Ganciclovir Sodium (Monograph)
Brand name: Cytovene
Drug class: Nucleosides and Nucleotides
Warning
-
Hematologic toxicity (e.g., granulocytopenia, anemia, thrombocytopenia, pancytopenia) reported in patients receiving ganciclovir.1
-
Based on animal data and limited human data, may cause temporary or permanent inhibition of spermatogenesis in males and suppression of fertility in females.1
-
Based on animal studies, has the potential to cause birth defects in humans.1
-
Based on animal studies, has the potential to cause cancers in humans.1
Introduction
Antiviral; nucleoside analog of guanine; active against herpesviruses.1 2 14 85 86
Uses for Ganciclovir Sodium
Cytomegalovirus (CMV) Retinitis
Initial treatment (induction therapy) and maintenance therapy (secondary prophylaxis) of CMV retinitis in immunocompromised patients, including HIV-infected adults.1 2 4 5 11 14 21 23 28 85 86 94 100 103 104 105 117 118 126 127 139 155 164 187 207 311 Also used for management of CMV retinitis in HIV-infected pediatric patients† [off-label].155
Like other antivirals, ganciclovir is not a cure for CMV retinitis; stabilization or improvement of ocular manifestations may occur, but relapse and/or progression of CMV retinitis possible during or following ganciclovir therapy.1 4 5 8 9 11 13 21 27 28 63 65 94 100 126 128 139 167
Retinitis is the most common clinical manifestation of CMV end-organ disease in HIV-infected patients;155 ideally should be managed in consultation with an ophthalmologist familiar with diagnosis and treatment of retinal diseases.155 156
Select antiviral regimen for initial treatment of CMV retinitis in HIV-infected individuals based on location and severity of CMV retinal lesions, severity of underlying immunosuppression, concomitant drug therapy, and patient’s ability to adhere to the treatment regimen.155 156 Select antiviral regimen for maintenance therapy based on location of CMV retinal lesions, vision in contralateral eye, patient's immunologic and virologic status, and patient's response to antiretroviral therapy.155 156
For management of immediate sight-threatening CMV retinal lesions (e.g., within 1.5 mm of the fovea) in HIV-infected adults and adolescents, CDC, NIH, and IDSA state that the preferred regimen is initial treatment (induction therapy) with intravitreal ganciclovir or intravitreal foscarnet (1–4 doses given over a period of 7–10 days) in conjunction with oral valganciclovir (twice daily for 14–21 days) followed by maintenance therapy (secondary prophylaxis) with oral valganciclovir (once daily).155 One alternative regimen recommended by these experts for sight-threatening CMV retinitis in HIV-infected adults and adolescents is intravitreal ganciclovir† [off-label] or intravitreal foscarnet (1–4 doses given over a period of 7–10 days) in conjunction with IV ganciclovir (twice daily for 14–21 days) followed by maintenance therapy (secondary prophylaxis) with oral valganciclovir (once daily).155 Systemic antivirals (without an intravitreal antiviral) usually adequate for management of CMV retinitis in patients with only small peripheral lesions.155
For management of CMV retinitis in HIV-infected pediatric patients† [off-label], CDC, NIH, IDSA, and others state that IV ganciclovir is drug of choice for initial treatment (induction therapy) and one of several options for maintenance therapy (secondary prophylaxis).156 These experts state that oral valganciclovir may be considered in older children† [off-label] and adolescents† [off-label] transitioning from IV ganciclovir to oral valganciclovir to complete treatment and/or for maintenance therapy following improvement of retinitis.156 Data are limited regarding use of intravitreal antivirals in children;156 intravitreal injections are impractical in most children.156
Because of risk of relapse, chronic maintenance therapy (secondary prophylaxis) of CMV retinitis usually continued until immune reconstitution occurs as a result of effective antiretroviral therapy.155 156 CDC, NIH, and IDSA state that discontinuance of maintenance therapy of CMV retinitis can be considered in HIV-infected adults and adolescents if CMV lesions have been treated for ≥3–6 months and are inactive and there has been a sustained (i.e., 3–6 months) increase in CD4+ T-cell count to >100/mm3 in response to antiretroviral therapy.155 Although safety of discontinuing maintenance therapy of CMV retinitis in HIV-infected pediatric patients not well studied, discontinuance of such therapy can be considered in those receiving antiretroviral therapy who have a sustained (i.e., >6 months) increase in CD4+ T-cell percentage to >15% (children <6 years of age) or increase in CD4+ T-cell count to >100/mm3 (children ≥6 years of age).156
If maintenance therapy of CMV is discontinued, continue regular ophthalmologic monitoring (optimally every 3–6 months) for early detection of CMV relapse or immune reconstitution uveitis.155 156 If CD4+ T-cell count decreases to <100/mm3 (adults, adolescents, children ≥6 years of age) or CD4+ T-cell percentage decreases to <15% (children <6 years of age), reinitiate CMV retinitis maintenance therapy.155 156
Extraocular CMV Infections
Although safety and efficacy not established for management of extraocular CMV infections,1 2 14 has been used in immunocompromised patients for management of CMV GI disease†,3 4 5 6 8 11 16 20 21 26 68 69 70 86 92 102 108 110 122 134 146 155 166 193 194 207 pneumonitis†,3 4 5 8 10 11 15 16 17 18 19 20 21 33 43 64 72 73 74 106 107 108 109 110 111 121 122 137 140 145 146 149 151 154 155 159 180 188 193 198 199 201 202 205 207 219 220 225 encephalitis†,4 5 8 11 21 86 110 155 156 165 207 231 or other CMV infections†.3 4 5 8 15 19 20 21 68 106 108 110 140 146 166 171 219
CDC, NIH, and IDSA state that IV ganciclovir usually is the preferred antiviral for initial management of CMV GI disease† in HIV-infected adults and transition to oral valganciclovir may be considered when patient can tolerate and absorb oral drugs.155
For management of well-documented CMV pneumonitis† in HIV-infected adults, CDC, NIH, and IDSA state that either IV ganciclovir or IV foscarnet is a reasonable choice.155
A combination regimen of IV ganciclovir and IV foscarnet has been used for management of CMV neurologic disease† (e.g., CMV encephalitis or myelitis),85 and is recommended by CDC, NIH, IDSA, and others for such infections in HIV-infected individuals.155 156
Congenital CMV Disease
Although safety and efficacy not established,1 2 14 has been used for management of symptomatic congenital CMV disease†.85 156 292
Transmission of CMV from infected mothers to their fetuses occurs as a result of maternal viremia and transplacental infection;1 2 14 perinatal infection also can occur from exposure to CMV shedding in mother's genital tract.1 2 14 Approximately 10% of neonates with congenital CMV infection are symptomatic at birth;1 2 14 mortality is about 10% and approximately 50–90% of symptomatic surviving neonates experience substantial morbidity (e.g., mental retardation, sensorineural hearing loss, microcephaly, seizures).1 2 14 Risk of congenital CMV infection resulting from primary maternal CMV infection may be higher and the disease more severe than that resulting from reactivation of maternal CMV infection.1 2 14
AAP and others recommend that oral valganciclovir be considered in neonates with moderate to severe symptomatic congenital CMV disease (with or without CNS involvement) when an antiviral indicated.84 85 292 Regimen of IV ganciclovir either alone or followed by oral valganciclovir also has been used in neonates with symptomatic congenital CMV disease†.85
CDC, NIH, IDSA, and others state that IV ganciclovir can be considered for initial treatment of symptomatic congenital CMV disease with CNS involvement in HIV-exposed or HIV-infected infants†.156
Antivirals not usually recommended for neonates with asymptomatic congenital CMV infection or only mildly symptomatic infection without evidence of CNS involvement.84 292
Prevention of CMV Infection and Disease
Prophylaxis to prevent CMV infection and disease in solid organ transplant recipients, bone marrow transplant (BMT) recipients, and hematopoietic stem cell transplant (HSCT) recipients at high risk for the disease.1 2 14 74 76 81 82 85 86 271 283 284 286 287 288 304 305 306 307 313 324
Has been used for preemptive treatment of CMV infection and disease† in transplant recipients.74 76 81 82 85
Varicella-Zoster Virus (VZV) Infections
Although optimal regimens for management of progressive outer retinal necrosis caused by VZV† not identified, CDC, NIH, and IDSA recommend that such infections in HIV-infected adults and adolescents be treated with at least one IV antiviral (acyclovir, ganciclovir, foscarnet, cidofovir) used in conjunction with at least one intravitreal antiviral (ganciclovir or foscarnet).155 Some experts recommend IV ganciclovir and/or IV foscarnet used in conjunction with intravitreal ganciclovir† and/or intravitreal foscarnet.155 156 Prognosis for visual preservation in patients with progressive outer retinal necrosis caused by VZV is poor;155 156 such infections should be managed in consultation with an ophthalmologist.155
Related/similar drugs
valacyclovir, valganciclovir, ganciclovir, Valcyte, Prevymis, letermovir, foscarnet
Ganciclovir Sodium Dosage and Administration
General
-
Test females of childbearing potential for pregnancy prior to initiation of ganciclovir.1 2 14 (See Pregnancy under Cautions.)
-
Assess renal function prior to and during ganciclovir therapy; adjust dosage as needed.1 2 14 (See Renal Effects Under Cautions.)
-
Frequently monitor CBCs with differential and platelet counts during ganciclovir therapy, especially in those who developed cytopenias during previous therapy with ganciclovir or other nucleoside analogs and in those with neutrophil counts <1000/mm3 prior to initiation of the drug.1 2 14 (See Hematologic Effects under Cautions.)
-
Do not exceed recommended ganciclovir dosage or recommended frequency and rate of administration.1 2 14
Administration
Administer by IV infusion.1
Do not administer by rapid IV infusion or direct IV injection since potentially toxic plasma ganciclovir concentrations may result.1
Do not administer by IM or sub-Q injection.1
Has been administered by intravitreal injection†;4 5 8 25 67 85 117 129 135 155 170 ganciclovir preparation specifically for intravitreal administration not commercially available in US.
Has been administered orally;85 86 321 325 347 oral preparations of ganciclovir no longer commercially available in US.
IV Infusion
For solution and drug compatibility information, see Compatibility under Stability.
Handle ganciclovir lyophilized powder and solutions of the drug cautiously because of the high pH of some preparations and because of the mutagenic and/or carcinogenic potential of the drug (see Mutagenicity and Carcinogenicity under Cautions).1 2 Use of disposable gloves recommended.1 2
Since ganciclovir shares some of the properties of cytotoxic drugs, consider consulting specialized references for procedures for proper handling and disposal of cytotoxic drugs.1 2 14
To avoid phlebitis and pain at IV infusion site, select a vein with adequate blood flow to allow for rapid dilution and distribution of ganciclovir.1 2 14
Reconstitution and Dilution
For IV infusion, reconstitute single-dose vial containing 500 mg of ganciclovir by adding 10 mL of preservative-free sterile water for injection to provide a solution containing 50 mg/mL.1 Do not use bacteriostatic water for injection containing parabens.1 Gently swirl vial until drug is completely wetted and a clear reconstituted solution is obtained.1 Withdraw appropriate dose of reconstituted solution from the vial and dilute in a compatible IV infusion solution (usually 100 mL).1 Solutions containing ganciclovir concentrations >10 mg/mL not recommended for IV infusion.1
Alternatively, if single-dose vials of solution containing 500 mg of ganciclovir (50 mg/mL) are used, shake vial containing the solution and withdraw appropriate dose and dilute in a compatible IV infusion solution (usually 100 mL).2 Solutions containing ganciclovir concentrations >10 mg/mL not recommended for IV infusion.2
Alternatively, commercially available single-dose IV bags containing 500 mg of ganciclovir in 250 mL of 0.8% sodium chloride (2 mg/mL) can be used for IV infusion without further dilution.14 The solution in the bag should appear clear.14 If any crystals have formed in the solution, gently shake the bag to redissolve the crystals prior to use.14 Discard any unused portions of the premixed solution.14
Rate of Administration
Administer by IV infusion at a constant rate over 1 hour.1 2 14
Dosage
Available as ganciclovir and ganciclovir sodium;1 2 dosage expressed in terms of ganciclovir.1 2 14
Pediatric Patients
CMV Retinitis in HIV-infected Pediatric Patients†
IV
Initial treatment (induction therapy) in children†: CDC, NIH, IDSA, and others recommend 5 mg/kg every 12 hours for 14–21 days (may be increased to 7.5 mg/kg every 12 hours if needed).156 292
Maintenance therapy (secondary prophylaxis) in children†: CDC, NIH, IDSA, and others recommend 5 mg/kg once daily for 5–7 days each week.156 292
Make decisions regarding discontinuance of CMV retinitis maintenance therapy in consultation with an ophthalmologist.155 (See Cytomegalovirus [CMV] Retinitis under Uses.)
CNS or Disseminated CMV Infections in HIV-infected Pediatric Patients†
IV
Initial treatment (induction therapy) of CMV CNS infections in children†: CDC, NIH, IDSA, and others recommend 5 mg/kg every 12 hours in conjunction with IV foscarnet.156 Continue initial treatment until symptomatic improvement.156
Initial treatment (induction therapy) of disseminated CMV infections in children†: CDC, NIH, IDSA, and others recommend 5 mg/kg IV every 12 hours (may be increased to 7.5 mg/kg every 12 hours if needed).156 Continue initial treatment for 14–21 days.156
Maintenance therapy (secondary prophylaxis) of CNS or disseminated CMV infections in children†: CDC, NIH, IDSA, and others recommend 5 mg/kg once daily for 5–7 days each week.156
Congenital CMV Disease†
IV
Symptomatic congenital CMV disease†: AAP and others recommend 6 mg/kg twice daily;84 292 350 transition to oral valganciclovir when infant is able to tolerate and absorb oral drugs.84 292
Initiate antiviral treatment within first month of life and continue for a total of 6 months.84 292
Prevention of CMV Infection and Disease in Pediatric Transplant Recipients†
IV
Prophylaxis of CMV in children†: Some clinicians recommend 5 mg/kg every 12 hours for 5–7 days (or 7–14 days), followed by 5 mg/kg once daily 7 days each week or 6 mg/kg once daily 5 days each week.292 350 Continue for 100–120 days posttransplantation.292 350
Prophylaxis of CMV in children†: Other clinicians recommend 5 mg/kg once daily continued for ≥3 months depending on immune status of the recipient and type of transplant.81
Preemptive treatment of CMV infection in high-risk pediatric patients†: 5 mg/kg twice daily for 7–14 days followed by 5 mg/kg once daily recommended.292
VZV Infections†
IV
Progressive outer retinal necrosis caused by VZV in HIV-infected pediatric patients†: CDC, NIH, IDSA, and others state 5 mg/kg every 12 hours (used with IV foscarnet) in conjunction with intravitreal ganciclovir† (used with or without intravitreal foscarnet) can be considered.156
Adults
CMV Retinitis
IV
Initial treatment (induction therapy): 5 mg/kg every 12 hours for 14–21 days.1 2 14 155 If patient has immediate sight-threatening CMV retinal lesions, CDC, NIH, and IDSA recommend that initial treatment also include an appropriate intravitreal antiviral.155 (See Cytomegalovirus [CMV] Retinitis under Uses.)
Maintenance therapy (secondary prophylaxis): 5 mg/kg once daily 7 days each week1 2 14 155 or 6 mg/kg once daily 5 days each week.1 2 14
Make decisions regarding discontinuance of CMV retinitis maintenance therapy in consultation with an ophthalmologist.155 (See Cytomegalovirus [CMV] Retinitis under Uses.)
CMV Esophagitis† or Colitis†
IV
CMV GI infections†: 5 mg/kg every 12 hours for 14–21 days has been used for initial treatment (induction); alternatively, 2.5 mg/kg IV every 8 hours has been used.6 8 11 13 15 16 20 33 68 70 92 110 140 145 146 If maintenance therapy required, dosages comparable to those used for maintenance therapy of CMV retinitis have been used.6 11
CMV esophagitis† or colitis† in HIV-infected adults: CDC, NIH, and IDSA recommend 5 mg/kg every 12 hours for 21–42 days or until signs and symptoms have resolved.155 Maintenance therapy (secondary prophylaxis) usually not necessary, but consider if relapse occurs.155
CMV Pneumonitis†
IV
5 mg/kg IV every 12 hours for 14–21 days has been used for initial treatment (induction); alternatively, 2.5 mg/kg IV every 8 hours has been used.8 11 13 15 16 20 33 68 70 110 140 145 146 If maintenance therapy required, dosages comparable to those used for maintenance therapy of CMV retinitis have been used.11
Well-documented CMV pneumonitis† in HIV-infected adults: CDC, NIH, and IDSA recommend same dosage used for management of CMV retinitis in HIV-infected adults.155 Optimal duration of treatment not established.155
CMV Neurologic Disease†
IV
CMV neurologic disease† in HIV-infected adults: CDC, NIH, and IDSA recommend same dosage used for management of CMV retinitis in HIV-infected adults.155 Use in conjunction with IV foscarnet.155 Optimal duration of treatment not established.155
Prevention of CMV Infection and Disease in Transplant Recipients
IV
Prophylaxis of CMV: Manufacturers recommend 5 mg/kg every 12 hours for 7–14 days, followed by 5 mg/kg once daily 7 days each week or 6 mg/kg once daily 5 days each week.1 2 14 Continue until 100–120 days posttransplantation.1 2 14
Prophylaxis of CMV: Some experts recommend 5 mg/kg once daily.76 81 82 Continue antiviral prophylaxis for 3 months in CMV-seropositive recipients of solid organs (kidney, pancreas, kidney/pancreas, liver, heart) and for 3–6 months in CMV-seronegative recipients of solid organs (kidney, pancreas, kidney/pancreas, liver, heart) from CMV-seropositive donors.81 82
Preemptive treatment of CMV infection in solid organ transplant recipients†: 5 mg/kg twice daily recommended.82
VZV Infections†
IV
Progressive outer retinal necrosis caused by VZV in HIV-infected adults†: CDC, NIH, IDSA, and others state 5 mg/kg every 12 hours (used with or without IV foscarnet) in conjunction with intravitreal ganciclovir† (used with or without intravitreal foscarnet) can be considered.155
Special Populations
Renal Impairment
In patients with impaired renal function, doses and/or frequency of administration of ganciclovir must be modified in response to the degree of impairment.1 2 14
Base dosage on the patient’s measured or estimated Clcr.1 2 14
CMV Retinitis
IV
Adults with renal impairment: Manufacturers recommend the following dosage for initial treatment (induction therapy) and maintenance therapy (secondary prophylaxis) based on Clcr.1 2 14 (See Table 1.)
Clcr (mL/minute) |
Initial Treatment (Induction) Dosage |
Maintenance Dosage |
---|---|---|
50–69 |
2.5 mg/kg every 12 hours |
2.5 mg/kg every 24 hours |
25–49 |
2.5 mg/kg every 24 hours |
1.25 mg/kg every 24 hours |
10–24 |
1.25 mg/kg every 24 hours |
0.625 mg/kg every 24 hours |
<10 |
1.25 mg/kg 3 times weekly |
0.625 mg/kg 3 times weekly |
Adults undergoing hemodialysis: Do not exceed initial treatment (induction therapy) dosage of 1.25 mg/kg 3 times weekly and do not exceed maintenance therapy dosage of 0.625 mg/kg 3 times weekly.1 2 14 Because hemodialysis may reduce ganciclovir plasma concentrations by approximately 50% (see Elimination under Pharmacokinetics),1 2 14 60 124 time doses on dialysis days to give them shortly after completion of dialysis.1 2 14
Geriatric Patients
Select dosage with caution because of age-related decreases in renal function.1 2 14 Assess renal function before and during ganciclovir therapy and adjust dosage as necessary.1 2 14 (See Renal Impairment under Dosage and Administration.)
Cautions for Ganciclovir Sodium
Contraindications
-
Clinically important hypersensitivity reaction (e.g., anaphylaxis) to ganciclovir, valganciclovir, or any component of the formulation.1 2 14
Warnings/Precautions
Warnings
Hematologic Effects
Hematologic toxicity, including granulocytopenia (neutropenia), anemia, thrombocytopenia, and pancytopenia, reported in patients receiving ganciclovir.1
Neutropenia (ANC <1000/mm3) frequently occurs and is most common dose-limiting adverse effect of ganciclovir.1 3 4 8 11 21 33 75 85 109 110 122 133 149 172 248 264 265
Granulocytopenia (neutropenia) usually develops early in treatment (e.g., during the first or second week of induction therapy),1 3 5 20 23 74 85 122 but can occur at any time.1 5 20 23 74
In most cases, interruption of ganciclovir therapy1 3 4 8 23 74 85 92 122 149 248 will result in increased neutrophil counts, usually evident within 3–7 days; however, prolonged or irreversible neutropenia has occurred.3 4 74 92 122 174 Neutropenia has recurred following reinitiation of ganciclovir therapy,3 33 occasionally even with reduced dosage.3
Carefully monitor CBCs with differential and platelet counts in all patients, especially in those with renal impairment, baseline neutrophil counts <1000/mm3, or history of leukopenia during treatment with ganciclovir or other nucleoside analogs and in those receiving myelosuppressive drugs or radiation treatments.1
Not recommended in patients with ANC <500/mm3, platelet count <25,000/mm3, or hemoglobin concentration <8 g/dL.1 2 14
Impairment of Fertility
Animal data from studies using ganciclovir and limited data from patients receiving valganciclovir (prodrug of ganciclovir) indicate ganciclovir may cause temporary or permanent inhibition of spermatogenesis in males and may cause suppression of fertility in females.1 2 14
In a small clinical study in adult male renal transplant patients receiving CMV prophylaxis with valganciclovir for up to 200 days posttransplantation, mean sperm density in evaluable patients at end-of-treatment visit was decreased by 11 million/mL from baseline; among evaluable patients in an untreated control group, mean sperm density increased by 33 million/mL.1 2 At final follow-up visit 6 months after the drug was discontinued, mean sperm density in evaluable patients in the valganciclovir group was comparable to that in evaluable patients in untreated control group (mean sperm density increased by 41 or 43 million/mL from baseline, respectively).1 2
Advise patients that ganciclovir may be associated with infertility.1 2 14
Teratogenicity
Animal data indicate that ganciclovir may cause fetal toxicity when administered to pregnant women.1 2 14
In studies in pregnant mice and rabbits, ganciclovir at dosages 2 times human exposure resulted in maternal toxicity and embryofetal toxicity (e.g., fetal resorptions, embryofetal mortality).1 2 14 In addition, teratogenic effects (cleft palate, anophthalmia/microphthalmia, hydrocephalus, brachygnathia, aplastic organs [kidney, pancreas]) reported in rabbits.1 2 14
Perform pregnancy testing before initiating ganciclovir in females of childbearing potential.1 2 14 Advise females of childbearing potential to use an effective method of contraception during and for ≥30 days after ganciclovir discontinued.1 2 14 Advise male patients to use a reliable method of barrier contraception during and for ≥90 days after ganciclovir discontinued.1 2 14 (See Pregnancy under Cautions.)
Mutagenicity and Carcinogenicity
Animal studies indicate that ganciclovir is mutagenic and carcinogenic.1 2 14
Consider ganciclovir a potential carcinogen in humans.1
Other Warnings/Precautions
Renal Effects
Increased Scr concentrations reported in geriatric patients and in transplant recipients receiving ganciclovir concomitantly with other nephrotoxic drugs (e.g., cyclosporine, amphotericin B).1 2 14
Patients should be adequately hydrated during ganciclovir therapy.1 2 14
Renal function monitoring is essential in all patients, especially in geriatric patients and transplant recipients receiving concomitant nephrotoxic drugs.1 2 14
Specific Populations
Pregnancy
Ganciclovir caused maternal and fetal toxicity, embryofetal mortality, and teratogenic effects in animal studies.1 2 14 (See Teratogenicity under Cautions.)
Data regarding use of ganciclovir in pregnant women inadequate to establish whether the drug poses a risk to pregnancy outcomes.1 Placental transfer of ganciclovir observed in ex vivo experiments with human placenta and in at least one case report in a pregnant woman.1
Perform pregnancy testing in females of childbearing potential prior to initiating ganciclovir.1
Advise females of childbearing potential to use an effective method of contraception during and for ≥30 days after ganciclovir therapy.1
Advise male patients to use a reliable method of barrier contraception during and for ≥90 days after ganciclovir therapy.1
Lactation
Not known whether distributes into human milk, affects the breast-fed infant, or affects milk production.1 2 14 Distributed into milk in rats.1 2 14
Because of potential for serious adverse effects in the infant, women should not breast-feed infants while receiving ganciclovir.1 2 14
Instruct HIV-infected women not to breast-feed because of risk of HIV transmission.1 2 14
Pediatric Use
Safety and efficacy not established in pediatric patients.1 2 14
In clinical trials in pediatric patients†, granulocytopenia and thrombocytopenia were most commonly reported adverse effects.1
Although pharmacokinetics reported in pediatric patients are similar to those reported in adults (see Pharmacokinetics), safety and efficacy of such ganciclovir exposures in pediatric patients not established.1 2 14
Geriatric Use
Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.1 2 14
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 2 14
Assess renal function before and during therapy; make appropriate dosage adjustments as necessary.1 2 14 (See Renal Impairment under Dosage and Administration.)
Hepatic Impairment
Safety and efficacy not evaluated.1 2 14
Renal Impairment
Use with caution in patients with impaired renal function.1 2 14
Dosage adjustment necessary in patients with renal impairment.1 (See Renal Impairment under Dosage and Administration.)
Common Adverse Effects
Hematologic effects (leukopenia, neutropenia, thrombocytopenia, anemia), pyrexia, GI effects (diarrhea, nausea, decreased appetite, abdominal pain), catheter-associated effects (sepsis), hyperhidrosis, asthenia, headache, cough, dyspnea, increased creatinine concentrations.1 2 14
Drug Interactions
Drug interaction studies were performed in patients with normal renal function.1 In patients with renal impairment, concomitant use of ganciclovir and other drugs eliminated by renal excretion may increase concentrations of ganciclovir and the concomitant drug; closely monitor for toxicity associated with ganciclovir and the concomitant drug.1
Specific Drugs
Drug |
Interaction |
Comments |
---|---|---|
Amphotericin B |
Possible increased Scr1 |
Monitor renal function1 |
Antineoplastic agents (doxorubicin, hydroxyurea, vinblastine, vincristine) |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Co-trimoxazole |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Dapsone |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Didanosine |
Increased peak plasma concentrations and AUC of didanosine; no effect on ganciclovir pharmacokinetics1 Some in vitro evidence that ganciclovir antagonizes antiretroviral activity of didanosine85 294 |
If used concomitantly, monitor closely for didanosine toxicity1 347 |
Flucytosine |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Foscarnet |
No apparent effect on pharmacokinetics of either drug352 Physically incompatible352 No in vitro evidence of antagonistic antiviral effects;253 in vitro evidence of additive or synergistic antiviral activity against CMV and herpes simplex virus type 2 (HSV-2)274 275 276 277 278 |
Do not admix352 |
Imipenem and cilastatin |
Concomitant use not recommended1 |
|
Immunosuppressive agents (azathioprine, corticosteroids, cyclosporine, mycophenolate mofetil, tacrolimus) |
Immunosuppressive agents: Possible increased risk of myelosuppression or nephrotoxicity1 15 19 140 188 193 202 219 262 Cyclosporine: Possible increased Scr;1 no effect on cyclosporine whole blood concentrations1 Mycophenolate mofetil: No effect on pharmacokinetics of either drug;1 possible increased toxicity1 Tacrolimus: Possible increased toxicity1 |
Immunosuppressive agents: Consider need for decreased dosage or temporary withdrawal of the immunosuppressive agent15 19 140 188 193 202 219 262 Cyclosporine: Monitor renal function1 Mycophenolate mofetil: Monitor for hematologic and renal toxicity1 Tacrolimus: Use concomitantly only if potential benefits outweigh risks1 |
Letermovir |
No in vitro evidence of antagonistic anti-CMV effects351 |
|
Pentamidine |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Probenecid |
Possible increased ganciclovir concentrations1 |
Monitor for ganciclovir-associated toxicity;1 ganciclovir dosage may need to be reduced1 |
Sulfamethoxazole |
Possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Tenofovir |
Tenofovir alafenamide or tenofovir disoproxil fumarate: Possible increased concentrations of ganciclovir and tenofovir200 |
Tenofovir alafenamide or tenofovir disoproxil fumarate: Monitor for tenofovir toxicities200 |
Trimethoprim |
No effect on pharmacokinetics of either drug;1 possible increased toxicity1 |
Use concomitantly only if potential benefits outweigh risks1 |
Zidovudine |
Increased risk of hematologic toxicity1 25 83 200 295 Some in vitro evidence that ganciclovir antagonizes antiretroviral activity of zidovudine85 294 |
Use concomitantly only if potential benefits outweigh risks1 18 25 83 87 96 126 129 133 135 170 187 293 295 |
Ganciclovir Sodium Pharmacokinetics
Absorption
Bioavailability
Following IV doses of 5 mg/kg every 12 hours given by IV infusion over 1 hour, peak plasma concentrations range between 8.3–9 mcg/mL.1
No apparent accumulation in patients with normal renal function receiving IV dosages of 3–15 mg/kg daily in divided doses.3 11 59 124
Limited data indicate minimal systemic absorption following intravitreal injection†.4 25 67
Distribution
Extent
Widely distributed following IV administration.85 Autopsy findings in patients who had been receiving IV ganciclovir suggest the drug concentrates in kidneys, with substantially lower concentrations occurring in lung, liver, brain, and testes.5 9 64
Appears to have good ocular distribution following IV administration;5 85 93 104 117 distributed into aqueous and vitreous humor.3 104
Distributed into CSF following IV administration.1 3 4 5 9 28 59 64 68
Crosses the placenta (based on ex vivo experiments and at least one case report in a pregnant woman).1
Not known whether distributed into human milk;1 distributed into milk in rats.1 3
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 4 5 11 28 59 61 64 124
Elimination Route
Following IV administration, approximately 90–99% of the dose is excreted unchanged in urine.1 3 4 5 11 28 59 61 64 124 Renal excretion occurs via glomerular filtration and active tubular secretion.1 3 5 11 59 124
Removed by hemodialysis;1 3 5 60 108 124 151 plasma concentrations reduced approximately 50% following 4-hour hemodialysis session.1
Half-life
Adults with normal renal function: 3.5 hours.1
Special Populations
Patients with impaired renal function: Plasma concentrations may be higher and elimination half-life prolonged.1 3 5 9 11 20 59 60 61 64 124 In immunocompromised patients with renal impairment, mean plasma half-life was 4.4 hours in those with Clcr of 25–59 mL/minute and 10.7 hours in those with Clcr <25 mL/minute.1 In adults with moderate to severe renal impairment (Clcr <50 mL/minute per 1.73 m2), terminal half-life ranged from 4.4–30 hours, depending on degree of impairment.1 3 11 60 61 64 124
Geriatric patients: Pharmacokinetics not specifically evaluated, but renal clearance decreases with age and decreased ganciclovir total body clearance and prolonged half-life expected in adults ≥65 years of age.1
Pediatric patients†: Plasma half-life of 2.4 hours reported in a limited number of neonates 2–49 days of age† and infants and children 9 months to 12 years of age† receiving IV ganciclovir.1
Stability
Storage
Parenteral
Powder for IV Infusion
Single-dose vials containing lyophilized powder: 25°C (may be exposed to 15–30°C).1
Following reconstitution with preservative-free sterile water for injection, stable in vial for ≤12 hours at 25°C;1 do not refrigerate or freeze.1
Following further dilution in compatible IV infusion solution, store at 2–8°C for ≤24 hours;1 do not freeze.1
Concentrate for Injection, for IV Infusion
Single-dose vials containing 500 mg of ganciclovir (50 mg/mL): 25°C (may be exposed to 15–30°C).2
Following dilution in compatible IV infusion solution, store at 2–8°C and use within 24 hours.2 Do not freeze.2
Injection for IV Infusion
Single-dose IV bags containing 500 mg of ganciclovir in 250 mL of 0.8% sodium chloride (2 mg/mL): 20–25°C (may be exposed to 15–30°C).14
Crystals may form in the premixed solution if exposed to temperatures lower than recommended;14 gently shake IV bag to redissolve crystals.14
Compatibility
Parenteral
Solution CompatibilityHID
Compatible |
---|
Dextrose 5% in water |
Ringer's injection |
Ringer's injection, lactated |
Sodium chloride 0.9% |
Drug Compatibility
Compatible |
---|
Allopurinol sodium |
Anidulafungin |
Caspofungin acetate |
Defibrotide sodium |
Docetaxel |
Doxorubicin HCl liposome injection |
Enalaprilat |
Etoposide phosphate |
Filgrastim |
Fluconazole |
Granisetron HCl |
Letermovir |
Linezolid |
Melphalan HCl |
Paclitaxel |
Pemetrexed disodium |
Propofol |
Remifentanil HCl |
Teniposide |
Thiotepa |
Incompatible |
Aldesleukin |
Amifostine |
Amsacrine |
Aztreonam |
Fludarabine phosphate |
Foscarnet sodium |
Gemcitabine HCl |
Ondansetron HCl |
Piperacillin sodium–tazobactam sodium |
Sargramostim |
Tacrolimus |
Vinorelbine tartrate |
Variable |
Cisatracurium besylate |
Actions and Spectrum
-
Prodrug with no antiviral activity until converted intracellularly to ganciclovir triphosphate.1 36 85 98 112 113 Initially converted to ganciclovir monophosphate via viral protein kinase pUL97;1 85 further phosphorylated by cellular kinases to ganciclovir triphosphate.1 85
-
Ganciclovir triphosphate is a viral DNA polymerase inhibitor;1 85 exerts antiviral activity by interfering with viral DNA synthesis and viral replication by incorporating into viral DNA chains1 8 9 57 58 99 113 133 206 209 and competitively inhibiting viral DNA polymerase pUL54.1 195
-
Active against various human herpesviruses,3 21 85 152 209 221 232 including CMV,1 3 11 12 37 85 herpes simplex virus types 1 and 2 (HSV-1 and HSV-2),3 11 12 46 78 79 80 81 97 161 163 209 222 and VZV.3 11 12 37 97 221 Although clinical importance unclear, has some in vitro activity against Epstein-Barr virus (EBV)3 11 12 85 89 97 169 222 and human herpesvirus type 685 232 and type 8.85 Not active against HIV.85
-
CMV resistant to ganciclovir have been selected in vitro in the presence of increasing concentrations of the drug.1 85 Ganciclovir-resistant CMV have been reported in ganciclovir-naive patients1 and may emerge after prolonged treatment or prophylaxis with the drug.1 85 Consider possibility of ganciclovir-resistant CMV in patients who show poor clinical response or relapse or experience persistent viral shedding during ganciclovir therapy.1 85
-
Resistance to ganciclovir usually results from amino acid substitutions in the viral protein kinase pUL97 and/or viral DNA polymerase pUL54.1 85
-
Cross-resistance between ganciclovir and foscarnet and/or cidofovir reported.1 85
Advice to Patients
-
Inform patients that ganciclovir may cause hematologic toxicity, including granulocytopenia (neutropenia), thrombocytopenia, and anemia, and that frequent blood tests are required to closely monitor blood cell counts.1 2 14
-
Advise patients that ganciclovir has been associated with decreased renal function and that Scr and Clcr should be monitored during treatment with the drug and dosage adjustments made if needed.1 2 14
-
Advise patients that ganciclovir may cause seizures, dizziness, and/or confusion, which may affect cognitive abilities (e.g., ability to drive or operate machinery).1 2 14
-
When ganciclovir used for management of CMV retinitis, advise patients that the drug is not a cure for CMV retinitis; progression may occur during or after ganciclovir treatment.1 2 14 Regular ophthalmologic examinations necessary; some patients may require more frequent follow-up.1 2 14
-
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1
-
Advise patients that ganciclovir is considered a potential carcinogen in humans.1 2 14
-
Advise patients that ganciclovir may cause temporary or permanent infertility in humans.1 2 14
-
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 2 14 Advise women to avoid pregnancy and to not breast-feed infants.1 2 14
-
Advise females of childbearing potential to use effective contraception during and for ≥30 days after ganciclovir therapy.1 2 14 Advise male patients to use barrier contraception during and for ≥90 days after ganciclovir therapy.1 2 14
-
Importance of advising patients of other important precautionary information.1 2 14 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Parenteral |
Injection, for IV infusion only |
2 mg/mL (500 mg) in 0.8% Sodium Chloride* |
Ganciclovir Injection |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Parenteral |
Concentrate, for injection, for IV infusion only |
50 mg (of ganciclovir) per mL (500 mg) |
Ganciclovir Injection |
|
For injection, for IV infusion only |
500 mg (of ganciclovir)* |
Cytovene-IV |
Roche |
|
Ganciclovir Sodium for Injection |
AHFS DI Essentials™. © Copyright 2024, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
1. Genentech. Cytovene-IV (ganciclovir sodium for injection) prescribing information. Nutley, NJ; 2018 Aug.
2. Pharmascience Inc. Ganciclovir sodium injection, solution prescribing information. Candiac Canada; 2018 Nov.
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. http://www.ncbi.nlm.nih.gov/pubmed/2831765?dopt=AbstractPlus
5. Fletcher CV, Balfour HH Jr. Evaluation of ganciclovir for cytomegalovirus disease. DICP. 1989; 23:5-12. http://www.ncbi.nlm.nih.gov/pubmed/2541566?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3037960?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3492139?dopt=AbstractPlus
8. Drew WL. Cytomegalovirus infection in patients with AIDS. J Infect Dis. 1988; 158:449-56. http://www.ncbi.nlm.nih.gov/pubmed/2841381?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3115376?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1247044&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3039841?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3545766?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2992335?dopt=AbstractPlus
14. Exela Pharma Sciences, LLC. Ganciclovir injection solution prescribing information. Lenoir, NC; 2017 Sep.
15. Nicholson ML, Flower AJE, Simpson A et al. Ganciclovir for severe cytomegalovirus infection in transplant recipients. Lancet. 1988; 2:1501-2. http://www.ncbi.nlm.nih.gov/pubmed/2904627?dopt=AbstractPlus
16. Rostoker G, Ben Maadi A, Buisson C et al. Ganciclovir for severe cytomegalovirus infection in transplant recipients. Lancet. 1988; 2:1137-8. http://www.ncbi.nlm.nih.gov/pubmed/2903346?dopt=AbstractPlus
17. Frank I, Friedman HM. Progress in the treatment of cytomegalovirus pneumonia. Ann Intern Med. 1988; 109:769-71. http://www.ncbi.nlm.nih.gov/pubmed/2847608?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3035246?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3005861?dopt=AbstractPlus
22. Meyers JD. Management of cytomegalovirus infection. Am J Med. 1988; 85(Suppl 2A):102-6. http://www.ncbi.nlm.nih.gov/pubmed/2841853?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3000248?dopt=AbstractPlus
24. Dorsky DI, Crumpacker CS. Drugs five years later: acyclovir. Ann Intern Med. 1987; 107:859-74. http://www.ncbi.nlm.nih.gov/pubmed/3318610?dopt=AbstractPlus
25. Henry K, Cantrill H, Kish MA. Intravitreous ganciclovir for patients receiving zidovudine. JAMA. 1987; 257:3066. http://www.ncbi.nlm.nih.gov/pubmed/3035245?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2541567?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3027195?dopt=AbstractPlus
29. Wood MJ, Geddes AM. Antiviral therapy. Lancet. 1987; 2:1189-93. http://www.ncbi.nlm.nih.gov/pubmed/2890817?dopt=AbstractPlus
30. Nahata MC. Clinical use of antiviral drugs. Drug Intell Clin Pharm. 1987; 21:399-405. http://www.ncbi.nlm.nih.gov/pubmed/3556126?dopt=AbstractPlus
31. Devita VT, Broder S, Fauci AS et al. Developmental therapeutics and the acquired immunodeficiency syndrome. Ann Intern Med. 1987; 106:568-81. http://www.ncbi.nlm.nih.gov/pubmed/2435201?dopt=AbstractPlus
32. Deeter RG, Khanderia U. Recent advances in antiviral therapy. Clin Pharm. 1986; 5:961-76. http://www.ncbi.nlm.nih.gov/pubmed/3542344?dopt=AbstractPlus
33. Keay S, Bissett J, Merigan TC. Ganciclovir treatment of cytomegalovirus infections in iatrogenically immunocompromised patients. J Infect Dis. 1987; 156:1016-21. http://www.ncbi.nlm.nih.gov/pubmed/2824621?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6302255?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6148640?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6324666?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185472&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6316844?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185366&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3878145?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3001505?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6307132?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=184786&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2986118?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=397581&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6306664?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=394216&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6436227?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6313660?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6289741?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=183674&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6295389?dopt=AbstractPlus
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. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2963435&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3010840?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180226&blobtype=pdf
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. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=3154749&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6095751?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176152&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3039910?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284197&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2536135?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6316950?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2992369?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3872662?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6324669?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=185483&blobtype=pdf
58. Jacobson MA, de Miranda P, Cederberg DM et al. Human pharmacokinetics and tolerance of oral ganciclovir. Antimicrob Agents Chemother. 1987; 31:1251-4. http://www.ncbi.nlm.nih.gov/pubmed/2820301?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174913&blobtype=pdf
59. Fletcher C, Sawchuk R, Chinnock B et al. Human pharmacokinetics of the antiviral drug DHPG. Clin Pharmacol Ther. 1986; 40:281-6. http://www.ncbi.nlm.nih.gov/pubmed/3017630?dopt=AbstractPlus
60. Lake KD, Fletcher CV, Love KR et al. Ganciclovir pharmacokinetics during renal impairment. Antimicrob Agents Chemother. 1988; 32:1899-1900. http://www.ncbi.nlm.nih.gov/pubmed/2854457?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=176042&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3035374?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2992334?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2992333?dopt=AbstractPlus
65. Harris ML, Mathalone MBR. Dihydroxypropoxymethyl guanine in the treatment of AIDS related retinitis due to cytomegalovirus. BMJ. 1987; 294:92. http://www.ncbi.nlm.nih.gov/pubmed/3032325?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1245099&blobtype=pdf
66. 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. http://www.ncbi.nlm.nih.gov/pubmed/2847609?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3026186?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2837082?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2539791?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2841850?dopt=AbstractPlus
71. Jabs DA, Enger C, Bartlett JG. Cytomegalovirus retinitis and acquired immunodeficiency syndrome. Arch Ophthalmol. 1989; 107:75-80. http://www.ncbi.nlm.nih.gov/pubmed/2535932?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2826608?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847610?dopt=AbstractPlus
74. Ljungman P, Hakki M, Boeckh M. Cytomegalovirus in hematopoietic stem cell transplant recipients. Hematol Oncol Clin North Am. 2011; 25:151-69. http://www.ncbi.nlm.nih.gov/pubmed/21236396?dopt=AbstractPlus
75. Hermans PE, Cockerill FR III. Antiviral agents. Mayo Clin Proc. 1987; 62:1108-15. http://www.ncbi.nlm.nih.gov/pubmed/3500376?dopt=AbstractPlus
76. Meesing A, Razonable RR. Pharmacologic and immunologic management of cytomegalovirus infection after solid organ and hematopoietic stem cell transplantation. Expert Rev Clin Pharmacol. 2018; 11:773-788. http://www.ncbi.nlm.nih.gov/pubmed/30009675?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3874596?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180149&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6326720?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6323620?dopt=AbstractPlus
81. Kotton CN, Kumar D, Caliendo AM et al. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation. Transplantation. 2018; 102:900-931. http://www.ncbi.nlm.nih.gov/pubmed/29596116?dopt=AbstractPlus
82. Razonable RR, Humar A. Cytomegalovirus in Solid Organ Transplant Recipients - Guidelines of the American Society of Transplantation Infectious Disease Community of Practice. Clin Transplant. 2019; :e13512. http://www.ncbi.nlm.nih.gov/pubmed/30817026?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3261316?dopt=AbstractPlus
84. Lim Y, Lyall H. Congenital cytomegalovirus - who, when, what-with and why to treat?. J Infect. 2017; 74 Suppl 1:S89-S94. http://www.ncbi.nlm.nih.gov/pubmed/28646968?dopt=AbstractPlus
85. Beauduy CE, Jacobson MA. Ganciclovir and valganciclovir. In: Grayson ML, ed. Kucers' the use of antibiotics: a clinical review of antibacterial, antifungal, antiparasitic, and antiviral drugs. 7th ed. Boca Raton, FL: CRC Press; 2018:3502-30.
86. Crumpacker CS. Cytomegalovirus (CMV). In: Bennett JE, Dolin R, Blaser MJ eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015: pp. 1738-53.
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. http://www.ncbi.nlm.nih.gov/pubmed/3873931?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2826613?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6321799?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=255580&blobtype=pdf
90. Bach MC. Breakthrough of cytomegalovirus infection despite 9-(1,3-dihydroxy -2-propoxymethyl)guanine therapy. Ann Intern Med. 1986; 104:587. http://www.ncbi.nlm.nih.gov/pubmed/3006573?dopt=AbstractPlus
91. Meyers JD. Prevention and treatment of cytomegalovirus infection after marrow transplantation. Bone Marrow Transplant. 1988; 3:95-104. http://www.ncbi.nlm.nih.gov/pubmed/2844342?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2844343?dopt=AbstractPlus
93. Jabs DA, Wingard JR, de Bustros S et al. BW B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol. 1986; 104:1436-7. http://www.ncbi.nlm.nih.gov/pubmed/3021090?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3024606?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2845899?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3495235?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174750&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2998275?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3021055?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3026243?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3008560?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2535917?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3028443?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2821466?dopt=AbstractPlus
104. Jabs DA, Newman C, de Bustros S et al. Treatment of cytomegalovirus retinitis with ganciclovir. Ophthalmology. 1987; 94:824-30. http://www.ncbi.nlm.nih.gov/pubmed/2821465?dopt=AbstractPlus
105. Holland GN, Sidikaro Y, Kreiger AE et al. Treatment of cytomegalovirus retinopathy with ganciclovir. Ophthalmology. 1987; 94:815-23. http://www.ncbi.nlm.nih.gov/pubmed/2821464?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847290?dopt=AbstractPlus
107. Crumpacker C, Marlowe S, Zhang JL et al. Treatment of cytomegalovirus pneumonia. Rev Infect Dis. 1988; 10(Suppl 3):S538-46. http://www.ncbi.nlm.nih.gov/pubmed/2847291?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847292?dopt=AbstractPlus
109. Snydman DR. Ganciclovir therapy for cytomegalovirus disease associated with renal transplants. Rev Infect Dis. 1988; 10(Suppl 3): S554-62. http://www.ncbi.nlm.nih.gov/pubmed/2847293?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847294?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2546077?dopt=AbstractPlus
113. Matthews T, Boehme R. Antiviral activity and mechanism of action of ganciclovir. Rev Infect Dis. 1988; 10(Suppl 3):S490-4. http://www.ncbi.nlm.nih.gov/pubmed/2847285?dopt=AbstractPlus
114. Raufman JP. Odynophagia/dysphagia in AIDS. Gastroenterol Clin North Am. 1988; 17:599-614. http://www.ncbi.nlm.nih.gov/pubmed/3049365?dopt=AbstractPlus
115. Crowe S, Mills J. The future of antiviral chemotherapy. Dermatol Clin. 1988; 6:521-37. http://www.ncbi.nlm.nih.gov/pubmed/3067915?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2843218?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1041517&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2843219?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1041518&blobtype=pdf
119. Furman PA. Chemotherapy of herpesvirus infections. Curr Eye Res. 1987; 6:213-9. http://www.ncbi.nlm.nih.gov/pubmed/3493884?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2537711?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847286?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3127217?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2847287?dopt=AbstractPlus
125. Palestine AG. Clinical aspects of cytomegalovirus retinitis. Rev Infect Dis. 1988; 10(Suppl 3):S515-21. http://www.ncbi.nlm.nih.gov/pubmed/2847288?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3035453?dopt=AbstractPlus
128. Pepose JS, Newman C, Bach MC. Pathologic features of cytomegalovirus retinopathy after treatment with the antiviral agent ganciclovir. Ophthalmology. 1987; 94:414-24. http://www.ncbi.nlm.nih.gov/pubmed/3035452?dopt=AbstractPlus
129. Cantrill HL, Henry K, Melroe NH et al. Treatment of cytomegalovirus retinitis with intravitreal ganciclovir—long-term results. Ophthalmology. 1989; 96:367-74. http://www.ncbi.nlm.nih.gov/pubmed/2540470?dopt=AbstractPlus
130. Sacks SL. Therapeutic use of newer antiviral agents. Int J Cell Cloning. 1986; 4(Suppl 1):155-73. http://www.ncbi.nlm.nih.gov/pubmed/3018100?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2844981?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3494740?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2536775?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2845321?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3002177?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2837848?dopt=AbstractPlus
141. Culbertson WW. Infections of the retina in AIDS. Int Ophthalmol Clin. 1989; 29:108-18. http://www.ncbi.nlm.nih.gov/pubmed/2541096?dopt=AbstractPlus
142. O’Donnell JJ, Jacobson MA. Cotton-wool spots and cytomegalovirus retinitis in AIDS. Int Ophthalmol Clin. 1989; 29:105-7. http://www.ncbi.nlm.nih.gov/pubmed/2541095?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2832836?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2845613?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2839916?dopt=AbstractPlus
148. Rook AH. Interactions of cytomegalovirus with the human immune system. Rev Infect Dis. 1988; 10(Suppl 3):S460-7. http://www.ncbi.nlm.nih.gov/pubmed/2847282?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2539692?dopt=AbstractPlus
150. Drew WL. Diagnosis of cytomegalovirus infection. Rev Infect Dis. 1988; 10(Suppl 3):S468-76. http://www.ncbi.nlm.nih.gov/pubmed/2847283?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2539690?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2652463?dopt=AbstractPlus
154. Mai M, Nery J, Sutker W et al. DHPG (gancyclovir) improves survival in CMV pneumonia. Transplant Proc. 1989; 21:2263-5. http://www.ncbi.nlm.nih.gov/pubmed/2540565?dopt=AbstractPlus
155. Panel on Opportunistic Infection in HIV-infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (Accessed February 6, 2019). Updates may be available at HHS AIDS Information (AIDSinfo) website https://aidsinfo.nih.gov/guidelines
156. Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society (Accessed February 6, 2019). Updates may be available at HHS AIDS Information (AIDSinfo) website https://aidsinfo.nih.gov/guidelines
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. http://www.ncbi.nlm.nih.gov/pubmed/2837718?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2650083?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2540560?dopt=AbstractPlus
160. Akula SK, Mansell PWA, Ruiz R. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986; 101:622. http://www.ncbi.nlm.nih.gov/pubmed/3010726?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3028250?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180604&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3010835?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180213&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/3495237?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2825580?dopt=AbstractPlus
165. Masdeu JC, Small CB, Weiss L et al. Multifocal cytomegalovirus encephalitis in AIDS. Ann Neurol. 1988; 23:97-99. http://www.ncbi.nlm.nih.gov/pubmed/2830836?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3014944?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3024605?dopt=AbstractPlus
168. Acheson JF, Shah SM, Spalton DJ et al. Treatment of CMV retinitis in an AIDS patient. Br J Ophthalmol. 1987; 71:810-6. http://www.ncbi.nlm.nih.gov/pubmed/2825756?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1041317&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2536518?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2845902?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2536201?dopt=AbstractPlus
172. Robinson MR, Teitelbaum C, Taylor-Findlay C. Thrombocytopenia and vitreous hemorrhage complicating ganciclovir treatment. Am J Ophthalmol. 1989; 107:560-1. http://www.ncbi.nlm.nih.gov/pubmed/2540661?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2842110?dopt=AbstractPlus
175. Reed EC, Meyers JD. Treatment of cytomegalovirus infection. Clin Lab Med. 1987; 7: 831-52. http://www.ncbi.nlm.nih.gov/pubmed/2446819?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3030112?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2820231?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3014941?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2539877?dopt=AbstractPlus
180. Morris DJ. Ganciclovir and immune globulin in cytomegalovirus pneumonia. Ann Intern Med. 1989; 110:575. http://www.ncbi.nlm.nih.gov/pubmed/2538100?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6097163?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=179941&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/6335382?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=180056&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2987369?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6201172?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2983421?dopt=AbstractPlus
187. Schulman JA, Peyman GA. Management of viral retinitis. Ophthalmic Surg. 1988; 19:876-84. http://www.ncbi.nlm.nih.gov/pubmed/2852786?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2835468?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6230976?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2822880?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3022304?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=387013&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2831212?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6092331?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6328301?dopt=AbstractPlus
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. Panel on Antiretroviral Guidelines for Adults and Adolescents, US Department of Health and Human Services (HHS). Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV (Accessed March 14, 2019). Updates may be available at HHS AIDS Information (AIDSinfo) website. https://aidsinfo.nih.gov/guidelines
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. http://www.ncbi.nlm.nih.gov/pubmed/2872484?dopt=AbstractPlus
202. Creasy TS, Flower AJE, Veitch PS. Life-threatening cytomegalovirus infection treated with dihydropropoxymethylguanine. Lancet. 1986; 1:675. http://www.ncbi.nlm.nih.gov/pubmed/2869359?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3031984?dopt=AbstractPlus
204. Montplaisir S. Latency and activation of cytomegalovirus in man and in mice. Can J Microbiol. 1979; 25:261-6. http://www.ncbi.nlm.nih.gov/pubmed/222415?dopt=AbstractPlus
205. 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.
206. Hooymans JMM, Sprenger HG, Weits J. Treatment of cytomegalovirus retinitis with DHPG in a patient with AIDS. Doc Ophthalmol. 1987; 67:5-12. http://www.ncbi.nlm.nih.gov/pubmed/2827978?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3489833?dopt=AbstractPlus
209. Visser OHE, Bos PJM. Kaposi’s sarcoma of the conjunctiva and CMV-retinitis in AIDS. Doc Ophthalmol. 1986; 64:77-85. http://www.ncbi.nlm.nih.gov/pubmed/3034535?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3030645?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2545018?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2821884?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=174864&blobtype=pdf
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.
216. Anon. Ganciclovir. Med Lett Drugs Ther. 1989; 31:79-80. http://www.ncbi.nlm.nih.gov/pubmed/2549352?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3027642?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3016127?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2831645?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2837853?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3010502?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3027389?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=253990&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2843084?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=172297&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2849621?dopt=AbstractPlus
226. Corey L. The diagnosis and treatment of genital herpes. JAMA. 1982; 248:1041-9. http://www.ncbi.nlm.nih.gov/pubmed/7109193?dopt=AbstractPlus
227. Pavan-Langston D, Park NH, Hettinger M. Ganglionic herpes simplex and systemic acyclovir. Arch Ophthalmol. 1981; 99:1417-9. http://www.ncbi.nlm.nih.gov/pubmed/6266375?dopt=AbstractPlus
228. Fiala M, Payne JE, Berne TV et al. Epidemiology of cytomegalovirus infection after transplantation and immunosuppression. J Infect Dis. 1975; 132:421-33. http://www.ncbi.nlm.nih.gov/pubmed/171315?dopt=AbstractPlus
229. Pavan-Langston D, Park NH, Lass JH. Herpetic ganglionic latency—aciclovir and vidarabine therapy. Arch Ophthalmol. 1979; 97:1508-10. http://www.ncbi.nlm.nih.gov/pubmed/223531?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/216753?dopt=AbstractPlus
231. Graveleau P, Perol R, Chapman A. Regression of cauda equina syndrome in AIDS patient being treated with ganciclovir. Lancet. 1989; 2:511-2. http://www.ncbi.nlm.nih.gov/pubmed/2570224?dopt=AbstractPlus
232. Russler SK, Tapper MA, Carrigan DR. Susceptibility of human herpesvirus 6 to acyclovir and ganciclovir. Lancet. 1989; 2:382. http://www.ncbi.nlm.nih.gov/pubmed/2569565?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2896909?dopt=AbstractPlus
234. Agut H, Huraux JM, Collandre H et al. Susceptibility of human herpesvirus 6 to acyclovir and ganciclovir. Lancet. 1989; 2:626. http://www.ncbi.nlm.nih.gov/pubmed/2570323?dopt=AbstractPlus
236. Lorian V, ed. Antibiotics in laboratory medicine. 2nd ed. Baltimore: Williams & Wilkins; 1986:365-8.
238. Holland GN, Pepose JS, Petit TH et al. Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology. 1983; 90:859-73. http://www.ncbi.nlm.nih.gov/pubmed/6314219?dopt=AbstractPlus
241. Pass RF. Epidemiology and transmission of cytomegalovirus. J Infect Dis. 1985; 152:243-8. http://www.ncbi.nlm.nih.gov/pubmed/2993429?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2854894?dopt=AbstractPlus
244. Palestine AG. Clinical aspects of cytomegalovirus retinitis. Rev Infect Dis. 1988; 10:S520-1. http://www.ncbi.nlm.nih.gov/pubmed/2847288?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2829672?dopt=AbstractPlus
246. Margulis SJ, Honig CL, Soave R et al. Biliary tract obstruction in the acquired immunodeficiency syndrome. Ann Intern Med. 1986; 105:207-10. http://www.ncbi.nlm.nih.gov/pubmed/3014940?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/3548523?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2550414?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/6326563?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2986450?dopt=AbstractPlus
252. Quinnan GV Jr, Masur H, Rook AH et al. Herpesvirus infections in the acquired immunodeficiency syndrome. JAMA. 1984; 252:72-77. http://www.ncbi.nlm.nih.gov/pubmed/6328055?dopt=AbstractPlus
253. 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. http://www.ncbi.nlm.nih.gov/pubmed/3014412?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9860006?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2547238?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/11192865?dopt=AbstractPlus
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.
259. Pollard RB. Cytomegalovirus infections in renal and heart and heart-lung and liver transplantation. Pediatr Infect Dis J. 1988; 7: S97-102. http://www.ncbi.nlm.nih.gov/pubmed/2456512?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2556990?dopt=AbstractPlus
265. Freeman WR. Intraocular antiviral therapy. Arch Ophthalmol. 1989; 107:1737-9. http://www.ncbi.nlm.nih.gov/pubmed/2556988?dopt=AbstractPlus
266. Davis CL, Springmeyer S, Gmerek BJ. Central nervous system side effects of ganciclovir. New Engl J Med. 1990; 322:933-4. http://www.ncbi.nlm.nih.gov/pubmed/2156162?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/2163228?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1848397?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1848679?dopt=AbstractPlus
272. Knox KK, Drobyski WR, Carrigan DR. Cytomegalovirus isolate resistant to ganciclovir and foscarnet from a marrow transplant patient. Lancet. 1991; 337:1292-3. http://www.ncbi.nlm.nih.gov/pubmed/1674092?dopt=AbstractPlus
273. Henderly DE, Jampol LM. Diagnosis and treatment of cytomegalovirus retinitis. J Acquir Immune Defic Syndr. 1991; 4(Suppl 1):S6-10. http://www.ncbi.nlm.nih.gov/pubmed/1848624?dopt=AbstractPlus
274. Manischewitz JF, Quinnan GV Jr. Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother. 1990; 34:373-5. http://www.ncbi.nlm.nih.gov/pubmed/2158278?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=171593&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/2559657?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1676798?dopt=AbstractPlus
278. Coker RJ, Tomlinson D, Horner P et al. Treatment of cytomegalovirus retinitis with ganciclovir and foscarnet. Lancet. 1991; 338:574. http://www.ncbi.nlm.nih.gov/pubmed/1678829?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1656826?dopt=AbstractPlus
281. Hirsch MS. The treatment of cytomegalovirus in AIDS—more than meets the eye. N Engl J Med. 1992; 326:264-6. http://www.ncbi.nlm.nih.gov/pubmed/1309391?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1345799?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1313549?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1658652?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1311352?dopt=AbstractPlus
286. Rubin RH. Preemptive therapy in immunocompromised hosts. N Engl J Med. 1991; 324:1057-8. http://www.ncbi.nlm.nih.gov/pubmed/1848680?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1846456?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1666492?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=245358&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/1645385?dopt=AbstractPlus
292. American Academy of Pediatrics. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics; 2018.
293. Pau AK, Pitrak DL. Management of cytomegalovirus infection in patients with acquired immunodeficiency syndrome. Clin Pharm. 1990; 9:613-31. http://www.ncbi.nlm.nih.gov/pubmed/2167189?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1510405?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=188848&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/1929243?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=284286&blobtype=pdf
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. http://www.ncbi.nlm.nih.gov/pubmed/1570851?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1312595?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1914362?dopt=AbstractPlus
300. Drew WL. Cytomegalovirus infection in patients with AIDS. Clin Infect Dis. 1992; 14:608-15. http://www.ncbi.nlm.nih.gov/pubmed/1313313?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1379914?dopt=AbstractPlus
302. Laske A, Gallino A, Carrel T et al. Ganciclovir for cytomegalovirus after heart transplantation. N Engl J Med. 1992; 327:892. http://www.ncbi.nlm.nih.gov/pubmed/1324433?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1662140?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/1654994?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8380242?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8380243?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8381032?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8387563?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8394858?dopt=AbstractPlus
312. Peters M, Schurmann D, Pohle HD et al. Combined and alternating ganciclovir/foscarnet in HIV-related cytomegalovirus encephalitis. Lancet. 1992; 340:970. http://www.ncbi.nlm.nih.gov/pubmed/1357363?dopt=AbstractPlus
313. Rubin RH, Tolkoff-Rubin NE. Antimicrobial strategies in the care of organ transplant recipients. Antimicrob Agents Chemother. 1993; 37:619-24. http://www.ncbi.nlm.nih.gov/pubmed/8494357?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=187724&blobtype=pdf
314. Zaia JA. Prevention and treatment of cytomegalovirus pneumonia in transplant recipients. Clin Infect Dis. 1993; 17(Suppl 2):S392-9. http://www.ncbi.nlm.nih.gov/pubmed/8274605?dopt=AbstractPlus
315. Buckner FS, Pomeroy C. Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infect Dis. 1993; 17:644-56. http://www.ncbi.nlm.nih.gov/pubmed/8268345?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8380610?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8678367?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8547499?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8618603?dopt=AbstractPlus
322. Crumpacker CS. Ganciclovir. N Engl J Med. 1996; 335:721-9. http://www.ncbi.nlm.nih.gov/pubmed/8786764?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/7603215?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9413463?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8629285?dopt=AbstractPlus
328. Paya CV. Defining an optimal regimen for cytomegalovirus prophylaxis in organ transplant recipients. Transplant Proc. 1996; 28(Suppl 2):9-11. http://www.ncbi.nlm.nih.gov/pubmed/9037269?dopt=AbstractPlus
329. Griffiths PD. Prophylaxis against CMV infection in transplant patients. J Antimicrob Chemother. 1997; 39:299-301. http://www.ncbi.nlm.nih.gov/pubmed/9096177?dopt=AbstractPlus
330. Conti DJ, Shen G, Singh T et al. Ganciclovir prophylaxis of cytomegalovirus disease. Transplant Proc. 1997; 29:804-6. http://www.ncbi.nlm.nih.gov/pubmed/9123534?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9116610?dopt=AbstractPlus
332. Badas A, Stoukides CA. Guidelines for prophylaxis of cytomegalovirus disease in bone marrow transplant patients. Ann Pharmacother. 1996; 30:1483-6. http://www.ncbi.nlm.nih.gov/pubmed/8968462?dopt=AbstractPlus
333. Reusser P. The challenge of cytomegalovirus infection after bone arrow transplantation: epidemiology, prophylaxis, and therapy. Bone Marrow Transplant. 1996; 18:107-9. http://www.ncbi.nlm.nih.gov/pubmed/8932809?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/7762909?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/8256974?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9588429?dopt=AbstractPlus
337. Cunningham ET, Margolis TP. Ocular manifestations of HIV infection. N Engl J Med. 1998; 339:336-44.
339. Balfour HH. Antiviral drugs. N Engl J Med. 1999; 340:1255-68. http://www.ncbi.nlm.nih.gov/pubmed/10210711?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9534987?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9593001?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/9663231?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/10458619?dopt=AbstractPlus
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.
350. Engorn B and Flerlage J eds. The Harriet Lane Handbook. 12th ed. Philadelphia, PA: Elsevier; 2015: p. 800.
351. Merck & Co., Inc. Prevymis (letermovir) film-coated tablets and injection, for intravenous use prescribing information. Whitehouse Station, NJ; 2017 Nov.
352. Hospira. Foscavir (foscarnet sodium) injection prescribing information. Lake Forest, IL; 2017 Nov.
HID. ASHP’s interactive handbook on injectable drugs. McEvoy, GK, ed. Bethesda, MD: American Society of Health-System Pharmacists, Inc; Accessed Mar 13, 2019. From HID website http://www.interactivehandbook.com/
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