Skip to Content

Vistide Side Effects

Generic Name: cidofovir

Note: This page contains side effects data for the generic drug cidofovir. It is possible that some of the dosage forms included below may not apply to the brand name Vistide.

For the Consumer

Applies to cidofovir: intravenous solution

As well as its needed effects, cidofovir (the active ingredient contained in Vistide) may cause unwanted side effects that require medical attention.

Medicines like cidofovir can sometimes cause serious side effects such as blood problems and kidney problems; these are described below. Cidofovir has also been found to cause cancer in animals, and there is a chance it could cause cancer in humans as well. Discuss these possible side effects with your doctor.

Major Side Effects

If any of the following side effects occur while taking cidofovir, check with your doctor immediately:

More common:
  • Fever, chills, or sore throat

Severity: Moderate

If any of the following side effects occur while taking cidofovir, check with your doctor or nurse as soon as possible:

More common:
  • Decreased urination
  • increased thirst and urination
  • Decreased vision or any change in vision

Minor Side Effects

Some cidofovir side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:
  • Diarrhea
  • headache
  • loss of appetite
  • nausea
  • vomiting
Less common:
  • Generalized weakness
  • loss of strength

For Healthcare Professionals

Applies to cidofovir: intravenous solution


The major side effect associated with cidofovir (the active ingredient contained in Vistide) therapy is renal toxicity. The most common adverse effects reported in clinical trials were proteinuria (50%), neutropenia (24%), decreased intraocular pressure (24%), decreased serum bicarbonate levels (16%), fever (14%), infection (12%), increased serum creatinine levels >= 2 mg/dL (12%), pneumonia (9%), dyspnea (8%), and nausea/vomiting (7%). The drug was discontinued in 39% of patients because of various adverse effects.[Ref]


Renal side effects have included nephrotoxicity. It may be irreversible and is the major side effect associated with cidofovir (the active ingredient contained in Vistide) therapy. Renal impairment, including cases of acute renal failure resulting in dialysis and/or contributing to death, has occurred with as few as one or two doses of the drug. Proteinuria (greater than 2+), reduced creatinine clearance (less than or equal to 55 mL/min), and/or elevations of serum creatinine concentration (greater than 0.4 mg/dL) occurred in about 59% of patients receiving a maintenance dose of 5 mg/kg every other week. Toxic nephropathy has also been reported.[Ref]

Adequate hydration and concomitant administration of probenecid is essential to lessen the risk of renal toxicity associated with cidofovir. Proteinuria, as measured by urinalysis, may be an early indicator of cidofovir-associated nephrotoxicity. Serum creatinine concentrations and routine urinalysis should be monitored prior to each dose of cidofovir. In patients with proteinuria, intravenous hydration should be administered and the urinalysis repeated. Patients who have had previous therapy with foscarnet may be at increased risk of renal toxicity and should be monitored closely.[Ref]


The risk of ocular hypotony may be increased in patients with diabetes mellitus.

Uveitis or iritis was reported in 15 (11%) of 135 patients who were administered the 5 mg/kg maintenance dose. Patients should be monitored for signs and symptoms of these complications and if they develop, treatment with topical corticosteroids with or without topical cycloplegic agents may be useful.[Ref]

Ocular side effects have included decreases intraocular pressure by more than 50% from baseline in 24% of patients in clinical trials; severe ocular hypotony (IOP less than 0.1 mmHg) occurred in 4%. Abnormal vision, amblyopia, blindness, cataract, conjunctivitis, corneal lesion, corneal opacity, diplopia, dry eyes, eye disorder, eye pain, iritis, keratitis, miosis, retinal detachment, retinal disorder, uveitis, and visual field defect have also been reported.[Ref]


Metabolic side effects including a decreased serum bicarbonate level to less than or equal to 16 mEq/L (16%) and multiple abnormalities of proximal renal tubular function or Fanconi's syndrome (1%) have occurred. Cases of metabolic acidosis, in association with liver dysfunction and pancreatitis, which resulted in death have also been reported. Cachexia, dehydration, edema, hypercalcemia, hyperglycemia, hyperkalemia, hyperlipemia, hypocalcemia, hypoglycemia, hypoglycemic reaction, hypokalemia, hypomagnesemia, hyponatremia, hypophosphatemia, hypoproteinemia, increased alkaline phosphatase, increased BUN, increased lactic dehydrogenase, increased SGOT, increased SGPT, peripheral edema, respiratory alkalosis, thirst, weight loss, and weight gain have also been observed in clinical trials. However, it could not be definitively determined from these trials that cidofovir (the active ingredient contained in Vistide) was the causative agent.[Ref]


Genitourinary side effects have included dysuria, glycosuria, hematuria, kidney stone, mastitis, metrorrhagia, nocturia, polyuria, prostatic disorder, urethritis, urinary casts, urinary incontinence, urinary retention, and urinary tract infection, although a causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to determine.[Ref]


Hematologic side effects have included neutropenia, anemia, and thrombocytopenia. Hypochromic anemia, leukocytosis, leukopenia, lymphadenopathy, lymphoma-like reaction, pancytopenia, splenic disorder, splenomegaly, thrombocytopenia, and thrombocytopenic purpura have also been reported but a causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to determine.[Ref]

Neutropenia (less than 500 cells/mm3) occurred in 24% of patients receiving cidofovir for CMV retinitis in clinical trials. Granulocyte colony-stimulating factor was used in 39% of patients to manage neutropenia due to cidofovir.[Ref]


Hypersensitivity or allergic reactions may include rash, fever, chills, and anaphylaxis. Patients receiving concomitant probenecid and cidofovir (the active ingredient contained in Vistide) may experience hypersensitivity reactions caused by probenecid. Cidofovir and probenecid therapy should be discontinued in patients who experience severe systemic reactions.[Ref]

Two patients developed erythroderma associated with concomitant administration of cidofovir and probenecid. Prophylactic or therapeutic use of antihistamines and/or acetaminophen may alleviate hypersensitivity reactions associated with the use of probenecid.[Ref]


Gastrointestinal side effects such as nausea and/or vomiting have occurred in 69% of patients receiving concomitant probenecid and cidofovir (the active ingredient contained in Vistide) for CMV retinitis. Diarrhea (26%), anorexia (23%), and abdominal pain (17%) also have been reported. Cholangitis, colitis, constipation, dysphagia, dyspepsia, esophagitis, fecal incontinence, flatulence, gastritis, gastrointestinal hemorrhage, gingivitis, melena, pancreatitis, proctitis, rectal disorder, stomatitis, aphthous stomatitis, tongue discoloration, mouth ulceration, and tooth caries have also been reported; however, a causal relationship to cidofovir was difficult to determine.[Ref]

Administration of probenecid after a meal and/or therapy with antiemetics may alleviate the nausea and vomiting associated with probenecid.[Ref]


Cardiovascular side effects such as cardiomyopathy, cardiovascular disorder, congestive heart failure, hypertension, hypotension, migraine, pallor, peripheral vascular disorder, postural hypotension, shock, syncope, tachycardia, vascular disorder, and edema have been reported from clinical trials. It was difficult, however, to prove a causal relationship to cidofovir (the active ingredient contained in Vistide) because many of the studied patients had very advanced disease and were administered numerous concomitant medications.[Ref]


Dermatological side effects which included rash (30%) and alopecia (27%) were observed in clinical trials that included the use of probenecid. Acne, angioedema, dry skin, eczema, exfoliative dermatitis, furunculosis, herpes simplex, nail disorder, pruritus, seborrhea, skin discoloration, skin disorder, skin hypertrophy, skin ulcer, sweating, and urticaria have also been reported in clinical trials. It is important to note that these trials included patients with very advanced disease who were also taking numerous concomitant medications, therefore, a causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to determine.[Ref]


Phlebitis has been reported with the use of intravenous cidofovir (the active ingredient contained in Vistide) [Ref]


Endocrine adverse effects are not common. Adrenal cortex insufficiency has been reported, although, a direct causal relationship to cidofovir (the active ingredient contained in Vistide) was not determined.[Ref]


Hepatic adverse effects are not common. Hepatitis, hepatomegaly, hepatosplenomegaly, jaundice, abnormal liver function, liver damage, and liver necrosis were reported in clinical trials although a causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to determine due to the fact that most of the patients received many concomitant medications and due to the broad manifestations of the underlying disease.[Ref]


Musculoskeletal side effects which have been reported in clinical trials regardless of the relationship to cidofovir (the active ingredient contained in Vistide) or probenecid include arthralgia, asthenia, arthrosis, bone necrosis, bone pain, joint disorder, leg cramps, myalgia, myasthenia, back pain, neck pain, and pathological fracture.[Ref]

Nervous system

Nervous system side effects have included abnormal dreams, abnormal gait, acute brain syndrome, agitation, amnesia, anxiety, ataxia, cerebrovascular disorder, confusion, convulsion, delirium, dementia, depression, dizziness, drug dependence, dry mouth, encephalopathy, facial paralysis, hallucinations, headache, hemiplegia, hyperesthesia, hypertonia, hypotony, incoordination, increased libido, insomnia, myoclonus, nervousness, neuropathy, paresthesia, personality disorder, somnolence, speech disorder, tremor, twitching, vasodilatation, and vertigo. A definitive causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to make, however, from these trials.[Ref]


Oncologic side effects have not been observed in humans. In a 26-week animal study, however, cidofovir (the active ingredient contained in Vistide) was found to be carcinogenic in rats.[Ref]


Respiratory side effects such as asthma, bronchitis, dyspnea, epistaxis, hemoptysis, hiccup, hyperventilation, hypoxia, increased sputum, larynx edema, lung disorder, pharyngitis, pneumonia, pneumothorax, rhinitis, sinusitis, and increased cough have been reported in clinical trials, however, a causal relationship to cidofovir (the active ingredient contained in Vistide) was difficult to determine.[Ref]


Other side effects reported in clinical trials regardless of the relationship to cidofovir (the active ingredient contained in Vistide) or probenecid were flu-like syndrome, hypothermia, malaise, mucous membrane disorder, photosensitivity reaction, sarcoma, infection, sepsis, oral moniliasis, taste perversion, ear disorder, ear pain, hyperacusis, otitis externa, otitis media, tinnitus, and hearing loss.[Ref]


1. "Product Information. Vistide (cidofovir)." Gilead Sciences, Foster City, CA.

2. Segarra-Newnham M, Vodolo KM "Use of cidofovir in progressive multifocal leukoencephalopathy." Ann Pharmacother 35 (2001): 741-4

3. Plosker GL, Noble S "Cidofovir - A review of its use in cytomegalovirus retinitis in patients with AIDS." Drugs 58 (1999): 325-45

4. Lalezari JP, Drew WL, Glutzer E, James C, Miner D, Flaherty J, Fisher PE, Cundy K, Hannigan J, Martin JC, et al "(S)-1-[3-hydroxy-2-(phosphonylmethoxy)propyl]cytosine (cidofovir): results of a phase I/II study of a novel antiviral nucleotide analogue." J Infect Dis 171 (1995): 788-96

5. Szczech LA "Hypertension and medication-related renal dysfunction in the HIV-infected patient." Semin Nephrol 21 (2001): 386-93

6. Roling J, Schmid H, Fischereder M, Draenert R, Goebel FD "HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy-Induced Nephropathy." Clin Infect Dis 42 (2006): 1488-95

7. Wald A "New therapies and prevention strategies for genital herpes." Clin Infect Dis 28 (1999): s4-13

8. Izzedine H, Launay-Vacher V, Deray G "Renal tubular transporters and antiviral drugs: an update." AIDS 19 (2005): 455-62

9. Polis MA, Spooner KM, Baird BF, Manischewitz JF, Jaffe HS, Fisher PE, Falloon J, Davey RT Jr, Kovacs JA, Walker RE, et al "Anticytomegaloviral activity and safety of cidofovir in patients with human immunodeficiency virus infection and cytomegalovirus viruria." Antimicrob Agents Chemother 39 (1995): 882-6

10. Torgovnick J, Sethi N, Karter D, Arsura E "Remission of AIDS-associated progressive multifocal leukoencephalopathy with combined cidofovir and radiotherapy: a case report." AIDS 20 (2006): 1569-1570

11. Yusuf U, Hale GA, Carr J, et al. "Cidofovir for the Treatment of Adenoviral Infection in Pediatric Hematopoietic Stem Cell Transplant Patients." Transplantation 81 (2006): 1398-1404

12. Kazory A, Singapuri S, Wadhwa A, Ejaz AA "Simultaneous development of Fanconi syndrome and acute renal failure associated with cidofovir." J Antimicrob Chemother 60 (2007): 193-4

13. Jabs DA "The ganciclovir implant plus oral ganciclovir versus parenteral cidofovir for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome: The ganciclovir cidofovir cytomegalovirus retinitis trial." Am J Ophthalmol 131 (2001): 457-67

14. Lopez V, Sola E, Gutierrez C, et al. "Anterior Uveitis Associated With Treatment With Intravenous Cidofovir in Kidney Transplant Patients With BK Virus Nephropathy." Transplant Proc 38 (2006): 2412-2413

15. Izzedine H, Launay-Vacher V, Deray G "Antiviral drug-induced nephrotoxicity." Am J Kidney Dis 45 (2005): 804-17

16. Shehab N, Sweet BV, Hogikyan ND "Cidofovir for the treatment of recurrent respiratory papillomatosis: a review of the literature." Pharmacotherapy 25 (2005): 977-89

17. Perazella MA "Drug-induced renal failure: update on new medications and unique mechanisms of nephrotoxicity." Am J Med Sci 325 (2003): 349-62

18. Chakrabarti S, Collingham KE, Osman H, Fegan CD, Milligan DW "Cidofovir as primary pre-emptive therapy for post-transplant cytomegalovirus infections." Bone Marrow Transplant 28 (2001): 879-81

19. Akler ME, Johnson DW, Burman WJ, Johnson SC "Anterior uveitis and hypotony after intravenous cidofovir for the treatment of cytomegalovirus retinitis." Ophthalmology 105 (1998): 651-7

20. Cabello V, Margarit N, Diaz Pedrero M, Bernal G, Pereira P, Gentil MA "Treatment of BK Virus-Associated Nephropathy With Cidofovir in Renal Transplantation." Transplant Proc 40 (2008): 2930-2

21. Tseng AL, Mortimer CB, Salit IE "Iritis associated with intravenous cidofovir." Ann Pharmacother 33 (1999): 167-71

22. Neau D, RenaudRougier MB, Viallard JF, Dutronc H, Cazorla C, Ragnaud JM, Dupon M, Lacut JY "Intravenous cidofovir-induced iritis." Clin Infect Dis 28 (1999): 156-7

23. Friedberg DN "Hypotony and visual loss with intravenous cidofovir treatment of cytomegalovirus retinitis." Arch Ophthalmol 115 (1997): 801-2

24. Kay TD, Hogan PG, McLeod S, Johnson DW "Severe irreversible proximal renal tubular acidosis and azotaemia secondary to cidofovir." Nephron 86 (2000): 348-9

It is possible that some side effects of Vistide may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.