(si DOF o veer)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Vistide: 75 mg/mL (5 mL)
Solution, Intravenous [preservative free]:
Generic: 75 mg/mL (5 mL)
Brand Names: U.S.
- Antiviral Agent
Cidofovir is converted to cidofovir diphosphate (the active intracellular metabolite); cidofovir diphosphate suppresses CMV replication by selective inhibition of viral DNA synthesis. Incorporation of cidofovir diphosphate into growing viral DNA chain results in viral DNA synthesis rate reduction.
Vd: 0.41 L/kg; does not cross significantly into CSF
Minimal; phosphorylation occurs intracellularly to the active metabolite cidofovir diphosphate
Urine (70% to 85% as unchanged drug)
Renal clearance without probenecid: 150 ± 26.9 mL/minute/1.73 m2
Renal clearance with probenecid: 98.6 ± 27.9 mL/minute/1.73 m2
Plasma: ~2.6 hours; intracellular elimination half-lives of metabolites are longer (range: 24 to 87 hours) (Lea, 1996)
Special Populations: Renal Function Impairment
Clearance decreases proportionally with CrCl.
Use: Labeled Indications
Cytomegalovirus retinitis: Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS.
Limitations of use: Safety and efficacy have not been established for treatment of other CMV infections (eg, pneumonitis, gastroenteritis), congenital or neonatal CMV disease, or CMV disease in non-HIV infected individuals.
Hypersensitivity to cidofovir or any component of the formulation; history of clinically-severe hypersensitivity to probenecid or other sulfa-containing medications; serum creatinine >1.5 mg/dL; CrCl ≤55 mL/minute; urine protein ≥100 mg/dL (≥2+ proteinuria); use with or within 7 days of nephrotoxic agents; direct intraocular injection
Cytomegalovirus (CMV) retinitis: Adults: IV:
Induction: 5 mg/kg/dose with concomitant probenecid once weekly for 2 consecutive weeks
Maintenance: 5 mg/kg/dose with concomitant probenecid once every 2 weeks
Probenecid: 2 g 3 hours prior to cidofovir dose, then 1 g at 2 hours and 8 hours after completion of the infusion.
Hydration: Patients should also receive 1 L of NS intravenously infused over 1 to 2 hours immediately prior to each cidofovir infusion. If tolerated, a second liter may be administered over 1 to 3 hours at the start of cidofovir infusion or immediately following infusion.
Dosage adjustment in renal impairment:
Preexisting renal impairment: Serum creatinine >1.5 mg/dL, CrCl ≤55 mL/minute, or urine protein ≥100 mg/dL (≥2+ proteinuria): Use is contraindicated.
Changes in renal function during therapy:
Serum creatinine increases by 0.3 to 0.4 mg/dL: Reduce dose to 3 mg/kg.
Serum creatinine increases ≥0.5 mg/dL or development of ≥3+ proteinuria: Discontinue therapy.
Dosage adjustment in hepatic impairment: There are no dosage adjustments provided in the manufacturer’s labeling.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).
Dilute dose in NS 100 mL prior to infusion.
For IV infusion only. Infuse over 1 hour. Administer with concomitant probenecid. Hydrate with 1 L of NS IV over 1 to 2 hours immediately prior to cidofovir infusion. If tolerated, a second liter may be administered over a 1- to 3-hour period at the start of or immediately following cidofovir infusion.
Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).
Stable in D51/4NS, D5W, NS.
Store intact vials at 20°C to 25°C (68°F to 77°F). Admixtures may be stored for ≤24 hours under refrigeration; however, admixtures must be administered within 24 hours of preparation.
Tenofovir Products: Cidofovir may increase the serum concentration of Tenofovir Products. Tenofovir Products may increase the serum concentration of Cidofovir. Monitor therapy
Central nervous system: Chills, fever, headache, pain
Dermatologic: Alopecia, rash
Gastrointestinal: Nausea, vomiting, diarrhea, anorexia
Hematologic: Anemia, neutropenia
Neuromuscular & skeletal: Weakness
Ocular: Intraocular pressure decreased, iritis, ocular hypotony, uveitis
Renal: Creatinine increased, proteinuria, renal toxicity
Respiratory: Cough, dyspnea
Miscellaneous: Infection, oral moniliasis, serum bicarbonate decreased
1% to 10%:
Renal: Fanconi syndrome
<1%: Hepatic failure, metabolic acidosis, pancreatitis
Frequency not defined (limited to important or life-threatening reactions):
Cardiovascular: Cardiomyopathy, cardiovascular disorder, CHF, edema, orthostatic hypotension, shock, syncope, tachycardia
Central nervous system: Agitation, amnesia, anxiety, confusion, convulsion, dizziness, hallucinations, insomnia, malaise, vertigo
Dermatologic: Photosensitivity reaction, skin discoloration, urticaria
Endocrine & metabolic: Adrenal cortex insufficiency
Gastrointestinal: Abdominal pain, aphthous stomatitis, colitis, constipation, dysphagia, fecal incontinence, gastritis, GI hemorrhage, gingivitis, melena, proctitis, splenomegaly, stomatitis, tongue discoloration
Genitourinary: Urinary incontinence
Hematologic: Hypochromic anemia, leukocytosis, leukopenia, lymphadenopathy, lymphoma-like reaction, pancytopenia, thrombocytopenia, thrombocytopenic purpura
Hepatic: Hepatomegaly, hepatosplenomegaly, jaundice, liver function tests abnormal, liver damage, liver necrosis
Local: Injection site reaction
Neuromuscular & skeletal: Tremor
Ocular: Amblyopia, blindness, cataract, conjunctivitis, corneal lesion, diplopia, vision abnormal
Otic: Hearing loss
Miscellaneous: Allergic reaction, sepsis
Concerns related to adverse effects:
• Carcinogenic/teratogenic: [US Boxed Warning]: Possibly carcinogenic and teratogenic based on animal data. May cause hypospermia.
• Metabolic acidosis: Monitor for signs of metabolic acidosis; decreased sodium bicarbonate with proximal tubule injury and renal wasting syndrome (including Fanconi syndrome), as well as metabolic acidosis with hepatic impairment and pancreatitis (including some fatal cases) have been reported.
• Nephrotoxicity: [US Boxed Warning]: Acute renal failure resulting in dialysis and/or contributing to death has occurred with as few as 1 or 2 doses of cidofovir. Renal function (serum creatinine and urine protein) must be monitored within 48 hours prior to each dose of cidofovir and the dose of cidofovir modified as appropriate. Administration must be accompanied by oral probenecid and intravenous saline prehydration.
• Neutropenia: [US Boxed Warning]: Neutropenia has been reported; monitor neutrophil counts during therapy.
• Ocular complications: Decreased intraocular pressure, sometimes associated with decreased visual acuity, uveitis, or iritis may occur; monitor intraocular pressure for and signs of iritis/uveitis during therapy. If uveitis or iritis occurs, consider treatment with topical corticosteroids with or without topical cycloplegic agents.
• Renal impairment: Contraindicated in patients with a baseline serum creatinine >1.5 mg/dL, CrCl ≤55 mL/minute, or urine protein ≥100 mg/dL (≥2+ proteinuria); dosage adjustment or discontinuation of therapy may be required for changes in renal function during treatment.
• Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).
• Administration: For intravenous use only, not for direct intraocular injection; iritis, ocular hypotony, and permanent impairment of vision may occur.
• Appropriate use: [US Boxed Warning]: Indicated only for CMV retinitis treatment in patients with AIDS.
Serum creatinine and urine protein (at baseline and within 48 hours of each dose), WBC with differential (prior to each dose); intraocular pressure and visual acuity, signs and symptoms of uveitis/iritis; metabolic acidosis.
Pregnancy Risk Factor
[US Boxed Warning]: Possibly carcinogenic and teratogenic based on animal data. May cause hypospermia. Women of childbearing potential should use effective contraception during therapy and for 1 month following treatment. Males should use a barrier contraceptive during therapy and for 3 months following treatment.
The indications for treating CMV retinitis during pregnancy are the same as in nonpregnant HIV infected woman; however systemic therapy should be avoided during the first trimester when possible. When therapy is needed to treat maternal infection, agents other than cidofovir are recommended (DHHS [Adult OI 2014]).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience headache, diarrhea, lack of appetite, alopecia, vomiting, cough, or nausea. Have patient report immediately to prescriber signs of kidney problems (urinary retention, blood in urine, change in amount of urine passed, weight gain), signs of infection, signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), illogical thinking, black, tarry, or bloody stools, angina, tachycardia, vision changes, eye pain, eye irritation, depression, hallucinations, change in balance, burning or numbness feeling, seizures, shortness of breath, excessive weight gain, swelling of arm or leg, bloating, tremors, difficulty moving, rigidity, bruising, bleeding, loss of strength and energy, or white patches in mouth (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
More about cidofovir
- Other brands: Vistide