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Ganciclovir (Ophthalmic)



(gan SYE kloe veer)

Index Terms

  • Nordeoxyguanosine

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Gel, Ophthalmic:

Zirgan: 0.15% (5 g) [contains benzalkonium chloride]

Implant, Intraocular:

Vitrasert: 4.5 mg (1 ea [DSC])

Brand Names: U.S.

  • Vitrasert [DSC]
  • Zirgan

Pharmacologic Category

  • Antiviral Agent, Ophthalmic


Ganciclovir is phosphorylated to a substrate, which competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of DNA replication by herpes simplex viruses.


Negligible systemic absorption (0.1% in comparison to IV doses and 0.04% in comparison to oral valganciclovir)

Use: Labeled Indications

Herpetic keratitis: Treatment of acute herpetic keratitis (dendritic ulcers)


There are no contraindications listed in the manufacturer’s labeling.

Dosing: Adult

Herpetic keratitis: Ophthalmic: Apply 1 drop in affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then apply 1 drop 3 times daily for 7 days

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Herpetic keratitis: Children ≥2 years and Adolescents: Ophthalmic: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.


For ophthalmic application only; avoid touching tip of applicator to eye or other surfaces.

Hazardous agent; use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).


Store at 15°C to 25°C (59°F to 77°F). Do not freeze.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

>10%: Ophthalmic: Blurred vision (60%), eye irritation (20%)

1% to 10%: Ophthalmic: Punctate keratitis (5%), conjunctival hyperemia (5%)


Concerns related to adverse effects:

• Ocular adverse events: Blurred vision commonly occurs; may also cause eye irritation.

Special populations:

• Contact lens wearers: Contact lenses should not be worn during the course of therapy or in any patient with signs/symptoms of herpetic keratitis.

Special handling:

• Hazardous agent: Use appropriate precautions for handling and disposal (NIOSH 2014 [group 2]).

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use only.

Monitoring Parameters

Ophthalmologic exams

Pregnancy Risk Factor


Pregnancy Considerations

Adverse events were observed in animal reproduction studies conducted with systemic ganciclovir. Based on animal studies, a U.S. Boxed Warning has been added to the labeling of the systemic product and effective contraception is recommended in males and females using systemic therapy. The amount of ganciclovir available systemically following topical application of the Zirgan ophthalmic gel is significantly less in comparison to IV doses (0.1%).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience blurred vision. Have patient report immediately to prescriber vision changes, eye pain, or severe eye irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.