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Ganciclovir Side Effects

In Summary

Commonly reported side effects of ganciclovir include: severe neutropenia, severe thrombocytopenia, anemia, leukopenia, neutropenia, and decreased creatinine clearance. Other side effects include: severe anemia. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to ganciclovir: capsule, powder for solution

Along with its needed effects, ganciclovir may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Medicines like ganciclovir can sometimes cause serious side effects such as blood problems; these are described below. Discuss these possible effects with your doctor.

Check with your doctor immediately if any of the following side effects occur while taking ganciclovir:

More commonFor oral capsules and injection into the vein only
  • Sore throat and fever
  • unusual bleeding or bruising
Less commonFor oral capsules and injection into the vein only
  • Mood or other mental changes
  • nervousness
  • pain at place of injection
  • skin rash
  • tremor
  • unusual tiredness and weakness
For injection into the eye only
  • Decreased vision or any change in vision

Some side effects of ganciclovir may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Abdominal or stomach pain
  • loss of appetite
  • nausea and vomiting

For Healthcare Professionals

Applies to ganciclovir: intravenous powder for injection, oral capsule


In phase 3 clinical trials, ganciclovir was discontinued due to adverse effects in 9% of patients receiving maintenance treatment for CMV retinitis. Ganciclovir was discontinued 19.5% of AIDS patients receiving CMV prophylaxis due to adverse events, new or worsening intercurrent disease, or laboratory abnormalities (compared to 16% receiving placebo).[Ref]


Hematologic side effects have included neutropenia, anemia, and thrombocytopenia and are the major toxicity of ganciclovir. Leukopenia, pancytopenia, hemolytic anemia, hemolytic uremic syndrome, pure red blood cell aplasia, eosinophilia, and neutrophil dysplasia (with evidence of bone marrow hypoplasia) have also been reported. Coagulation disorder has been reported in pediatric patients.[Ref]

Bone marrow suppression is dose-related and usually occurs before a total dose of 200 mg/kg is reached. Sargramostim (GM-CSF) or filgrastim (G-CSF) have been used for the management of neutropenia due to ganciclovir.[Ref]


Gastrointestinal side effects have included diarrhea (41% to 48%), anorexia (14% to 19%), vomiting (13% to 14%), nausea, flatulence, abdominal pain, aphthous stomatitis, constipation, dyspepsia, eructation, intestinal ulceration, gastrointestinal perforation, pancreatitis, dysphasia, and cholelithiasis.[Ref]


Renal side effects have included increased serum creatinine, kidney failure, abnormal kidney function, and renal tubular disorder. Abnormal kidney function has also been reported in pediatric patients.[Ref]


Genitourinary side effects have included urinary frequency, infertility, and testicular hypotrophy.[Ref]


Hypersensitivity side effects have included allergic reaction, anaphylactic reaction, exfoliative dermatitis, and Stevens-Johnson syndrome.[Ref]


Ocular side effects have included retinal detachment (8% to 11%) in patients with CMV retinitis, both before and after initiation of treatment. Abnormal vision, dry eyes, vitreous disorder, cataracts, and oculomotor nerve paralysis have also been reported.[Ref]


Cases of ventricular tachycardia associated with ganciclovir infusions in patients with AIDS have been reported, although it is known that HIV infection is associated with myocarditis, decreased left ventricular function, and in some cases, nonsustained ventricular tachycardia.[Ref]

Cardiovascular side effects have included hypertension, phlebitis, edema, vasodilatation, cardiac arrest, cardiac conduction abnormality, vasculitis, stroke, torsades de pointes, and ventricular tachycardia. Hypertension has been reported in pediatric patients.[Ref]


Dermatologic side effects have included pruritus (5% to 10%), alopecia, and dry skin. Interstitial granulomatous drug reaction has been reported in at least one patient.[Ref]


Rare cases of hepatitis associated with ganciclovir have been reported, but in most cases, other potentially hepatotoxic drugs were coadministered.[Ref]

Hepatic side effects have included increased SGOT and SGPT, cholestasis, hepatic failure, and hepatitis.[Ref]

Nervous system

Seizures, psychosis, nightmares, anxiety, ataxia, and somnolence have been reported, but are rare and difficult to attribute to ganciclovir therapy since the patients are otherwise very ill and receiving other medications.[Ref]

Nervous system side effects have included neuropathy (8% to 21%), abnormal dreams, anxiety, confusion, depression, dizziness, dry mouth, insomnia, seizures, somnolence, abnormal thinking, tremor, agitation, delirium, dysesthesia, encephalopathy, extrapyramidal reaction, facial palsy, hallucinations, intracranial hypertension, irritability, loss of memory, and myelopathy.[Ref]


Endocrine side effects have included sweating (11% to 14%).[Ref]


Local side effects have included catheter infection (4% to 9%), catheter sepsis (1% to 8%), and injection site inflammation.[Ref]


Metabolic side effects have included weight loss, acidosis, elevated triglyceride levels, hypercalcemia, hyponatremia, and inappropriate serum ADH. Hypokalemia has been reported in pediatric patients.[Ref]


Musculoskeletal side effects have included arthralgia, leg cramps, myalgia, myasthenia, arthritis, and rhabdomyolysis.[Ref]


Respiratory side effects have included increased cough, dyspnea, bronchospasm, and pulmonary fibrosis. Pneumonia has been reported in pediatric patients.[Ref]


Other side effects have included fever (35% to 48%), infection (8% to 13%), chills (7% to 10%), sepsis (3% to 15%), abdominal enlargement, asthenia, chest pain, edema, headache, malaise, multiple organ failure, pain, taste perversion, tinnitus, loss of sense of smell, and peripheral ischemia.[Ref]


Immunologic side effects have included immune system disorder in pediatric patients.[Ref]


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Some side effects of ganciclovir may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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