplex virus types 1 and 2. Antimicrob Agents Chemother. 1982; 22:55-61. [IDIS 153517] [PubMed 6289741]

47. Ashton WT, Karkas JD, Field AK et al. Activation by thymidine kinase and potent antiherpetic activity of 2′-nor-2′-deoxyguanosine (2′NDG). Biochem Biophys Res Commun. 1982; 108:1716-21. [PubMed 6295389]

48. Bowden RA, Digel J, Reed EC et al. Immunosuppressive effects of ganciclovir on in vitro lymphocyte responses. J Infect Dis. 1987; 156: 899-903.

49. Freitas VR, Smee DF, Chernow M et al. Activity of 9-(1,3-dihydroxy-2-propoxymethyl)guanine compared with that of acyclovir against human and monkey, and rodent cytomegaloviruses. Antimicrob Agents Chemother. 1985; 28:240-5. [PubMed 3010840]

50. Plotkin SA, Drew WL, Felsenstein D et al. Sensitivity of clinical isolates of human cytomegalovirus to 9-(1,3-dihydroxy-2 -propoxymethyl)guanine. J Infect Dis. 1985; 152: 833-4.

51. Cheng YC, Grill SP, Dutschman GE et al. Effects of 9-(1,3-dihydroxy-2-propoxymethyl)guanine, a new antiherpesvirus compound, on synthesis of macromolecules in herpes simplex virus-infected cells. Antimicrob Agents Chemother. 1984; 26:283-8. [PubMed 6095751]

52. St. Clair MH, Lambe CU, Furman PA. Inhibition by ganciclovir of cell growth and DNA synthesis of cells biochemically transformed with herpesvirus genetic information. Antimicrob Agents Chemother. 1987; 31:844-9. [PubMed 3039910]

53. Erice A, Chou S, Biron KK et al. Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients. N Engl J Med. 1989; 320:289-293. [IDIS 250260] [PubMed 2536135]

54. Germershausen J, Bostedor R, Field AK et al. A comparison of the antiviral agents 2′-nor-2 ′-deoxyguanosine and acyclovir: uptake and phosphorylation in tissue culture and kinetics of in vitro inhibition of viral and cellular DNA polymerases by their respective triphosphates. Biochem Biophys Res Commun. 1983; 116:360-7. [PubMed 6316950]

55. Collins P, Oliver NM. Comparison of the in vitro and in vivo antiherpes virus activities of the acyclic nucleosides and acyclovir (Zovirax), 9-[(2-hydroxy-1-hydroxymethyl-ethoxy)methyl]guanine (BWB759U). Antiviral Res. 1985; 5:145-56. [PubMed 2992369]

56. Smee DF, Boehme R, Chernow M et al. Intracellular metabolism and enzymatic phosphorylation of 9-(1,3-dihydroxy-2-propoxymethyl)guanine and acyclovir in herpes simplex virus-infected and uninfected cells. Biochem Pharmacol. 1985; 34: 1049-56. [PubMed 3872662]

57. Tocci MJ, Livelli TJ, Perry HC et al. Effects of the nucleoside analog 2′-nor-2′-deoxyguanosine on human cytomegalovirus replication. Antimicrob Agents Chemother. 1984; 25:247-52. [PubMed 6324669]

58. Jacobson MA, de Miranda P, Cederberg DM et al. Human pharmacokinetics and tolerance of oral ganciclovir. Antimicrob Agents Chemother. 1987; 31:1251-4. [IDIS 234808] [PubMed 2820301]

59. Fletcher C, Sawchuk R, Chinnock B et al. Human pharmacokinetics of the antiviral drug DHPG. Clin Pharmacol Ther. 1986; 40:281-6. [IDIS 221684] [PubMed 3017630]

60. Lake KD, Fletcher CV, Love KR et al. Ganciclovir pharmacokinetics during renal impairment. Antimicrob Agents Chemother. 1988; 32:1899-1900. [IDIS 249135] [PubMed 2854457]

61. Weller S, Liao SHT, Cederberg DM et al. The pharmacokinetics of ganciclovir in patients with cytomegalovirus (CMV) infections. J Pharm Sci. 1987; 76:S120.

62. O’Donnell JJ, Jacobson MA, Mills J. Development of cytomegalovirus (CMV) retinitis in a patient with AIDS during ganciclovir therapy for CMV colitis. New Engl J Med. 1987; 316:1607-8. [IDIS 230810] [PubMed 3035374]

63. Felsenstein D, D’Amico DJ, Hirsch MS et al. Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl)]guanine. Ann Intern Med. 1985; 103:377-80. [IDIS 205820] [PubMed 2992334]

64. Shepp DH, Dandliker PS, de Miranda P et al. Activity of 9-[2-hydroxy-1- (hydroxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Ann Intern Med. 1985; 103:368-73. [IDIS 205819] [PubMed 2992333]

65. Harris ML, Mathalone MBR. Dihydroxypropoxymethyl guanine in the treatment of AIDS related retinitis due to cytomegalovirus. BMJ. 1987; 294:92. [IDIS 225294] [PubMed 3032325]

66. Newman C, Polk BF. Resolution of oral hairy leukoplakia during therapy with 9-(1,3-dihydroxy -2-propoxymethyl)guanine (DHPG). Ann Intern Med. 1987; 107:348-50. [IDIS 233641] [PubMed 3039887]

67. Henry K, Cantrill H, Fletcher C et al. Use of intravitreal ganciclovir (dihydroxy propoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol. 1987; 103:17-23. [IDIS 224850] [PubMed 3026186]

68. Stein DS, Verano AS, Levandowski RA. Successful treatment with ganciclovir of disseminated cytomegalovirus infection after liver transplantation. Am J Gastroenterol. 1988; 83:684-6. [IDIS 242447] [PubMed 2837082]

69. Kotler DP, Tierney AR, Altilio D et al. Body mass repletion during ganciclovir treatment of cytomegalovirus infections in patients with acquired immunodeficiency syndrome. Arch Intern Med. 1989; 149:901-5. [IDIS 253961] [PubMed 2539791]

70. Jacobson MA, Cello JP, Sande MA. Cholestasis and disseminated cytomegalovirus disease in patients with the acquired immunodeficiency syndrome. Am J Med. 1988; 84:218-24. [IDIS 238483] [PubMed 2841850]

71. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome. Arch Ophthalmol. 1989; 107:75-80. [IDIS 250794] [PubMed 2535932]

72. Hecht DW, Snydman DR, Crumpacker CS et al. Ganciclovir for treatment of renal transplant-associated primary cytomegalovirus pneumonia. J Infect Dis. 1988; 157:187-90. [IDIS 237043] [PubMed 2826608]

73. Reed EC, Bowden RA, Dandliker PS et al. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med. 1988; 109:783-8. [IDIS 248033] [PubMed 2847610]

74. Emanuel D, Cunningham I, Jules-Elysee K et al. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and high-dose intravenous immune globulin. Ann Intern Med. 1988; 109:777-82. [IDIS 248032] [PubMed 2847609]

75. Hermans PE, Cockerill FR III. Antiviral agents. Mayo Clin Proc. 1987; 62:1108-15. [IDIS 238951] [PubMed 3500376]

76. Smith PD, Lane HC, Gill VJ et al. Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1988; 108:328-33. [IDIS 239613] [PubMed 2829677]

77. Crowe S, Mills J. Chemotherapy of herpesvirus infections: present successes and future hopes. Eur J Clin Microbiol. 1985; 4:459-63. [PubMed 2998787]

78. Klein RJ, Friedman-Kien AE. Effect of 9-(1, 3-dihydroxy-2-propoxymethyl)guanine on the acute local phase of herpes simplex virus-induced skin infections in mice and the establishment of latency. Antimicrob Agents Chemother. 1985; 27:763-8. [PubMed 3874596]

79. Smith KO, Hodges SL, Kennell WL et al. Experimental ocular herpetic infections in rabbits: treatment with 9-([2-hydroxy-1- (hydroxymethyl)ethoxy methyl)]guanine. Arch Ophthalmol. 1984; 102:778-81. [PubMed 6326720]

80. Field HJ, Anderson JR, Efstathiou S. A quantitative study of the effects of several nucleoside analogues on established herpes encephalitis in mice. J Gen Virol. 1984; 65:707-19. [PubMed 6323620]

81. Trousdale MD, Nesburn AB, Willey DE et al. Efficacy of BW759 (9-[2-hydroxy 1-(hydroxymethyl)ethoxy]methylguanine] against herpes simplex virus type 1 keratitis in rabbits. Curr Eye Res. 1984; 3:1007-15. [PubMed 6333319]

82. Peterson P, Stahl-Bayliss CM. Cytomegalovirus thrombophlebitis after successful DHPG therapy. Ann Intern Med. 1987; 106:632-3. [IDIS 227984] [PubMed 3030175]

83. Jacobson MA, de Miranda P, Gordon SM et al. Prolonged pancytopenia due to combined ganciclovir and zidovudine therapy. J Infect Dis. 1988; 158:489-90. [IDIS 309476] [PubMed 3261316]

84. Henry K, Cantrill H, Kish MA. Intravitreous ganciclovir for patients receiving zidovudine. JAMA. 1987; 257:3066. [IDIS 230070] [PubMed 3035245]

85. Appelbaum FR, Meyers JD, Deeg HJ et al. Toxicity trial of prophylactic 9-[2-hydroxy -1-(hydroxymethyl)ethoxymethyl]guanine (ganciclovir) after marrow transplantation in dogs. Antimicrob Agents Chemother. 1988; 32:271-3. [PubMed 2834998]

86. Chun YS, Park NH. Effect of ganciclovir [9-(1,3-dihydroxy-2-propoxymethyl) guanine] on viral DNA and protein synthesis in cells infected with herpes simplex virus. Antimicrob Agents Chemother. 1987; 31:349-51. [PubMed 3032100]

87. Pulido J, Peyman GA, Lesar T et al. Intravitreal toxicity of hydroxyacyclovir (BW-B759U) and a new antiviral agent. Arch Ophthalmol. 1985; 103:840-1. [PubMed 3873931]

88. Debs RJ, Montgomery AB, Brunette EN et al. Aerosol administration of antiviral agents to treat lung infection due to murine cytomegalovirus. J Infect Dis. 1988; 157:327-31. [PubMed 2826613]

89. Lin JC, Smith MC, Pagano JS. Prolonged inhibitory effect of 9-(1,3-dihydroxy -2-propoxymethyl)guanine against replication of Epstein-Barr virus. J Virol. 1984; 50:50-5. [PubMed 6321799]

90. Bach MC. Breakthrough of cytomegalovirus infection despite 9-(1,3-dihydroxy -2-propoxymethyl)guanine therapy. Ann Intern Med. 1986; 104:587. [PubMed 3006573]

91. Meyers JD. Prevention and treatment of cytomegalovirus infection after marrow transplantation. Bone Marrow Transplant. 1988; 3:95-104. [PubMed 2844342]

92. Reed EC, Shepp DH, Dandliker PS et al. Ganciclovir treatment of cytomegalovirus infection of the gastrointestinal tract after marrow transplantation. Bone Marrow Transplant. 1988; 3: 199-206. [PubMed 2844343]

93. Jabs DA, Wingard JR, de Bustros S et al. BW B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol. 1986; 104:1436-7. [IDIS 222066] [PubMed 3021090]

94. Holland GN, Sakamoto MJ, Hardy D et al. Treatment of cytomegalovirus retinopathy in patients with acquired immunodeficiency syndrome: use of the experimental drug 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Arch Ophthalmol. 1986; 104:1794-800. [IDIS 225306] [PubMed 3024606]

95. Jacobson MA, Mills J, Rush J et al. Failure of antiviral therapy for acquired immunodeficiency syndrome-related cytomegalovirus myelitis. Arch Neurol. 1988; 45:1090-2. [PubMed 2845899]

96. Sommadossi JP, Carlisle R. Toxicity of 3′-azido-3′-deoxythymidine and 9-(1,3-dihydroxy -2-propoxymethyl)guanine for normal human hematopoietic progenitor cells in vitro. Antimicrob Agents Chemother. 1987; 31:452-4. [PubMed 3495235]

97. Smee DF, Campbell NL, Matthews TR. Comparative anti-herpesvirus activities of 9-(1,3-dihydroxy -2-propoxymethyl)guanine and acyclovir, and two 2′-fluoropyrimidine nucleosides. Antiviral Res. 1985; 5:259-67. [PubMed 2998275]

98. Duke AE, Smee DF, Chernow M et al. In vitro and in vivo activities of phosphate derivatives of 9-(1, 3-dihydroxy-2-propoxymethyl)guanine against cytomegalovirus. Antiviral Res. 1986; 6:299-308. [PubMed 3021055]

99. Fong CKY, Cohen SD, McCormick S et al. Antiviral effect of 9-(1,3-dihydroxy-2-propoxymethyl) guanine against cytomegalovirus infection in a guinea pig model. Antiviral Res. 1987; 7:11-23. [PubMed 3026243]

100. Rosecan LR, Stahl-Bayliss CM, Kalman CM et al. Antiviral therapy for cytomegalovirus retinitis in AIDS with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986; 101:405-18. [IDIS 214266] [PubMed 3008560]

101. Small PM, McPhaul LW, Sooy CD et al. Cytomegalovirus infection of the laryngeal nerve presenting as hoarseness in patients with acquired immunodeficiency syndrome. Am J Med. 1989; 86:108-10. [IDIS 249375] [PubMed 2535917]

102. Kotler DP, Culpepper-Morgan JA, Tierney AR et al. Treatment of disseminated cytomegalovirus infection with 9-(1,3-dihydroxy-2-propoxymethyl) guanine: evidence of prolonged survival in patients with the acquired immunodeficiency syndrome. AIDS Res. 1986; 2:299-308. [PubMed 3028443]

103. Orellana J, Teich SA, Friedman AH et al. Combined short- and long-term therapy for the treatment of cytomegalovirus retinitis using ganciclovir (BW B759U). Ophthalmology. 1987; 94:831-8. [PubMed 2821466]

104. Jabs DA, Newman C, de Bustros S et al. Treatment of cytomegalovirus retinitis with ganciclovir. Ophthalmology. 1987; 94:824-30. [PubMed 2821465]

105. Holland GN, Sidikaro Y, Kreiger AE et al. Treatment of cytomegalovirus retinopathy with ganciclovir. Ophthalmology. 1987; 94:815-23. [PubMed 2821464]

106. Dieterich DT, Chachoua A, Lafleur F et al. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis. 1988; 10(Suppl 3):S532-7. [IDIS 309929] [PubMed 2847290]

107. Crumpacker C, Marlowe S, Zhang JL et al. Treatment of cytomegalovirus pneumonia. Rev Infect Dis. 1988; 10(Suppl 3):S538-46. [IDIS 309930] [PubMed 2847291]

108. Winston DJ, Ho WG, Bartoni K et al. Ganciclovir therapy for cytomegalovirus infections in recipients of bone marrow transplants and other immunosuppressed patients. Rev Infect Dis. 1988; 10(Suppl 3):S547-53. [IDIS 309931] [PubMed 2847292]

109. Snydman DR. Ganciclovir therapy for cytomegalovirus disease associated with renal transplants. Rev Infect Dis. 1988; 10(Suppl 3): S554-62. [IDIS 309932] [PubMed 2847293]

110. Keay S, Petersen E, Icenogle T et al. Ganciclovir treatment of serious cytomegalovirus infection in heart and heart-lung transplant recipients. Rev Infect Dis. 1988; 10(Suppl 3): S563-72. [IDIS 309933] [PubMed 2847294]

111. Gianello P, Stoffel M, Squifflet JP et al. Ganciclovir for cytomegalovirus infections in renal transplant recipients. Lancet. 1989; 1:217.

112. Crumpacker CS II. Molecular targets of antiviral therapy. N Engl J Med. 1989; 321:163-72. [IDIS 257079] [PubMed 2546077]

113. Matthews T, Boehme R. Antiviral activity and mechanism of action of ganciclovir. Rev Infect Dis. 1988; 10(Suppl 3):S490-4. [IDIS 309924] [PubMed 2847285]

114. Raufman JP. Odynophagia/dysphagia in AIDS. Gastroenterol Clin North Am. 1988; 17:599-614. [PubMed 3049365]

115. Crowe S, Mills J. The future of antiviral chemotherapy. Dermatol Clin. 1988; 6:521-37. [PubMed 3067915]

116. Montgomery P, Lopez JR. DHPG in cytomegalovirus infections. Drug Intell Clin Pharm. 1986; 20:854-5.

117. Daikos GL, Pulido J, Kathpalia SB et al. Intravenous and intraocular ganciclovir for CMV retinitis in patients with AIDS or chemotherapeutic immunosuppression. Br J Ophthalmol. 1988; 72:521-4. [PubMed 2843218]

118. Orellana J, Teich SA, Winterkorn JS et al. Treatment of cytomegalovirus retinitis with ganciclovir (9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (BW B759U)). Br J Ophthalmol. 1988; 72:525-9. [PubMed 2843219]

119. Furman PA. Chemotherapy of herpesvirus infections. Curr Eye Res. 1987; 6:213-9. [PubMed 3493884]

120. Teich SA, Castle J, Friedman AH et al. Active cytomegalovirus particles in the eyes of an AIDS patient being treated with 9-[2-hydroxy -1-(hydroxymethyl)ethoxymethyl]guanine (ganciclovir). Br J Ophthalmol. 1988; 72 293-8.

121. Hutter JA, Scott J, Wreghitt T et al. The importance of cytomegalovirus in heart-lung transplant recipients. Chest. 1989; 95:627-31. [IDIS 252504] [PubMed 2537711]

122. Buhles Jr WC, Mastre BJ, Tinker AJ et al. Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients. Rev Infect Dis. 1988; 10(Suppl 3):S495-506. [IDIS 309925] [PubMed 2847286]

123. Winston DJ, Ho WG, Gale RP et al. Prophylaxis of infection in bone marrow transplants. Eur J Cancer Clin Oncol. 1988; 24(Suppl 1):S15-23. [PubMed 3127217]

124. Sommadossi JP, Bevan R, Ling T et al. Clinical pharmacokinetics of ganciclovir in patients with normal and impaired renal function. Rev Infect Dis. 1988; 10(Suppl 3):S507-14. [IDIS 309926] [PubMed 2847287]

125. Palestine AG. Clinical aspects of cytomegalovirus retinitis. Rev Infect Dis. 1988; 10(Suppl 3):S515-21. [IDIS 309927] [PubMed 2847288]

126. Mills J, Jacobson MA, O’Donnell JJ et al. Treatment of cytomegalovirus retinitis in patients with AIDS. Rev Infect Dis. 1988; 10(Suppl 3):S522-31.

127. Henderly DE, Freeman WR, Causey DM et al. Cytomegalovirus retinitis and response to therapy with ganciclovir. Ophthalmology. 1987; 94:425-434. [PubMed 3035453]

128. Pepose JS, Newman C, Bach MC. Pathologic features of cytomegalovirus retinopathy after treatment with the antiviral agent ganciclovir. Ophthalmology. 1987; 94:414-24. [PubMed 3035452]

129. Cantrill HL, Henry K, Melroe NH et al. Treatment of cytomegalovirus retinitis with intravitreal ganciclovir—long-term results. Ophthalmology. 1989; 96:367-74. [PubMed 2540470]

130. Sacks SL. Therapeutic use of newer antiviral agents. Int J Cell Cloning. 1986; 4(Suppl 1):155-73. [PubMed 3018100]

131. Jacobson MA, O’Donnell JJ, Brodie HR et al. Randomized prospective trial of ganciclovir maintenance therapy for cytomegalovirus retinitis. J Med Virol. 1988; 25:339-49. [PubMed 2844981]

132. Sommadossi JP, Bevan R. High-performance liquid chromatographic method for the determination of 9-(1,3-dihydroxy-2-propoxymethyl)guanine in human plasma. J Chromatogr. 1987; 414:429-33. [PubMed 3494740]

133. Tyms AS, Taylor DL, Parkin JM. Cytomegalovirus, the acquired immunodeficiency syndrome. J Antimicrob Ther. 1989; 23(Suppl A): 89-105.

134. Ong ELC, Ellis ME, Tweedle DEF et al. Cytomegalovirus cholecystitis and colitis associated with the acquired immunodeficiency syndrome. J Infect. 1989; 18:73-5. [PubMed 2536775]

135. Ussery FM III, Gibson SR, Conklin RH et al. Intravitreal ganciclovir in the treatment of AIDS-associated cytomegalovirus retinitis. Ophthalmology. 1988; 95:640-8. [PubMed 2845321]

136. Pollard RB, Matzke DS, Ramsey KM et al. Therapy of disseminated cytomegalovirus (CMV) infections in immunosuppressed individuals using dihydroxy propoxymethyl guanine (DHPG). Clin Res. 1985; 33:416A.

137. Shepp DH, Dandliker PS, Burnette TC et al. 9-[(2-Hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine: antiviral activity in cytomegalovirus pneumonia. Clin Res. 1985; 33:419A.

138. Lewis RA, Watkins L, St. Jeor S. Enhancement of deoxyguanosine kinase activity in human lung fibroblast cells infected with human cytomegalovirus. Mol Cell Biochem. 1985; 65:67-71.

139. Palestine AG, Stevens G Jr, Lane HC. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986; 101: 95-101. [IDIS 210854] [PubMed 3002177]

140. Cantarovich M, Hiesse C, Lantz O et al. Treatment of cytomegalovirus infections in renal transplant recipients with 9-(1,3-dihydroxy -2-propoxymethyl) guanine. Transplantation. 1988; 45:1139-41. [PubMed 2837848]

141. Culbertson WW. Infections of the retina in AIDS. Int Ophthalmol Clin. 1989; 29:108-18. [PubMed 2541096]

142. O’Donnell JJ, Jacobson MA. Cotton-wool spots and cytomegalovirus retinitis in AIDS. Int Ophthalmol Clin. 1989; 29:105-7. [PubMed 2541095]

143. Gaub J, Poulsen AG, Pedersen C et al. Efficacy and safety of two different dose levels of ganciclovir for the treatment of cytomegalovirus chorioretinitis in AIDS patients. Scand Infect Dis. 1988; 20:479-82.

144. Shea BF, Hoffman S, Sesin GP et al. Ganciclovir hepatotoxicity. Pharmacotherapy. 1987; 7:223-6. [IDIS 391052] [PubMed 2832836]

145. Stoffel M, Gianello P, Squifflet JP et al. Effect of 9-(2-hydroxy -1-[hydroxymethyl]ethoxymethyl)guanine (DHPG) on cytomegalovirus pneumonitis after renal transplantation. Transplantation. 1988; 46:594-5. [PubMed 2845613]

146. Harbison MA, DeGirolami PC, Jenkins RL et al. Ganciclovir therapy of severe cytomegalovirus infections in solid-organ transplant recipients. Transplantation. 1988; 46:82-8. [PubMed 2839916]

147. Merigan TC. Introduction and summary: conference on cytomegalovirus therapy. Rev Infect Dis. 1988; 10(Suppl 3):S457-9. [IDIS 309933] [PubMed 2847294]

148. Rook AH. Interactions of cytomegalovirus with the human immune system. Rev Infect Dis. 1988; 10(Suppl 3):S460-7. [IDIS 309922] [PubMed 2847282]

149. Milliken S, Powles R, Ettinger N et al. Ganciclovir in the treatment of cytomegalovirus pneumonitis in bone marrow transplant recipients. Transplant Proc. 1989; 21:3110-1. [PubMed 2539692]

150. Drew WL. Diagnosis of cytomegalovirus infection. Rev Infect Dis. 1988; 10(Suppl 3):S468-76. [PubMed 2847283]

151. Ho WG, Winston DJ, Champlin RE. Tolerance and efficacy of ganciclovir in the treatment of cytomegalovirus infections in immunosuppressed patients. Transplant Proc. 1989; 21:3103-6. [PubMed 2539690]

152. Verheyden JPH. Evolution of therapy for cytomegalovirus infection. Rev Infect Dis. 1988; 10(Suppl 3):S477-89.

153. Rubin RH, Tolkoff-Rubin NE. Infection: the new problems. Transplant Proc. 1989; 21:1440-5. [PubMed 2652463]

154. Mai M, Nery J, Sutker W et al. DHPG (gancyclovir) improves survival in CMV pneumonia. Transplant Proc. 1989; 21:2263-5. [PubMed 2540565]

155. Schulman J, Peyman GA, Horton MB et al. Intraocular 9-([2-hydroxy -1-(hydroxymethyl)ethoxymethyl)]guanine levels after intravitreal and subconjunctival administration. Ophthalmic Surg. 1986; 17:429-32. [PubMed 3014412]

156. Pollard RB. Cytomegalovirus infections in renal and heart and heart-lung and liver transplantation. Pediatr Infect Dis J. 1988; 7: S97-102. [PubMed 2456512]

157. Lim W, Kahn E, Gupta A et al. Treatment of cytomegalovirus enterocolitis with ganciclovir in an infant with acquired immunodeficiency syndrome. Pediatr Infect Dis J. 1988; 7:354-7. [PubMed 2837718]

158. Shelby J, Saffle JR, Kern ER. Delayed type hypersensitivity (DTH) response and skin graft survival in 9-(1,3-dihydroxy-2-propoxymethyl) guanine (DHPG) treated mice. Transplant Proc. 1989; 21:1150-1. [PubMed 2650083]

159. Lang P, Buisson C, Rostoker G et al. DHPG treatment of kidney transplant recipients with severe CMV infection. Transplant Proc. 1989; 21:2084-6. [PubMed 2540560]

160. Akula SK, Mansell PWA, Ruiz R. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986; 101:622. [IDIS 215296] [PubMed 3010726]

161. Pulliam L, Panitch HS, Baringer JR et al. Effect of antiviral agents on replication of herpes simplex virus type 1 in brain cultures. Antimicrob Agents Chemother. 1986; 30:840-6. [PubMed 3028250]

162. Shanley JD, Morningstar J, Jordan MC. Inhibition of murine cytomegalovirus lung infection and interstitial pneumonitis by acyclovir and 9-(1, 3-dihydroxy-2-propoxymethyl) guanine. Antimicrob Agents Chemother. 1985; 28:172-5. [PubMed 3010835]

163. Davies MEM, Bondi JV, Grabowski L et al. 2′-Nor-2′-deoxyguanosine is an effective therapeutic agent for treatment of experimental herpes keratitis. Antiviral Res. 1987; 7:119-25. [PubMed 3495237]

164. Bach MC, Hedstrom PS. CMV retinitis treated with ganciclovir [9-(1,3-dihydroxy -2-propoxymethyl)guanine] in patients with AIDS. Ann Ophthalmol. 1987; 19:369-75. [PubMed 2825580]

165. Masdeu JC, Small CB, Weiss L et al. Multifocal cytomegalovirus encephalitis in AIDS. Ann Neurol. 1988; 23:97-99. [PubMed 2830836]

166. Topiel MS, Kutscher JJ, Pilipshen SJ et al. Cytomegalovirus infection and 9-(1,3-dihydroxy -2-propoxymethyl)guanine, and Crohn’s disease. Ann Intern Med. 1986; 105:302-3. [IDIS 219674] [PubMed 3014944]

167. D’Amico DJ, Talamo JH, Felsenstein D et al. Ophthalmoscopic and histologic findings in cytomegalovirus retinitis treated with BW-B759U. Arch Ophthalmol. 1986; 104:1788-93. [IDIS 225305] [PubMed 3024605]

168. Acheson JF, Shah SM, Spalton DJ et al. Treatment of CMV retinitis in an AIDS patient. Br J Ophthalmol. 1987; 71:810-6. [PubMed 2825756]

169. Pirsch JD, Stratta RJ, Sollinger HW et al. Treatment of severe Epstein-Barr virus-induced lymphoproliferative syndrome with ganciclovir: two cases after solid organ transplantation. Am J Med. 1989; 86:241-4. [IDIS 251010] [PubMed 2536518]

170. Büchi ER, Fitting PL, Michel AE. Long-term intravitreal ganciclovir for cytomegalovirus retinitis in a patient with AIDS. Arch Ophthalmol. 1988; 106:1349-50. [IDIS 311852] [PubMed 2845902]

171. Gonwa TA, Capehart JE, Pilcher JW et al. Cytomegalovirus myocarditis as a cause of cardiac dysfunction in a heart transplant recipient. Transplantation. 1989; 47:197-9. [PubMed 2536201]

172. Robinson MR, Teitelbaum C, Taylor-Findlay C. Thrombocytopenia and vitreous hemorrhage complicating ganciclovir treatment. Am J Ophthalmol. 1989; 107:560-1. [IDIS 254648] [PubMed 2540661]

173. De Clercq E. Recent trends and development in antiviral chemotherapy. Antiviral Res. 1985; 5(Suppl 1):11-9.

174. Jacobson MA, Mills J. Cytomegalovirus infection. Clin Chest Med. 1988; 9:443-8. [PubMed 2842110]

175. Reed EC, Meyers JD. Treatment of cytomegalovirus infection. Clin Lab Med. 1987; 7: 831-52. [PubMed 2446819]

176. Henderly DE, Freeman WR, Smith RE et al. Cytomegalovirus retinitis as the initial manifestation of the acquired immune deficiency syndrome. Am J Ophthalmol. 1987; 103:316-20. [PubMed 3030112]

177. Teich SA, Orellana J, Friedman AH. Prevalence and pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987; 104:312-4. [IDIS 234590] [PubMed 2820231]

178. Reed EC, Dandliker PS, Meyers JD. Treatment of cytomegalovirus pneumonia with 9-[2-hydroxy-1- (hydroxymethyl)ethoxymethyl]guanine and high-dose corticosteroids. Ann Intern Med. 1986; 105:214-5. [IDIS 219657] [PubMed 3014941]

179. Verdonck LF, de Gast GC, Dekker AW et al. Treatment of cytomegalovirus pneumonia after bone marrow transplantation with cytomegalovirus immunoglobulin combined with ganciclovir. Bone Marrow Transplant. 1989; 4:187-9. [PubMed 2539877]

180. Morris DJ. Ganciclovir and immune globulin in cytomegalovirus pneumonia. Ann Intern Med. 1989; 110:575. [PubMed 2538100]

181. Rasmussen L, Chen PT, Mullenax JG et al. Inhibition of human cytomegalovirus replication by 9-(1,3-dihydroxy-2-propoxymethyl)guanine alone and in combination with human interferons. Antimicrob Agents Chemother. 1984; 26:441-5. [PubMed 6097163]

182. Fraser-Smith EB, Eppstein DA, Marsh YV et al. Enhanced efficacy of the acyclic nucleoside 9-(1, 3-dihydroxy-2-propoxymethyl)guanine in combination with alpha-interferon against herpes simplex virus type 2 in mice. Antimicrob Agents Chemother. 1984; 26:937-8. [PubMed 6335382]

183. Moran DM, Kern ER, Overall JC Jr. Synergism between recombinant human interferon and nucleoside antiviral agents against herpes simplex virus: examination with an automated microtiter plate assay. J Infect Dis. 1985; 151:1116-22. [PubMed 2987369]

184. Eppstein DA, Marsh YV. Potent synergistic inhibition of herpes simplex virus-2 by [9-(1, 3-dihydroxy-2-propoxy)methyl]guanine in combination with recombinant interferons. Biochem Biophys Res Commun. 1984; 120:66-73. [PubMed 6201172]

185. Schmidt GM, Kovacs A, Zaia JA et al. Ganciclovir/immunoglobulin combination therapy for the treatment of human cytomegalovirus-associated interstitial pneumonia in bone marrow allograft recipients. Transplantation. 1988; 48:905-7.

186. Dolin R. Antiviral chemotherapy and chemoprophylaxis. Science. 1985; 227:1296-303. [IDIS 196674] [PubMed 2983421]

187. Schulman JA, Peyman GA. Management of viral retinitis. Ophthalmic Surg. 1988; 19:876-84. [PubMed 2852786]

188. Watson FS, O’Connell JB, Amber IJ et al. Treatment of cytomegalovirus pneumonia in heart transplant recipients with 9-(1,3-dihydroxy -2-propoxymethyl)guanine (DHPG). J Heart Transplant. 1988; 7:102-5. [PubMed 2835468]

189. Wiltink EHH. DHPG: een nieuw virustaticum bij herpesvirus-infecties. (Dutch; with English abstract.) Pharm Weekbl. 1987; 122:421-6.

190. Heath PH, Hodges GR. Administration of gancyclovir: treatment of cytomegalovirus infection. J Intraven Nurs. 1988; 11:176-7. [PubMed 2836578]

191. National Institute of Allergy and Infectious Diseases. A treatment protocol for the use of intravenous ganciclovir in AIDS patients with immediately sight-threatening CMV retinitis. Bethesda, MD: National Institute of Allergy and Infectious Diseases; 1989 Feb 1. (Publication No. TX 303.)

192. Gordin FM, Simon GL, Wofsy CB et al. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1984; 100:495-9. [IDIS 183827] [PubMed 6230976]

193. Icenogle TB, Peterson E, Ray G. DHPG effectively treats CMV infection in heart and heart-lung transplant patients: a preliminary report. J Heart Transplant. 1987; 6:199-203. [PubMed 2822880]

194. Biron KK, Fyfe JA, Stanat SC et al. A human cytomegalovirus mutant resistant to the nucleoside analog 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine (BW B759U) induces reduced levels of BW B759U triphosphate. Proc Natl Acad Sci USA. 1986; 83:8769-73. [PubMed 3022304]

195. Reid R, Mar EC, Huang ES et al. Insertion and extension of acyclic and dideoxy, and ara nucleotides by Herpesviridae and human α and human β polymerases. J Biol Chem. 1988; 263:3898-904. [PubMed 2831212]

196. Boehme RE. Phosphorylation of the antiviral precursor 9-(1,3-dihydroxy-2-propoxymethyl) guanine monophosphate by guanylate kinase isoenzymes. J Biol Chem. 1984; 259:12346-9. [PubMed 6092331]

197. Murray JF, Felton CP, Garay SM et al. Pulmonary complications of the acquired immunodeficiency syndrome: report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984; 310:1682-8. [PubMed 6328301]

198. Bratanow N, Ash RC, Turner P et al. The use of 9(1,3-dihydroxy-2-propoxymethyl)guanine (ganciclovir, DHPG) and intravenous immunoglobulin (IVIG) in the treatment of serious cytomegalovirus (CMV) infections in thirty-one allogeneic bone marrow transplant (BMT) patients. Blood. 1987; 70(Suppl 1):302.

199. Bratanow NC, Ash RC, Turner PA et al. Successful treatment of serious cytomegalovirus disease with 9(1,3-dihydroxy-2-propoxymethyl) guanine in bone marrow transplant (BMT) patients. Blood. 1986; 68:280a.

200. Reed EC, Bowden RA, Dandliker PS et al. Treatment of cytomegalovirus (CMV) pneumonia in bone marrow transplant (BMT) patients (pts) with ganciclovir (GCV) and CMV immunoglobulin (CMV-IG). Blood. 1987; 70(Suppl 1):313.

201. Selby P, Powles RL, Jameson B et al. Treatment of cytomegalovirus pneumonitis after bone marrow transplantation with 9-[2-hydroxy -1-(hydroxymethyl)ethoxymethyl]guanine. Lancet. 1986; 1:1377-8. [IDIS 217284] [PubMed 2872484]

202. Creasy TS, Flower AJE, Veitch PS. Life-threatening cytomegalovirus infection treated with dihydropropoxymethylguanine. Lancet. 1986; 1:675. [IDIS 214510] [PubMed 2869359]

203. Freeman WR, Henderly DE, Wan WL et al. Prevalence and pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987; 103:527-36. [IDIS 228106] [PubMed 3031984]

204. Montplaisir S. Latency and activation of cytomegalovirus in man and in mice. Can J Microbiol. 1979; 25:261-6. [PubMed 222415]

205. Fletcher CV. Treatment of cytomegalovirus (CMV) (AIDS-2). ASHP Midyear Clinical Meeting Abstracts. 1988; 23:41.

206. Hooymans JMM, Sprenger HG, Weits J. Treatment of cytomegalovirus retinitis with DHPG in a patient with AIDS. Doc Ophthalmol. 1987; 67:5-12. [PubMed 2827978]

207. Chachoua A, Dieterich DT. 9-(1,3-Dihydroxy -2-propoxymethyl)guanine in patients with AIDS and CMV infections. Clin Res. 1986; 34:514A.

208. Kenley RA, Jackson SE, Winterle JS et al. Water soluble complexes of the antiviral drugs 9-[(1,3-dihydroxy-2-propoxy)methyl)]guanine and acyclovir: the role of hydrophobicity in complex formation. J Pharm Sci. 1986; 75:648-53. [PubMed 3489833]

209. Visser OHE, Bos PJM. Kaposi’s sarcoma of the conjunctiva and CMV-retinitis in AIDS. Doc Ophthalmol. 1986; 64:77-85. [PubMed 3034535]

210. Cole NL, Balfour HH Jr. In vitro susceptibility of cytomegalovirus isolates from immunocompromised patients to acyclovir and ganciclovir. Diag Microbiol Infect Dis. 1987; 6:255- 61.

211. Shiota H, Naito T, Mimura Y. Anti-herpes simplex virus (HSV) effect of 9-(1,3-dihydroxy -2-propoxymethyl)guanine (DHPG) in rabbit cornea. Curr Eye Res. 1987; 6:241-5. [PubMed 3030645]

212. D’Alessandro AM, Pirsch JD, Stratta RJ et al. Successful treatment of severe cytomegalovirus infections with ganciclovir and CMV hyperimmune globulin in liver transplant recipients. Transplant Proc. 1989; 21:3560-1. [PubMed 2545018]

213. Wilson EJ, Medearis DN Jr, Hansen LA et al. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine prevents death but not immunity in murine cytomegalovirus-infected normal and immunosuppressed BALB/c mice. Antimicrob Agents Chemother. 1987; 31:1017-20. [PubMed 2821884]

214. Taylor DL, Jeffries DJ, Taylor-Robinson D et al. The susceptibility of adenovirus infection to the anti-cytomegalovirus drug and ganciclovir (DHPG). FEMS Microbiol Lett. 1988; 49:337-41.

215. Macdonald EA. Treatment of cytomegalovirus retinitis in a patient with AIDS with 9-(1, 3-dihydroxy-2-propoxymethyl)guanine. Can J Ophthalmol. 1987; 22:48-52. [PubMed 3028588]

216. Anon. Ganciclovir. Med Lett Drugs Ther. 1989; 31:79-80. [PubMed 2549352]

217. Rosecan LR, Laskin OL, Kalman CM et al. Antiviral therapy with ganciclovir for cytomegalovirus retinitis and bilateral exudative retinal detachments in an immunocompromised child. Ophthalmology. 1986; 93:1401-7. [PubMed 3027642]

218. Katzenstein DA, Crane RT, Jordan MC. Successful treatment of murine cytomegalovirus disease does not prevent latent virus infection. J Lab Clin Med. 1986; 108:155-60. [PubMed 3016127]

219. de Hemptinne B, Lamy ME, Salizzoni M et al. Successful treatment of cytomegalovirus disease with 9-(1,3-dihydroxy-2-propoxymethyl)guanine. Transplant Proc. 1988; 20(Suppl 1):652-5. [PubMed 2831645]

220. Shabtai M, Luft B, Waltzer WC et al. Massive cytomegalovirus pneumonia and myocarditis in a renal transplant recipient: successful treatment with DHPG. Transplant Proc. 1988; 20:562-3. [PubMed 2837853]

221. Baba M, Konno K, Shigeta S et al. Inhibitory effects of selected antiviral compounds on newly isolated clinical varicella-zoster virus strains. Tohoku J Exp Med. 1986; 148:275-83. [PubMed 3010502]

222. van der Horst CM, Lin JC, Raab-Traub N et al. Differential effects of acyclovir and 9-(1, 3-dihydroxy-2-propoxymethyl)guanine on herpes simplex virus and Epstein-Barr virus in a dually infected human lymphoblastoid cell line. J Virol. 1987; 61:607-10. [PubMed 3027389]

223. Woolf NK, Ochi JW, Silva EJ et al. Ganciclovir prophylaxis for cochlear pathophysiology during experimental guinea pig cytomegalovirus labyrinthitis. Antimicrob Agents Chemother. 1988; 32:865-72. [PubMed 2843084]

224. Meijer H, Bruggeman CA, Dormans PHJ et al. Human cytomegalovirus induces a cellular deoxyguanosine kinase and also interacting with acyclovir. FEMS Microbiol Lett. 1984; 25:283-7.

225. Drew WL, Buhles W, Erlich KS. Herpesvirus infections (cytomegalovirus and herpes simplex virus, varicella-zoster virus): how to use ganciclovir (DHPG) and acyclovir. Infect Dis Clin North Am. 1988; 2: 495-509. [PubMed 2849621]

226. Corey L. The diagnosis and treatment of genital herpes. JAMA. 1982; 248:1041-9. [IDIS 155741] [PubMed 7109193]

227. Pavan-Langston D, Park NH, Hettinger M. Ganglionic herpes simplex and systemic acyclovir. Arch Ophthalmol. 1981; 99:1417-9. [PubMed 6266375]

228. Fiala M, Payne JE, Berne TV et al. Epidemiology of cytomegalovirus infection after transplantation and immunosuppression. J Infect Dis. 1975; 132:421-33. [PubMed 171315]

229. Pavan-Langston D, Park NH, Lass JH. Herpetic ganglionic latency—aciclovir and vidarabine therapy. Arch Ophthalmol. 1979; 97:1508-10. [PubMed 223531]

230. Bader C, Crumpacker CS, Schnipper LE et al. The natural history of recurrent facial-oral infection with herpes simplex virus. J Infect Dis. 1978; 138:897-905. [PubMed 216753]

231. Graveleau P, Perol R, Chapman A. Regression of cauda equina syndrome in AIDS patient being treated with ganciclovir. Lancet. 1989; 2:511-2. [IDIS 258971] [PubMed 2570224]

232. Russler SK, Tapper MA, Carrigan DR. Susceptibility of human herpesvirus 6 to acyclovir and ganciclovir. Lancet. 1989; 2:382. [PubMed 2569565]

233. Yamanishi K, Okuno T, Shiraki K et al. Identification of human herpesvirus-6 as a causal agent for exanthem subitum. Lancet. 1988; 1:1065-7. [PubMed 2896909]

234. Agut H, Huraux JM, Collandre H et al. Susceptibility of human herpesvirus 6 to acyclovir and ganciclovir. Lancet. 1989; 2:626. [IDIS 259199] [PubMed 2570323]

235. de Miranda P, Burnette T, Cederberg D et al. Absorption and pharmacokinetics of the antiviral 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]-guanine (BW B759U) in humans. Proceedings of ICAAC New Orleans, LA 1986. 1986:200. Abstract No. 566.

236. Lorian V, ed. Antibiotics in laboratory medicine. 2nd ed. Baltimore: Williams & Wilkins; 1986:365-8.

237. Food and Drug Administration. Cumulative list of orphan drugs and biological designations. Fed Regist. 1989; 54:16294-305.

238. Holland GN, Pepose JS, Petit TH et al. Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology. 1983; 90:859-73. [PubMed 6314219]

239. Tyms AS, Taylor DL, Davis JM et al. Cytomegalovirus and adenovirus infections: Response to DHPG. Proceedings of ICAAC Washington, DC 1987:156. Abstract No. 4.4.

240. Danner SA, Eeftinck Schattenkerk JKM, Visser OHE et al. Effects of DHPG on severe cytomegalovirus infection in AIDS. Proceedings of ICAAC Washington, DC 1987:46. Abstract No. 220.

241. Pass RF. Epidemiology and transmission of cytomegalovirus. J Infect Dis. 1985; 152:243-8. [PubMed 2993429]

242. Mintz L, Drew WL, Miner RC et al. Cytomegalovirus infections in homosexual men: an epidemiologic study. Ann Intern Med. 1983; 98:326-9.

243. Jacobson MA, O’Donnell JJ, Porteous D et al. Retinal and gastrointestinal disease due to cytomegalovirus in patients with the acquired immunodeficiency syndrome: prevalence and natural history, and response to ganciclovir therapy. Q J Med. 1988; 67:473-86. [IDIS 311228] [PubMed 2854894]

244. Palestine AG. Clinical aspects of cytomegalovirus retinitis. Rev Infect Dis. 1988; 10:S520-1. [IDIS 309927] [PubMed 2847288]

245. Crawford SW, Bowden RA, Hackman RC et al. Rapid detection of cytomegalovirus pulmonary infection by bronchoalveolar lavage and centrifugation culture. Ann Intern Med. 1988; 108:180-5. [PubMed 2829672]

246. Margulis SJ, Honig CL, Soave R et al. Biliary tract obstruction in the acquired immunodeficiency syndrome. Ann Intern Med. 1986; 105:207-10. [PubMed 3014940]

247. Schneiderman DJ, Cello JP, Laing FC et al. Papillary stenosis and sclerosing cholangitis in the acquired immunodeficiency syndrome. Ann Intern Med. 1987; 106:546-9. [PubMed 3548523]

248. Ettinger NA, Selby P, Powles R et al. Cytomegalovirus pneumonia: the use of ganciclovir in marrow transplant recipients. J Antimicrob Chemother. 1989; 24:53-62. [PubMed 2550414]

249. Grundy JE, Shanley JD, and Griffiths PD. Is cytomegalovirus interstitial pneumonitis in transplant recipients an immunopathological condition? Lancet. 1987; 2:996-9.

250. Guarda LA, Luna MA, Smith JL Jr et al. Acquired Immune deficiency syndrome: postmortem findings. Am J Clin Pathol. 1984; 81:549-57. [PubMed 6326563]

251. Glasgow BJ, Anders K, Layfield LJ et al. Clinical and pathologic findings of the liver in the acquired immune deficiency syndrome (AIDS). Am J Clin Pathol. 1985; 83:582-8. [PubMed 2986450]

252. Quinnan GV Jr, Masur H, Rook AH et al. Herpesvirus infections in the acquired immunodeficiency syndrome. JAMA. 1984; 252:72-77. [PubMed 6328055]

254. Jabs DA, Bolten SG, Dunn JP et al. Discontinuing anticytomegalovirus therapy in patients with immune reconstitution after combination antiretroviral therapy. Am J Ophthalmol. 1998; 126:817-22. [IDIS 422432] [PubMed 9860006]

255. Agut H, Collandre H, Aubin JT et al. In vitro sensitivity of human herpesvirus-6 to antiviral drugs. Res Virol. 1989; 140:219-28. [PubMed 2547238]

256. Jouan M, Saves M, Tubiana R et al. Discontinuation of maintenance therapy for cytomegalovirus retinitis in HIV-infected patients receiving highly active antiretroviral therapy. AIDS. 2001; 15:23-31. [PubMed 11192865]

257. Grossberg HS, Bonnem EM, Buhles Jr WC. GM-CSF with ganciclovir for the treatment of CMV retinitis in AIDS. New Engl J Med. 1989; 320:1560.

258. Primaxin I.V. (imipenem and cilastatin sodium for injection) prescribing information. In: Huff BB, ed. Physicians’ desk reference. 56th ed. Montvale, NJ: Medical Economics Company Inc: 2002:2160-4

260. Yarchoan R, Mitsuya Y, Myers CE et al. Clinical pharmacology of 3′-azido-2′, 3′-dideoxythymidine (zidovudine) and related dideoxynucleosides. N Engl J Med. 1989; 321:726-38.

261. Yarchoan R, Mitsuya H, Thomas RV et al. In vivo activity against HIV and favorable toxicity profile of 2′,3′-dideoxyinosine. Science. 1989; 245:412-5.

262. Reviewers’ comments (personal observations).

263. Dorfman J (Syntex Laboratories, Inc, Palo Alto, CA): Personal communication; 1989 Dec.

264. Heinemann MH. Long-term intravitreal ganciclovir therapy for cytomegalovirus retinopathy. Arch Ophthalmol. 1989; 107:1767-72. [IDIS 261799] [PubMed 2556990]

265. Freeman WR. Intraocular antiviral therapy. Arch Ophthalmol. 1989; 107:1737-9. [IDIS 261797] [PubMed 2556988]

266. Davis CL, Springmeyer S, Gmerek BJ. Central nervous system side effects of ganciclovir. New Engl J Med. 1990; 322:933-4. [IDIS 264358] [PubMed 2156162]

267. Hochster H, Dieterich D, Bozzette S et al. Toxicity of combined ganciclovir and zidovudine for cytomegalovirus disease associated with AIDS: an AIDS clinical trials group study. Ann Intern Med. 1990; 113:111-7. [IDIS 268657] [PubMed 2163228]

268. Anon. Drugs for non-HIV viral infections. Med Lett Drugs Ther. 2000; 44:9-16.

270. Sulecki M, Rosenfeld CS, Przepiorka D et al. Treatment of ganciclcovir-induced neutropenia with recombinant human GM-CSF. Am J Med. 1991; 90:401-2. [IDIS 279302] [PubMed 1848397]

271. Schmidt GM, Horak DA, Niland JC et al. A randomized, controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants. N Engl J Med. 1991; 324:1005-11. [IDIS 279260] [PubMed 1848679]

272. Malone K. From the FDA electronic bulletin board: foscarnet approved. [P91-24] Rockville, MD: Food and Drug Administration; 1991 Sep 27.

273. Henderly DE, Jampol LM. Diagnosis and treatment of cytomegalovirus retinitis. J Acquir Immune Defic Syndr. 1991; 4(Suppl 1):S6-10. [PubMed 1848624]

274. Manischewitz JF, Quinnan GV Jr. Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother. 1990; 34:373-5. [IDIS 262918] [PubMed 2158278]

275. Freitas VR, Fraser-Smith EB, Matthews TR. Increased efficacy of ganciclovir in combination with foscarnet against cytomegalovirus and herpes simplex virus type 2 in vitro and in vivo. Antiviral Res. 1989; 12:205-12. [PubMed 2559657]

276. Jacobson MA, O’Donnell JJ. Approaches to the treatment of cytomegalovirus retinitis: ganciclovir and foscarnet. J Acquir Immune Defic Syndr. 1991; 4(Suppl 1):S11-5.

277. Nelson MR, Barter G, Hawkins D et al. Simultaneous treatment of cytomegalovirus retinitis with ganciclovir and foscarnet. Lancet. 1991; 338:250. [IDIS 283637] [PubMed 1676798]

278. Coker RJ, Tomlinson D, Horner P et al. Treatment of cytomegalovirus retinitis with ganciclovir and foscarnet. Lancet. 1991; 338:574. [IDIS 284714] [PubMed 1678829]

279. Kupfer C, Jabs D, Stein M et al. Clinical alert and HHS News: findings of the Foscarnet-Ganciclovir Cytomegalovirus Trial. Bethesda, MD: National Institutes of Health, National Eye Institute; 1991 Oct 17 and Rockville, MD: US Public Health Service; 1991 Oct 21.

280. Palestine AG, Polis MA, De Smet MD et al. A randomized, controlled trial of foscarnet in the treatment of cytomegalovirus retinitis in patients with AIDS. Ann Intern Med. 1991; 115:665-73. [IDIS 286914] [PubMed 1656826]

281. Hirsch MS. The treatment of cytomegalovirus in AIDS—more than meets the eye. N Engl J Med. 1992; 326:264-6. [IDIS 290416] [PubMed 1309391]

282. Ocular Complications of AIDS Research Group and the AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med. 1992; 326:213-20. [IDIS 290413] [PubMed 1345799]

283. Merigan TC, Renlund DG, Keay S et al. A controlled trial of ganciclovir to prevent cytomegalovirus disease after heart transplantation. N Engl J Med. 1992; 326:1182-6. [IDIS 295126] [PubMed 1313549]

284. Goodrich JM, Mori M, Gleaves CA et al. Early treatment with ganciclovir to prevent cytomegalovirus disease after allogeneic bone marrow transplantation. N Engl J Med. 1991; 325:1601-7. [IDIS 288478] [PubMed 1658652]

285. Bailey TC, Trulock EP, Ettinger NA et al. Failure of prophylactic ganciclovir to prevent cytomegalovirus disease in recipients of lung transplants. J Infect Dis. 1992; 165:548-52. [IDIS 292344] [PubMed 1311352]

286. Rubin RH. Preemptive therapy in immunocompromised hosts. N Engl J Med. 1991; 324:1057-8. [PubMed 1848680]

287. Laske A, Gallino A, Mohacsi P et al. Prophylactic treatment with ganciclovir for cytomegalovirus infection in heart transplantation. Transplant Proc. 1991; 23:1170-3. [PubMed 1846456]

288. Bailey TC, Trulock EP, Storch GA et al. Ganciclovir for cytomegalovirus after heart transplantation. N Engl J Med. 1991; 327:891.

289. Winston DJ. Ganciclovir for cytomegalovirus after heart transplantation. N Engl J Med. 1991; 327:891.

290. Stanat SC, Reardon JE, Erice A et al. Ganciclovir-resistant cytomegalovirus clinical isolates: mode of resistance to ganciclovir. Antimicrob Agents Chemother. 1991; 35:2191-7. [PubMed 1666492]

291. Jacobson MA, Drew WL, Feinberg J et al. Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis in patients with AIDS. J Infect Dis. 1991; 163:1348-51. [IDIS 283425] [PubMed 1645385]

292. Knox KK, Drobyski WR, Carrigan DR. Cytomegalovirus isolate resistant to ganciclovir and foscarnet from a marrow transplant patient. Lancet. 1991; 337:1292-3. [IDIS 281171] [PubMed 1674092]

293. Pau AK, Pitrak DL. Management of cytomegalovirus infection in patients with acquired immunodeficiency syndrome. Clin Pharm. 1990; 9:613-31. [IDIS 269444] [PubMed 2167189]

294. Medina DJ, Hsiung GD, Mellors JW. Ganciclovir antagonizes the anti-human immunodeficiency virus type 1 activity of zidovudine and didanosine in vitro. Antimicrob Agents Chemother. 1992; 36:1127-30. [PubMed 1510405]

295. Prichard MN, Prichard LE, Baguley WA et al. Three-dimensional analysis of the synergistic cytotoxicity of ganciclovir and zidovudine. Antimicrob Agents Chemother. 1991; 35:1060-5. [PubMed 1929243]

296. Parasrampuria J, Li LC, Stelmach AH et al. Stability of ganciclovir sodium in 5% dextrose injection and in 0.9% sodium chloride injection over 35 days. Am J Hosp Pharm. 1992; 49:116-8. [PubMed 1570851]

297. Mole L, Oliva C, O’Hanley P. Extended stability of ganciclovir for outpatient parenteral therapy for cytomegalovirus retinitis. J Acquir Immune Defic Syndr. 1992; 5:354-8. [PubMed 1312595]

298. Hartman NR, Yarchoan R, Pluda JM et al. Pharmacokinetics of 2′,3′-dideoxyinosine in patients with severe human immunodeficiency infection: II. The effects of different oral formulations and the presence of other medications. Clin Pharmacol Ther. 1991; 50:278-85. [IDIS 289389] [PubMed 1914362]

299. Bristol. Videx (didanosine) prescribing information. Princeton, NJ; (undated).

300. Drew WL. Cytomegalovirus infection in patients with AIDS. Clin Infect Dis. 1992; 14:608-15. [IDIS 292077] [PubMed 1313313]

301. Faulds D, Brogden RN. Didanosine: a review of its antiviral activity, pharmacokinetic properties and therapeutic potential in human immunodeficiency virus infection. Drugs. 1992; 44:94-116. [PubMed 1379914]

302. Laske A, Gallino A, Carrel T et al. Ganciclovir for cytomegalovirus after heart transplantation. N Engl J Med. 1992; 327:892. [IDIS 302113] [PubMed 1324433]

303. Merigan TC, Renlund D, Buhles W et al. N Engl J Med. 1992; 327:892-3. Reply.

304. Yau JC, Dimopoulos MA, Huan SD et al. Prophylaxis of cytomegalovirus infection with ganciclovir in allogeneic marrow transplantation. Eur J Haematol. 1991; 47:371-6. [PubMed 1662140]

305. Atkinson K, Downs K, Golenia M et al. Prophylactic use of ganciclovir in allogeneic bone marrow transplantation: absence of clinical cytomegalovirus infection. Br J Haematol. 1991; 79:57-62. [PubMed 1654994]

306. Goodrich JM, Bowden RA, Fisher L et al. Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant. Ann Intern Med. 1993; 118:173-8. [IDIS 308701] [PubMed 8380242]

307. Winston DJ, Ho WG, Bartoni K et al. Ganciclovir prophylaxis of cytomegalovirus infection and disease in allogeneic bone marrow transplant recipients. Ann Intern Med. 1993; 118:179-84. [IDIS 308702] [PubMed 8380243]

309. Jacobson MA, Owen W, Campbell J et al. Tolerability of combined ganciclovir and didanosine for the treatment of cytomegalovirus disease associated with AIDS. Clin Infect Dis. 1993; 16(Suppl 1):S69-73. [IDIS 309737] [PubMed 8381032]

310. Dieterich DT, Poles MA, Lew EA et al. Concurrent use of ganciclovir and foscarnet to treat cytomegalovirus infection in AIDS patients. J Infect Dis. 1993; 167:1184-8. [IDIS 313719] [PubMed 8387563]

311. Spector SA, Weingeist T, Pollard RB et al. A randomized, controlled study of intravenous ganciclovir therapy for cytomegalovirus peripheral retinitis in patients with AIDS. J Infect Dis. 1993; 168:557-63. [IDIS 320045] [PubMed 8394858]

312. Peters M, Schurmann D, Pohle HD et al. Combined and alternating ganciclovir/foscarnet in HIV-related cytomegalovirus encephalitis. Lancet. 1992; 340:970. [IDIS 304141] [PubMed 1357363]

313. Rubin RH, Tolkoff-Rubin NE. Antimicrobial strategies in the care of organ transplant recipients. Antimicrob Agents Chemother. 1993; 37:619-24. [IDIS 312544] [PubMed 8494357]

314. Zaia JA. Prevention and treatment of cytomegalovirus pneumonia in transplant recipients. Clin Infect Dis. 1993; 17(Suppl 2):S392-9. [IDIS 323663] [PubMed 8274605]

315. Buckner FS, Pomeroy C. Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infect Dis. 1993; 17:644-56. [IDIS 320731] [PubMed 8268345]

316. Dieterich DT, Kotler DP, Busch DF et al. Ganciclovir treatment of cytomegalovirus colitis in AIDS: a randomized, double-blind, placebo-controlled multicenter study. J Infect Dis. 1993; 167:278-82. [IDIS 308739] [PubMed 8380610]

317. US Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA) Prevention of Opportunistic Infections Working Group. 2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons with human immunodeficiency virus. From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website ()

319. Masur H, Whitcup SM, Cartwright C et al. Advances in the management of AIDS-related cytomegalovirus retinitis. Ann Intern Med. 1996; 125:126-36. [IDIS 367652] [PubMed 8678367]

320. Stewart JA, Reef SE, Pellett PE et al. Herpesvirus infections in persons infected with human immunodeficiency virus. Clin Infect Dis. 1995; 21(Suppl 1):S114-20. [PubMed 8547499]

321. Spector SA, McKinley GF, Lalezari JP et al. Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. N Engl J Med. 1996; 334:1491-7. [IDIS 366984] [PubMed 8618603]

322. Crumpacker CS. Ganciclovir. N Engl J Med. 1996; 335:721-9. [IDIS 371706] [PubMed 8786764]

323. Chiron Vision Corporation. Vitrasert sterile intravitreal implant with cytovene (ganciclovir, 4.5 mg) for intravitreal implantation only prescribing information. Irvine, CA; 1996.

324. Winston DJ, Wirin D, Shaked A et al. Randomised comparison of ganciclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in liver-transplant recipients. Lancet. 1995; 346:69-74. [IDIS 351694] [PubMed 7603215]

325. Gane E, Saliba S, Valdecasas JCG et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. Lancet. 1997; 350:1729-33. [IDIS 396260] [PubMed 9413463]

326. Goodrich J, Khardori N. Cytomegalovirus: the taming of the beast? Lancet. 1997; 350:1718-19.

327. Patel R, Snydman DR, Rubin RH et al. Cytomegalovirus prophylaxis in solid organ transplant recipients. Transplantation. 1996; 61:1279-89. [IDIS 366072] [PubMed 8629285]

328. Paya CV. Defining an optimal regimen for cytomegalovirus prophylaxis in organ transplant recipients. Transplant Proc. 1996; 28(Suppl 2):9-11. [IDIS 377216] [PubMed 9037269]

329. Griffiths PD. Prophylaxis against CMV infection in transplant patients. J Antimicrob Chemother. 1997; 39:299-301. [IDIS 384980] [PubMed 9096177]

330. Conti DJ, Shen G, Singh T et al. Ganciclovir prophylaxis of cytomegalovirus disease. Transplant Proc. 1997; 29:804-6. [IDIS 381942] [PubMed 9123534]

331. Prentice HG, Kho P. Clinical strategies for the management of cytomegalovirus infection and disease in allogeneic bone marrow transplant. Bone Marrow Transplant. 1997; 19:135-42. [IDIS 384620] [PubMed 9116610]

332. Badas A, Stoukides CA. Guidelines for prophylaxis of cytomegalovirus disease in bone marrow transplant patients. Ann Pharmacother. 1996; 30:1483-6. [IDIS 376989] [PubMed 8968462]

333. Reusser P. The challenge of cytomegalovirus infection after bone arrow transplantation: epidemiology, prophylaxis, and therapy. Bone Marrow Transplant. 1996; 18:107-9. [IDIS 380276] [PubMed 8932809]

334. Hibberd PL, Tolkoff-Rubin NE, Conti D et al. Preemptive ganciclovir therapy to prevent cytomegalovirus disease in cytomegalovirus antibody-positive renal transplant recipients. Ann Intern Med. 1995; 123:18-26. [IDIS 348622] [PubMed 7762909]

335. Rowe JM, Ciobanu N, Ascensao J et al et al. Recommended guidelines for the management of autologous and allogeneic bone marrow transplantation: a report from the Eastern Cooperative Oncology Group (ECOG). Ann Intern Med. 1994; 120:143-58. [IDIS 323859] [PubMed 8256974]

336. Whitley RS, Jacobson MA, Friedberg DN et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy—recommendations of an international panel. Arch Intern Med. 1998; 158:957-69. [IDIS 406378] [PubMed 9588429]

337. Cunningham ET, Margolis TP. Ocular manifestations of HIV infection. N Engl J Med. 1998; 339:336-44.

338. Roche. Valcyte (valganciclovir hydrochloride) tablets prescribing information. Nutley, NJ; 2001 Mar.

339. Balfour HH. Antiviral drugs. N Engl J Med. 1999; 340:1255-68. [IDIS 423356] [PubMed 10210711]

340. Martin DF, Dunn JP, Davis JL et al. Use of ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy: recommendations of the International AIDS Society—USA panel. Am J Ophthalmol. 1999; 127:329-39. [IDIS 425111] [PubMed 10088745]

341. Tural C, Romeu J, Sirera G et al. Long-lasting remission of cytomegalovirus retinitis without maintenance therapy in human immunodeficiency virus-infected patients. J Infect Dis. 1998; 177:1080-3. [IDIS 403650] [PubMed 9534987]

342. MacDonald JC, Torriani FJ, Morse LS et al. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis. 1998; 177:1182-7. [IDIS 405276] [PubMed 9593001]

343. Vrabec TR, Baldassano VF, Whitcup SM. Discontinuation of maintenance therapy in patients with quiescent cytomegalovirus retinitis and elevated CD4+ counts. Ophthalmology. 1998; 105:1259-64. [PubMed 9663231]

344. Martin DF, Kuppermann BD, Wolitz RA et al. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. N Engl J Med. 1999; 340:1063-70. [IDIS 430951] [PubMed 10194235]

345. Whitley RJ, Holland GN. Cytomegalovirus retinitis—evolving therapies in a new era. N Engl J Med. 1999; 340:1109-10. [IDIS 430953] [PubMed 10194243]

346. Jayasekara D, Aweeka FT, Rodriguez R et al. Antiviral therapy for HIV patients with renal insufficiency. J Acquir Immune Defic Syndr. 1999; 21:384-95. [IDIS 433126] [PubMed 10458619]

347. Cimoch PJ, Lavelle P, Pollard R et al. Pharmacokinetics of oral ganciclovir alone and in combination with zidovudine, didanosine, and probenecid in HIV-infected subjects. J Acquir Immun Defic Syndr Hum Retrovirol. 1998; 17:227-34.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:550-3.

b. Bristol-Myers Squibb. Videx (didanosine) chewable/dispersible buffered tablets, buffered powder for oral solution, pediatric powder for oral solution prescribing information. Princeton, NJ; 2003 Feb.

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