eOphtha

Menu

 



Acetazolamide | Acetylcholine | Acyclovir | Adalimumab | Amikacin | Amphotericin B | Ampicillin | Apraclonidine| Atropine | Azathioprine | Azelastine | Betaxolol | Bevacizumab| Biologicals | Brimonidine | Brinzolamide  | Bupivacaine | Capsofungin  | Cefazolin | Cidofovir | Ciprofloxacin | Clotrimazole | Corticosteroids | Cyclopentolate | Cyclosporine A | Cyclophosphamide | Daclizumab | Dorzolamide | EDTA | Epinephrine | Etanercept| Erythromycin | Famciclovir | Foscarnet | Fluconazole | Fluorescein Sodium | Fluorometholone | 5-Fluorouracil | Flurbiprofen   | Ganciclovir | Gatifloxacin | Gentamicin | Glycerin | Homatropine | Hydroxypropyl | Idoxurudine | Indocyanine Green | Infliximab | Interferon alpha | Itraconazole | Ketoconazole | Ketorolac | Latanoprost | Leflunomide | Lidocaine | Loteprednol | Mannitol  | Methotrexate | Methylene Blue | Mitomycin | Moxifloxacin | Mycophenolate Mofetil | Naphazoline | Natamycin | Nedocromil Sodium | Neomycin Sulfate | Ofloxacin | Olopatadine | Pegaptanib | Pilocarpine | Timolol | Valacyclovir | Valganciclovir | Vidarabine | Voriconazole

Ganciclovir


Ganciclovir is a synthetic analog of deoxyguanosine that has greater activity against CMV.

Mode of action:  

Ganciclovir acts by selective inhibition of CMV DNA polymerase after phosphorylation in CMV-infected cells. It appears to interfere with DNA synthesis via competition with deoxyguanosine for incorporation into viral DNA, and by incorporation into growing viral DNA chains.

Pharmacokinetics:

Ganciclovir can be administered intravenously, orally, or via intraocular implant. Cerebrospinal fluid concentrations are approximately 50% of those in serum. The elimination half-life of the drug is 4 hours with normal renal function and the intracellular half-life is 18 hours. Clearance of the drug is related to creatinine clearance. However, the bioavailability of oral ganciclovir is poor. In intraocular implant, ganclovir is slowly released into the vitreous cavity at a rate of approximately 1.4 mcg/h.
Sustained release intraocular implant of ganciclovir has been found to be effective and safe both as an alternative to intravenous ganciclovir therapy in myelosuppressed patients and as a supplement to intravenous therapy in uncontrolled CMV retinitis. It avoids the risks of systemic toxicity associated with other routes of administration and negates the need for repeated injections. The implant is placed surgically in the vitreous cavity, and can provide therapeutic levels of up to 8 months depending on the rate of drug release. However an increased risk of CMV retinitis developing in the fellow eye and of systemic involvement in the patients who received implants compared with patients who received the drug intravenously has been observed. For which, these patients may be given oral ganciclovir.

Anti-viral profile:

Ganciclovir has been found effective against CMV, HSV, VZV, EBV, HHV-6, and KSHV (Kaposi's sarcoma-associated herpes virus) in vitro.It is currently recommended for the treatment of CMV retinitis in immunocompromised patients and for CMV prophylaxis in transplant patients. Because ganciclovir is only virustatic, continuous therapy with the IV drug is necessary to prevent viral breakthrough in the immunosuppressed patient. However, despite careful management, many patients have reactivation of the disease.

Adverse effects:

Unlike acyclovir, ganciclovir is more susceptible to phosphorylation by enzymes in uninfected (host) cells, especially in rapidly dividing cells like bone marrow. That is why the drug is more toxic to the bone marrow and causes significant neutropenia in more than half of the patients treated. Other less frequent side effects include nausea, neurotoxicity, hepatic dysfunction, fever.

Resistance:

Resistant CMV strains have been reported. The drug does not code for thymidine kinase and is, therefore can be used in TK-resistant HSV and VZV strains.


Drugs to treat CMV infections Click Here

Statutory Warning

Materials / Informations provided here are for educational purpose only ; and not to be used for medical advice, diagnosis or treatment