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Foscarnet Disease Interactions

There are 4 disease interactions with foscarnet:

Major

Foscarnet (applies to foscarnet) dehydration

Major Potential Hazard, High plausibility.

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 1000 mL (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. Deray G, Le Hoang P, Soubrie C, et al "Foscarnet-induced acute renal failure and effectiveness of haemodialysis." Lancet 2 (1987): 216
  2. Evans LM, Grossman ME "Foscarnet-induced penile ulcer." J Am Acad Dermatol 27 (1992): 124-6
  3. 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
  4. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
  5. 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
  6. Cacoub P, Deray G, Baumelou A, et al "Acute renal failure induced by foscarnet: 4 cases." Clin Nephrol 29 (1988): 315-8
  7. Deray G, Martinez F, Katlama C, et al "Foscarnet nephrotoxicity: mechanism, incidence and prevention." Am J Nephrol 9 (1989): 316-21
  8. Saint-Marc T, Fournier F, Touraine J-L, Marneff E "Uvula and oesophageal ulcerations with foscarnet." Lancet 340 (1992): 970-1
  9. Caumes E, Gatineau M, Bricaire F, Dohin E, Katlama C, Gentilini M "Foscarnet-induced vulvar erosion." J Am Acad Dermatol 28 (1993): 799
  10. Moyle G, Barton S, Gazzard BG "Penile ulceration with foscarnet therapy." AIDS 7 (1993): 140-1
  11. Jacobson MA "Review of the toxicities of foscarnet." J Acquir Immune Defic Syndr 5 (1992): s11-7
  12. Holbrook J, Jabs D, Jacobson M, Mendez P, Min Y, Murphy R "Foscarnet-related abnormalities in serum creatinine, calcium, and magnesium in patients with CMV retinitis. The SOCA Research Group." Int Conf AIDS 9 (1993): 361
  13. Navarro JF, Quereda C, Moreno A, Quereda C "Renal tubular acidosis following treatment with foscarnet." AIDS 9 (1995): 1389-90
  14. Gilquin J, Weiss L, Kazatchkine MD "Genital and oral erosions induced by foscarnet." Lancet 335 (1990): 287
  15. Fegeuex S, Salmon D, Picard C, et al "Penile ulcerations with foscarnet." Lancet 335 (1990): 547-8
  16. Deray G, Katlama C, Dohin E "Prevention of foscarnet nephrotoxicity." Ann Intern Med 113 (1990): 332
  17. Lacey HB, Ness A, Mandal BK "Vulval ulceration associated with foscarnet." Genitourin Med 68 (1992): 182
View all 17 references
Major

Foscarnet (applies to foscarnet) electrolyte disturbances

Major Potential Hazard, High plausibility. Applicable conditions: 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. Malin A, Miller RF "Foscarnet-induced hypokalaemia." J Infect 25 (1992): 329-30
  4. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
  5. 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
  6. Gearhart MO, Sorg TB "Foscarnet-induced severe hypomagnesemia and other electrolyte disorders." Ann Pharmacother 27 (1993): 285-9
  7. Brown DL, Sather S, Cheitlin MD "Reversible cardiac dysfunction associated with foscarnet therapy for cytomegalovirus esophagitis in an AIDS patient." Am Heart J 125 (1993): 1439-41
  8. Holbrook J, Jabs D, Jacobson M, Mendez P, Min Y, Murphy R "Foscarnet-related abnormalities in serum creatinine, calcium, and magnesium in patients with CMV retinitis. The SOCA Research Group." Int Conf AIDS 9 (1993): 361
  9. 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
  10. 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 115 (1991): 665-73
  11. Jacobson MA "Review of the toxicities of foscarnet." J Acquir Immune Defic Syndr 5 (1992): s11-7
  12. Blanshard C "Treatment of HIV-related cytomegalovirus disease of the gastrointestinal tract with foscarnet." J Acquir Immune Defic Syndr 5 (1992): s25-8
View all 12 references
Major

Foscarnet (applies to foscarnet) renal dysfunction

Major Potential Hazard, High plausibility.

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 1000 mL (for 90 to 120 mg/kg dose of foscarnet) of hydration fluid concurrently with each subsequent foscarnet infusion. Foscarnet should be used with caution in patients with abnormal renal function because reduced plasma clearance of foscarnet will result in elevated plasma levels. Foscarnet dosing must be individualized according to the patient's renal function status. The use of foscarnet is not recommended in patients with severe renal impairment indicated by a CrCl < 0.4 mL/min/kg and in those patients undergoing hemodialysis because dosage guidelines have not been established.

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
  4. Jacobson MA "Review of the toxicities of foscarnet." J Acquir Immune Defic Syndr 5 (1992): s11-7
  5. Seidel EA, Koenig S, Polis MA "A dose escalation study to determine the toxicity and maximally tolerated dose of foscarnet." AIDS 7 (1993): 941-5
  6. Aweeka FT, Omachi R, Jacobson MA, Schoenfeld P, Munley SM, Gambetoglio J "Pharmacokinetics (PK) of foscarnet in patients (PTS) with varying degrees of renal function." Int Conf AIDS 9 (1993): p485o-b26-2097
  7. Navarro JF, Quereda C, Moreno A, Quereda C "Renal tubular acidosis following treatment with foscarnet." AIDS 9 (1995): 1389-90
  8. Holbrook J, Jabs D, Jacobson M, Mendez P, Min Y, Murphy R "Foscarnet-related abnormalities in serum creatinine, calcium, and magnesium in patients with CMV retinitis. The SOCA Research Group." Int Conf AIDS 9 (1993): 361
  9. Deray G, Katlama C, Dohin E "Prevention of foscarnet nephrotoxicity." Ann Intern Med 113 (1990): 332
  10. 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
  11. Farese RV Jr, Schambelan M, Hollander H, et al "Nephrogenic diabetes insipidus associated with foscarnet treatment of cytomegalovirus retinitis." Ann Intern Med 112 (1990): 955-6
  12. Deray G, Le Hoang P, Soubrie C, et al "Foscarnet-induced acute renal failure and effectiveness of haemodialysis." Lancet 2 (1987): 216
  13. Deray G, Martinez F, Katlama C, et al "Foscarnet nephrotoxicity: mechanism, incidence and prevention." Am J Nephrol 9 (1989): 316-21
  14. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
  15. SOCA Reseach Group, et al "Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis." N Engl J Med 326 (1992): 213-20
  16. MacGregor RR, Graziani AL, Weiss R, et al "Successful foscarnet therapy for cytomegalovirus retinitis in an AIDS patient undergoing hemodialysis: rationale for empiric dosing and plasma level monitoring." J Infect Dis 164 (1991): 785-7
View all 16 references
Moderate

Foscarnet (applies to foscarnet) hematologic toxicities

Moderate Potential Hazard, High plausibility. Applicable conditions: Anemia, Neutropenia, Thrombocytopenia, History - Blood Dyscrasias

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. Jacobson MA "Review of the toxicities of foscarnet." J Acquir Immune Defic Syndr 5 (1992): s11-7
  2. Willocks L, Brettle R "Foscarnet and pancytopenia." J Antimicrob Chemother 29 (1992): 232
  3. "Product Information. Foscavir (foscarnet)." Astra USA, Westborough, MA.
  4. 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 115 (1991): 665-73
  5. 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
  6. 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
View all 6 references

Foscarnet drug interactions

There are 336 drug interactions with foscarnet

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.