Home Drug Guide Cidofovir

Drug Guide

Generic Name

Cidofovir

Brand Names Vistide

Classification

Therapeutic: Antiviral

Pharmacological: Nucleotide Analog

FDA Approved Indications

  • Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS

Mechanism of Action

Cidofovir inhibits viral DNA polymerase, resulting in DNA chain termination and inhibition of viral DNA synthesis.

Dosage and Administration

Adult: 5 mg/kg IV once weekly for 2 weeks, then every 2 weeks; prehydration with saline and probenecid recommended.

Pediatric: Use is off-label; dosing based on weight and clinical judgment.

Geriatric: Adjust dose carefully, monitor renal function closely.

Renal Impairment: Reduce dose or extend dosing interval; prehydration and probenecid used to reduce nephrotoxicity.

Hepatic Impairment: No specific adjustment; monitor closely.

Pharmacokinetics

Absorption: Administered intravenously; not absorbed orally.

Distribution: Widely distributed, concentrates in renal cortex.

Metabolism: Not metabolized; excreted unchanged.

Excretion: Primarily through kidneys via glomerular filtration and active tubular secretion.

Half Life: approximately 2.6 hours in patients with normal renal function.

Contraindications

  • Hypersensitivity to cidofovir or probenecid.

Precautions

  • Renal impairment, pre-existing kidney disease, prior aminoglycoside use, dehydration.

Adverse Reactions - Common

  • Nephrotoxicity (Common)
  • Neutropenia (Less common)
  • Ocular complications (Rare)

Adverse Reactions - Serious

  • Acute renal failure (Serious)
  • Severe neutropenia (Serious)
  • Fanconi syndrome (renal tubular dysfunction) (Serious)

Drug-Drug Interactions

  • Nephrotoxic drugs (e.g., aminoglycosides, NSAIDs), which increase risk of renal damage.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor renal function (serum creatinine, urine tests) before and during therapy. Assess for signs of neutropenia and ocular toxicity.

Diagnoses:

  • Risk for nephrotoxicity
  • Risk for infection due to neutropenia

Implementation: Ensure adequate hydration, administer probenecid 2 g orally 2 hours before and 1 hour after cidofovir infusion, monitor lab values, educate patient on renal and ocular symptoms.

Evaluation: Regularly evaluate renal function tests, blood counts, and ocular health.

Patient/Family Teaching

  • Report signs of kidney problems (e.g., decreased urine output, swelling).
  • Avoid dehydration.
  • Understand the importance of follow-up labs and ocular exams.
  • Inform about potential side effects and when to seek medical attention.

Special Considerations

Black Box Warnings:

  • Nephrotoxicity, which can be severe and lead to kidney failure.

Genetic Factors: None currently identified.

Lab Test Interference: May increase serum creatinine and blood urea nitrogen (BUN).

Overdose Management

Signs/Symptoms: Severe kidney damage, neutropenia.

Treatment: Supportive; dialysis may be necessary for renal failure.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable when stored properly, consult package insert for expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.