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Foscarnet Disease Interactions

There are 4 disease interactions with foscarnet:

Major

Foscarnet (Includes Foscarnet) ↔ Dehydration

Severe Potential Hazard, High plausibility

Applies to: Dehydration

Foscarnet is nephrotoxic. Foscarnet crystals may deposit in renal tubules and capillaries, sometimes causing acute tubular necrosis and renal failure. Foscarnet may also concentrate in the urine and cause penile or vulvovaginal irritation. Adequate hydration is crucial to minimize the risk of renal damage and genital ulcerations. Generally, foscarnet should be administered by an infusion pump over 1 to 2 hours accompanied by hydration. The manufacturer recommends 750 to 1000 mL of normal saline or 5% dextrose solution prior to the first infusion of foscarnet to establish diuresis, then 500 mL (for 40 to 60 mg/kg dose of foscarnet) or 750 to 1000mL (for 90 to 120 mg/kg dose of foscarnet) of hydration fluid concurrently with each subsequent foscarnet infusion. Patients who are dehydrated may be at increased risk for the development of nephrotoxicity and may benefit from additional hydration if tolerated.

References

  1. Sohl Akerlund A, Keisu M, Lernestedt JO, Sandberg M "Penile ulcerations in connection with foscarnet therapy. Clinical picture and incidence." Int Conf AIDS 9 (1993): 358
  2. Deray G, Le Hoang P, Soubrie C, et al "Foscarnet-induced acute renal failure and effectiveness of haemodialysis." Lancet 2 (1987): 216
  3. Evans LM, Grossman ME "Foscarnet-induced penile ulcer." J Am Acad Dermatol 27 (1992): 124-6
View all 17 references
Major

Foscarnet (Includes Foscarnet) ↔ Electrolyte Disturbances

Severe Potential Hazard, High plausibility

Applies to: Hypocalcemia, Hypokalemia, Magnesium Imbalance, Phosphate Imbalance, Electrolyte Abnormalities, CNS Disorder, Heart Disease

Foscarnet may cause electrolyte disturbances, including hypocalcemia, hypo- or hyperphosphatemia, hypomagnesemia, and hypokalemia. Ionized serum calcium may also demonstrate a dose-dependent (and possibly rate-dependent) decrease that may not be reflected in total serum calcium. Patients should be instructed to report symptoms of low ionized calcium such as perioral tingling, numbness in the extremities, and paresthesias. Other electrolyte-related complications include tetany, seizures, and cardiac disturbances. Therapy with foscarnet should be administered cautiously in patients with preexisting fluid and electrolyte imbalance and those with underlying cardiac or neurologic abnormalities. Serum electrolyte levels should be closely monitored and managed in all patients treated with foscarnet.

References

  1. Conn J, Colman P, Brown G, Street A, Bate K "Nephrogenic diabetes insipidus associated with foscarnet - a case report." J Antimicrob Chemother 37 (1996): 1179-81
  2. Jacobson MA, Gambertoglio JG, Aweeka FT, et al "Foscarnet-induced hypocalcemia and effects of foscarnet on calcium metabolism." J Clin Endocrinol Metab 72 (1991): 1130-5
  3. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
View all 12 references
Major

Foscarnet (Includes Foscarnet) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Foscarnet is eliminated primarily by the kidney. Patients with renal impairment may be at greater risk for dose-limiting nephrotoxicity and other adverse effects of foscarnet due to decreased drug clearance. Renal function should be closely monitored in all patients receiving therapy with foscarnet, and the dosage adjusted based on serum creatinine. Hydration is recommended to reduce the risk of nephrotoxicity. The manufacturer recommends 750 to 1000 mL of normal saline or 5% dextrose solution prior to the first infusion of foscarnet to establish diuresis, then 500 mL (for 40 to 60 mg/kg dose of foscarnet) or 750 to 1000mL (for 90 to 120 mg/kg dose of foscarnet) of hydration fluid concurrently with each subsequent foscarnet infusion. The use of foscarnet is not recommended in patients with severe renal impairment indicated by a CrCl < 0.4 mL/min/kg.

References

  1. Cacoub P, Deray G, Baumelou A, et al "Acute renal failure induced by foscarnet: 4 cases." Clin Nephrol 29 (1988): 315-8
  2. Chrisp P, Clissold SP "Foscarnet: a review of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with cytomegalovirus retinitis." Drugs 41 (1991): 104-29
  3. Deray G, Martinez F, Katlama C, et al "Foscarnet nephrotoxicity: mechanism, incidence and prevention." Am J Nephrol 9 (1989): 316-21
View all 16 references
Moderate

Foscarnet (Includes Foscarnet) ↔ Hematologic Toxicities

Moderate Potential Hazard, High plausibility

Applies to: Anemia, Neutropenia, Thrombocytopenia

The use of foscarnet is associated with hematologic toxicities, most commonly anemia and granulocytopenia. Thrombocytopenia has been reported rarely. Therapy with foscarnet should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Routine blood counts are recommended.

References

  1. Ringden O, Lonnqvist B, Paulin T, et al "Pharmacokinetics, safety and preliminary clinical experiences using foscarnet in the treatment of cytomegalovirus infections in bone marrow and renal transplant recipients." J Antimicrob Chemother 17 (1986): 373-87
  2. Jacobson MA "Review of the toxicities of foscarnet." J Acquir Immune Defic Syndr 5 (1992): s11-7
  3. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
View all 6 references

foscarnet drug Interactions

There are 148 drug interactions with foscarnet

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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