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Drug Interactions between cidofovir and ganciclovir

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

ganciclovir cidofovir

Applies to: ganciclovir and cidofovir

CONTRAINDICATED: Coadministration of cidofovir with other nephrotoxic agents may increase the risk of renal impairment due to additive effects on the kidney. Dose-related nephrotoxicity is the major toxicity of cidofovir. Cases of acute renal failure resulting in dialysis and/or contributing to death have occurred with as few as one or two doses of cidofovir. Proteinuria may be an early indicator of cidofovir-related nephrotoxicity, and continued treatment may lead to additional proximal tubular cell injury resulting in glycosuria; decreases in serum phosphate, uric acid, and bicarbonate; elevations in serum creatinine; and acute renal failure. Some reported cases have met the criteria of Fanconi syndrome. In clinical trials, cases of nephrotoxicity in which renal function did not return to baseline after drug discontinuation have also been reported.

MANAGEMENT: Concomitant use of cidofovir with other potentially nephrotoxic agents (e.g., aminoglycosides; polypeptide, glycopeptide, and polymyxin antibiotics; amphotericin B; aminosalicylates; antiviral/antiretroviral agents such as acyclovir, adefovir, foscarnet, ganciclovir, and tenofovir; antineoplastics such as aldesleukin, cisplatin, clofarabine, ifosfamide, streptozocin, and high intravenous dosages of methotrexate; chelating agents such as deferasirox, deferoxamine, edetate disodium, and edetate calcium disodium; immunosuppressants such as cyclosporine, everolimus, sirolimus, and tacrolimus; intravascular contrast media; intravenous bisphosphonates; intravenous pentamidine; high dosages and/or chronic use of nonsteroidal anti-inflammatory agents; gallium nitrate; lithium; penicillamine) is considered contraindicated. Such agents should be discontinued for at least seven days prior to starting therapy with cidofovir. Initiation of cidofovir is also contraindicated in patients with a serum creatinine >1.5 mg/dL, a calculated creatinine clearance <=55 mL/min, or a urine protein >=100 mg/dL (2+ proteinuria or greater).

References (1)
  1. (2001) "Product Information. Vistide (cidofovir)." Gilead Sciences

Drug and food interactions

Moderate

ganciclovir food

Applies to: ganciclovir

ADJUST DOSING INTERVAL: Food delays but enhances the oral absorption and bioavailability of ganciclovir capsules, possibly due to prolongation of gastrointestinal transit time. In 20 HIV- and CMV-seropositive subjects, ganciclovir dosing (1000 mg every 8 hours) following a standardized high-fat breakfast increased the mean steady-state peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of ganciclovir by an average of 15% and 22%, respectively, compared to dosing after an overnight fast. The time to reach peak plasma concentration (Tmax) was prolonged from 1.8 to 3 hours. In another study of 15 such patients, administration of ganciclovir (2000 mg) within 30 minutes following a high-fat breakfast increased the Cmax and AUC an average of 111% and 114%, respectively, compared to administration in the fasting state (i.e. at least 1 hour before or 2 hours after a meal or snack). Over the total day of dosing (2000 mg orally three times a day), there was a mean increase of 48% and 97% in Cmax and AUC, respectively, and a 36% decrease in half-life during administration with meals.

MANAGEMENT: To ensure maximal oral absorption, oral ganciclovir should be administered with or immediately after a meal.

References (3)
  1. (2002) "Product Information. Cytovene (ganciclovir)." Genentech
  2. Lavelle J, Follansbee S, Trapnell CB, Buhles WC, Griffy KG, Jung D, Dorr A, Conner J (1996) "Effect of food on the relative bioavailability of oral ganciclovir." J Clin Pharmacol, 36, p. 238-41
  3. Jung D, Griffy K, Dorr A (1999) "Effect of food on high-dose oral ganciclovir disposition in HIV-positive subjects." J Clin Pharmacol, 39, p. 161-5

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Acyclovir-like antivirals

Therapeutic duplication

The recommended maximum number of medicines in the 'acyclovir-like antivirals' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'acyclovir-like antivirals' category:

  • cidofovir
  • ganciclovir

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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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.

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