Ganciclovir (Intravenous, Oral)

This medication is primarily used to treat cytomegalovirus disease, as well as the infections caused by the disease, and can be delivered by either the oral route or by injection.

Overview

People who have a compromised immune system, perhaps due to being infected with AIDS, or who have undergone an organ transplant, are the patients most likely to contract cytomegalovirus (CMT), and who will then require treatment such as ganciclovir. The viral infection which requires treatment occurs in the eyes, and the most effective way to halt the spread of this infection is by using an anti-viral medication such as this one.

Ganciclovir can be administered at home, either orally or by injection, but if you are self-administering the injectable form of this medication, it will be necessary to have a thorough understanding of the procedure from your doctor before attempting it at home. This means that you should be familiar with how to use syringes, and all other materials needed for home usage, and that you should ask your doctor any questions you may have about the process before home dosing.

It is generally better to take oral ganciclovir with food, so as to increase its absorption by the body, and if it is being injected this will not be as much of an issue, since it will be delivered directly into the bloodstream. It should be kept in mind that ganciclovir will not cure CMT disease, but will instead help to prevent the further spread of infection.

Condition Treated

  • Prevents cytomegalovirus and infections caused by it

Type Of Medicine

  • Anti-viral

Side Effects

In addition to the beneficial effects imparted to a patient by ganciclovir, there may be some less desirable side effects that some patients will experience. It's possible that some people taking this medication will have no side effects whatsoever, while others may experience some of the side effects listed below to a mild or moderate degree. If you should experience side effects to the extent that they make you extremely uncomfortable, you should contact your doctor for some kind of treatment alternative. One of the most important side effects to be on the alert for is the potential for an allergic reaction to ganciclovir. The symptoms from an allergic reaction can worsen to the point where they can become life-threatening, so it's very important that you seek immediate medical attention if you experience any of the side effects below which may indicate a potential allergic reaction.

  • Severe puffiness or swelling in the facial area, especially around the eyelids, throat, lips, and tongue
  • Extreme itchiness at various locations around the body
  • Lightheadedness or dizziness, as though you are about to faint
  • Difficulty breathing, often accompanied by tightness in the chest
  • Hives and or rashes appearing on the skin.

There are specific side effects which may occur when using the oral capsule form of ganciclovir, or the form which is injected directly into a vein. Those side effects include all of the following:

  • Noticeable mood changes or changes in behavior
  • Agitation or nervousness
  • Pain, blistering, peeling, or tenderness at the site of the injection
  • Skin rashes
  • Trembling or shaking
  • Unexplained weakness or fatigue
  • Sore throat
  • Fever
  • Unusual bruising and/or bleeding
  • Abdominal cramping or pains
  • Stomach cramping or pains
  • Paleness of the skin
  • Signs of an infection
  • Tingling sensation or numbness in the hands, feet, or legs
  • Nausea and/or vomiting
  • Persistent diarrhea
  • Decrease of appetite
  • Profuse sweating
  • Severe itchiness
  • Decrease in production of sperm
  • Infertility.

When ganciclovir is injected into the eye, there is a possibility for the following side effects to occur:

  • Blurry vision
  • Double vision
  • Decreased vision
  • Any other changes to vision.

There may be other side effects which come and go in the days following a dosage of ganciclovir. These are generally relatively mild, and they will often fade away all on their own, without the need for any kind of medical intervention. These side effects appear briefly and generally without causing extreme discomfort to the patient, and will subside as the body adjusts itself to the medication.

Dosage

The dosing schedule for ganciclovir should be arranged such that there is a constant amount of the medication in the patient's bloodstream, since that is how this drug is used most effectively. It is also important for this medication to be taken with food, so as to ensure that it is entirely absorbed by the body, and will have an optimal chance to provide the intended benefits for a patient.

Even though the actual dosages for any given patient will vary based on a number of factors, the important thing to remember is that the schedule itself should be strictly adhered to, so as to maintain a desired level of the medication in the bloodstream.

  • For an oral capsule dosage, treating CMV retinitis, and following a ganciclovir injection for 2 to 3 weeks consecutively teenagers and adults should receive 1000 mg three times daily with a meal; alternatively 500 mg six times daily, spaced three hours apart, and with a meal. For child patients, a specific dosage and treatment schedule must be determined by the family doctor, based on specific age, medical condition and tolerance
  • For organ transplant patients and those with advanced HIV infection, or for those patients where CMV disease needs to be prevented adults and teenagers should receive 1000 mg three times daily, with a meal; child patients in this category must have their dosage and treatment schedule determined by a doctor based on appropriate factors
  • For the injection dosage treatment of CMV retinitis teenagers and adults will need to have a dosage calculated based on their body weight. Initially, a dosage of 5 mg per kilogram of body weight should be injected every 12 hours into a vein, for a period lasting between 14 and 21 days. Afterward, a dosage of 5 mg per kilogram of body weight should be injected into a vein just a single time each day for seven consecutive days; an alternative to this would be injecting 6 mg per kilogram of body weight directly into a vein once daily for five consecutive days. Children being treated with an injection dosage for CMV retinitis must have their precise dosage calculated by the family doctor, although it too will be based on body weight, along with several other factors
  • For an injection dosage targeted at the prevention of CMV for patients who have undergone an organ transplant¬† teenagers and adults will have the dosage based on body weight, initially established at 5 mg per kilogram of body weight, which would be injected into a vein at intervals 12 hours apart, for a period lasting between seven and 14 days. After this, the dosage would be reduced to 5 mg per kilogram of body weight once daily for seven days consecutively; alternatively a 6 mg per kilogram of body weight dosage can be injected into a vein, a single time each day for five successive days; children in this category must have their precise dosage and treatment schedule predetermined by the family doctor, and to be based on body weight along with several other medical factors.

Interactions

Any patient being treated with ganciclovir, or any other prescription medication, will have the potential for interaction with other drugs, or with existing medical conditions the patient may already have. The kinds of interactions which are possible can produce adverse side effects in the patient, or the interactions may cause a decrease in the effectiveness of one or the other drugs.

In order to prevent these kinds of drug interactions, a doctor will need to know all the medications you are currently taking, so that such interactions can be prevented. To facilitate this process, you will need to prepare a full list of all the medications you are currently taking, including vitamins, herbal supplements, over-the-counter drugs, and all other prescription medications, as well as the dosage for each one of these.

After reviewing this list, your doctor can make a determination whether some drugs need to be discontinued temporarily, or possibly to reduce the dosage level of one or more of them, so as to avoid any potential conflicts. You can also use this list to take with you to any other healthcare clinic where your primary care doctor is not in residence, or if you have a need to visit an emergency room for unscheduled treatment. Any doctor at one of these healthcare facilities will be able to review your list of medications and be able to safely prescribe treatment for whatever condition brought you to the emergency room or clinic.

The drugs which are known to interact with Jen sick liver, and which most doctors will always check for before prescribing ganciclovir include all of the following:

  • Ondansetron
  • Spironolactone
  • Trimethoprim
  • Sulfamethoxazole
  • Trimethoprim
  • Phenytoin
  • Acetaminophen
  • Valganciclovir
  • Levothyroxine
  • Methylprednisolone
  • Tacrolimus
  • Gabapentin
  • Furosemide
  • Heparin
  • Buspirone
  • Captopril
  • Cefotaxime
  • Meperidine
  • Epetin alfa
  • Ciprofloxacin
  • Levothyroxine.

In addition to interactions with other medications, there is a potential for ganciclovir to cause some kind of impact on an existing disease or medical condition you may have. Those medical conditions in this category include the following:

  • Hemodialysis
  • Renal dysfunction
  • Bone marrow suppression.

Warnings

Patients being treated with ganciclovir should be aware of some precautions and warnings that are associated with the medication. Being alert to these situations beforehand will help you avoid serious medical situations that might put your health at risk. There is a potential for ganciclovir to significantly reduce the number of white blood cells present in the bloodstream, which in turn can increase the likelihood of sustaining some kind of infection. It also has the potential for lowering the count of platelets in your blood, and that can lead to less effective blood clotting.

If you should experience a bruise or a cut in some kind of accident, there would be a potential for you to bleed much more than normal, and it may be difficult to stop this bleeding. With this being the case, it is highly advised that you observe some of the following specific precautions related to the diminution of blood clotting efficiency, and lower count of white blood cells.

  • You should be extremely careful when shaving yourself, or when using any other sharp objects in connection with your skin, fingernails, or toenails.
  • If you should notice any unusual bleeding or bruising, you should contact your doctor immediately
  • Recognizing any dark colored stools or stools with a tarry consistency should be reported to your doctor, as well as any blood which is observed in the stool or in urinary discharge
  • Be vigilant for the appearance of any purple-colored or red-colored spots that may appear on your skin
  • If you suspect you are getting an infection, or if you feel the onset of chills and or fever, you should alert your doctor immediately
  • Although it may seem harmless, you should be extremely careful when brushing your teeth with a normal toothbrush, or with dental floss, and even when using a toothpick. Any of these actions can trigger bleeding of the gums, and that could lead to a dangerous situation. If you expect to undergo a dental cleaning or any other kind of dental actions, you should inform your dentist that you are taking ganciclovir, and that you are at greater risk for bleeding gums.

Make sure to keep all appointments with your primary care physician during the period you are being treated with ganciclovir, so that any kind of blood problems can be identified as quickly as possible, and serious medical conditions can be avoided.

If you are aware that you have CMV retinitis, you will also need to arrange for regular visits with your ophthalmologist, because of the potential for some kind of vision change or vision loss during the period you are being treated with ganciclovir.

It is extremely important that females of child-bearing age avoid the possibility of pregnancy while taking ganciclovir. Based on research which has been conducted on animal populations, this drug has been shown to carry the potential for birth defects in humans, as well as a wide range of other potential afflictions.

It is also extremely important that a mother does not breast-feed while being treated with ganciclovir, because this medication can be passed on through breast milk and can trigger serious adverse reactions in a nursing infant.

Prior to being prescribed for treatment with ganciclovir, it is highly advisable that a woman be tested for pregnancy, and while being treated with this medication, it is likewise very important that reliable contraceptive methods be used, so as to exclude the possibility of becoming pregnant.

Storage

Storage of the oral capsule form of ganciclovir should be at room temperature, in a setting where no extremes of temperature are possible, and where there is no excessive humidity. If you are self-administering the injectable form of ganciclovir, you should be very careful about the storage of needles and syringes, especially if there are small children in the household. When expired medication needs to be disposed of, make sure to follow disposal methods recommended by your doctor or pharmacist. When disposing of used needles and syringes, be sure to package them in a puncture-proof container prior to disposal.

Summary

Ganciclovir is an antiviral which is used in the treatment of CMV retinitis, and is generally indicated for patients who have compromised immune systems. This situation is common among AIDS patients, and with patients who have had to undergo an organ transplant. The medication itself is available in capsule form and can also be delivered intravenously. A fairly common program of treatment with this drug calls for an initial period of injections for two or three weeks, followed by several more weeks of capsule-form ingestion. It is always advised to take this medication with food, so as to increase its absorption into the bloodstream, and maintain its effectiveness.