Home Drug Guide Ganciclovir

Drug Guide

Generic Name

Ganciclovir

Brand Names Cytovene, Vitrasert, Zirgan, Ganzyk-rtu

Classification

Therapeutic: Antiviral

Pharmacological: Nucleoside analogue, DNA synthesis inhibitor

FDA Approved Indications

  • Treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients
  • Prevention of CMV disease in organ transplant recipients

Mechanism of Action

Ganciclovir inhibits viral DNA polymerase after being phosphorylated by viral kinases, leading to termination of viral DNA synthesis.

Dosage and Administration

Adult: Typically 5 mg/kg IV every 12 hours for 14-21 days, then maintenance dosing as per protocol

Pediatric: Dosing varies based on weight and age; usually 5 mg/kg IV every 12 hours, adjusted for renal function

Geriatric: Dose adjustments based on renal function; increased monitoring advised

Renal Impairment: Dose reduction required based on creatinine clearance

Hepatic Impairment: Use with caution; no specific dose adjustment established

Pharmacokinetics

Absorption: Poor oral bioavailability (~6%), IV administration common

Distribution: Widely distributed including eye and CSF; crosses blood-brain barrier

Metabolism: Minimal hepatic metabolism; primarily renal excretion

Excretion: Renal excretion of unchanged drug; dose adjustment needed in renal impairment

Half Life: 3-4 hours in patients with normal renal function

Contraindications

  • Hypersensitivity to ganciclovir or valganciclovir

Precautions

  • Bone marrow suppression, renal impairment, active infections, pregnancy and lactation (category C)

Adverse Reactions - Common

  • Bone marrow suppression (neutropenia, thrombocytopenia, anemia) (Common)
  • Headache, fever, nausea (Common)

Adverse Reactions - Serious

  • Severe neutropenia, anemia, thrombocytopenia leading to infections or bleeding (Serious and warrants monitoring)
  • Renal toxicity (Serious, especially in renal impairment)
  • Neurotoxicity (confusion, hallucinations) (Rare)

Drug-Drug Interactions

  • Mycophenolate mofetil, zidovudine, other marrow suppressants

Drug-Food Interactions

  • None significant

Drug-Herb Interactions

  • None established

Nursing Implications

Assessment: Monitor CBC, renal function, signs of infection and neurotoxicity

Diagnoses:

  • Impaired infection defense
  • Risk for bleeding or anemia

Implementation: Administer IV as prescribed; monitor blood counts; adjust dose in renal impairment

Evaluation: Assess for resolution or progression of CMV infection, monitor side effects

Patient/Family Teaching

  • Report fever, sore throat, unusual bleeding or bruising
  • Maintain hydration to support renal function
  • Adhere to scheduled monitoring appointments

Special Considerations

Black Box Warnings:

  • Myelosuppression, fertility impairment, carcinogenic and mutagenic risks

Genetic Factors: None established impacting use

Lab Test Interference: May cause false elevation in blood urea nitrogen and serum creatinine

Overdose Management

Signs/Symptoms: Severe bone marrow suppression, neurotoxicity, renal failure

Treatment: Supportive care, discontinue drug, consider hemodialysis for severe cases

Storage and Handling

Storage: Store at room temperature, protect from light and moisture

Stability: Consult manufacturer data for specific stability info

🛡️ 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.