Home Drug Guide Ganciclovir Sodium

Drug Guide

Generic Name

Ganciclovir Sodium

Brand Names Cytovene

Classification

Therapeutic: Antiviral

Pharmacological: Nucleoside analog

FDA Approved Indications

  • Cytomegalovirus (CMV) retinitis in immunocompromised patients
  • Prevention of CMV disease in transplant recipients

Mechanism of Action

Ganciclovir inhibits viral DNA synthesis by incorporating into the DNA strand and causing chain termination, thereby inhibiting viral replication.

Dosage and Administration

Adult: Typically 5 mg/kg IV every 12 hours for 14-21 days, then maintenance doses; dosage adjustments may be necessary based on renal function.

Pediatric: Dosing similar to adults based on body weight, with adjustments for renal function; specific protocols should be followed.

Geriatric: Use caution; renal function should be carefully monitored due to increased risk of toxicity.

Renal Impairment: Reduce dose and increase interval based on creatinine clearance.

Hepatic Impairment: No specific adjustment recommended, but caution advised.

Pharmacokinetics

Absorption: Not absorbed orally; given intravenously.

Distribution: Widely distributed; crosses the blood-brain barrier and the placenta.

Metabolism: Minimal metabolism; primarily excreted unchanged.

Excretion: Renally excreted via glomerular filtration and tubular secretion.

Half Life: Approx. 3 hours in individuals with normal renal function.

Contraindications

  • Hypersensitivity to ganciclovir or valganciclovir.

Precautions

  • Use with caution in pregnant or breastfeeding women, in patients with renal impairment, or active bone marrow suppression.

Adverse Reactions - Common

  • Granulocytopenia (Common)
  • Thrombocytopenia (Common)
  • Elevated liver enzymes (Common)
  • Renal impairment (Common)

Adverse Reactions - Serious

  • Severe bone marrow suppression leading to neutropenia, anemia, thrombocytopenia (Serious but less common)
  • Potential carcinogenicity and teratogenicity in animal studies (Warning for pregnant women) (Serious)

Drug-Drug Interactions

  • Myelosuppressive agents such as zidovudine, immunosuppressants

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor renal function (BUN, creatinine), complete blood counts (CBC), and signs of infection.

Diagnoses:

  • Risk for infection
  • Risk for bleeding due to thrombocytopenia
  • Risk for impaired renal function

Implementation: Administer IV as prescribed, monitor CBC and renal function regularly, observe for side effects.

Evaluation: Assess for resolution of CMV infection, monitor blood counts, and renal function for toxicity

Patient/Family Teaching

  • Report fever, chills, sore throat, unusual bleeding, or bruising.
  • Understand the importance of regular blood tests.
  • Report signs of kidney problems or allergic reactions.

Special Considerations

Black Box Warnings:

  • Potential for reproductive toxicity; effective contraception should be used during treatment and for at least 30 days after the last dose.
  • Use caution in pregnant women; only use if clearly needed. Dilution and infusion should be prepared carefully to avoid extravasation.

Genetic Factors: N/A

Lab Test Interference: May cause transient elevations of serum creatinine and liver enzymes.

Overdose Management

Signs/Symptoms: Bone marrow suppression, nephrotoxicity.

Treatment: Discontinue drug, provide supportive care, and consider hematopoietic growth factors or dialysis if necessary.

Storage and Handling

Storage: Store vials at room temperature, protected from light.

Stability: Stable until expiration date on the package.

🛡️ 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.