More Information About - Herpigel 5gm Eye Gel - 5 g
Description
Generic Name
Ganciclovir
Precaution
Renal impairment; preexisting cytopenias or history of cytopenic reactions to drugs; child; contraceptive precautions to be followed during and at least 90 days thereafter; care in administering only into veins with good blood flow. Avoid contact with the skin and eyes. Maintain adequate hydration during infusion. Monitor WBC and platelet counts regularly during treatment. Eye examinations should be conducted at least once every 4-6 wk during treatment for CMV retinitis.
Lactation: excretion in milk unknown; use with caution
FDA has not yet classified the drug into a specified pregnancy category.
Mode of Action
Ganciclovir is a synthetic guanine nucleoside analogue with activity against cytomegalovirus (CMV). It competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase, thus inhibiting viral DNA synthesis.
Interaction
Increased risk of haematologic toxicity w/ zidovudine. May increase serum levels of didanosine. Increased serum concentration w/ probenecid and other drugs that inhibit renal tubular secretion and resorption. Use of IV ganciclovir w/ oral mycophenolate mofetil may result in increased plasma concentrations of both drugs due to competition for renal tubular secretion. Concomitant use w/ immunosuppressive agents (e.g. azathioprine, ciclosporin, corticosteroids) may result in excessive suppression of bone marrow or the immune system. Generalised seizure may occur when taken w/ imipenem and cilastatin. Concurrent use w/ drugs that inhibit replication of rapidly dividing cells (e.g. dapsone, pentamidine, pyrimethamine, flucytosine, cytotoxic antineoplastic agents, amphotericin B, co-trimoxazole, other nucleoside analogues) may result in additive toxicity.
Pregnancy Category Note
Pregnancy
Placental transfer of ganciclovir has been shown to occur based on ex vivo experiments with human placenta and in at least 1 case report in a pregnant woman; however, no adequate human data are available to establish whether ganciclovir poses a risk to pregnancy outcomes
In animal studies, ganciclovir caused maternal and fetal toxicity and embryo-fetal mortality in pregnant mice and rabbits as well as teratogenicity in rabbits at exposures 2 times the exposure at the recommended human dose (RHD)
Disease-associated maternal and/or embryo-fetal risk
Most maternal CMV infections are asymptomatic or they may be associated with a self-limited mononucleosis-like syndrome; however, in immunocompromised patients, CMV infections may be symptomatic and may result in significant maternal morbidity and mortality
CMV fetal transmission results from maternal viremia and transplacental infection
Perinatal infection can also occur from exposure of the neonate to CMV shedding in the genital tract ~10% of children with congenital CMV infection are symptomatic at birth
Mortality in symptomatic infants is ~10% and ~50-90% of symptomatic surviving newborns experience significant morbidity, including mental retardation, sensorineural hearing loss, microcephaly, seizures, and other medical problems
Risk of congenital CMV infection resulting from primary maternal CMV infection may be higher and of greater severity than that resulting from maternal reactivation of CMV infection
Contraception
Test for pregnancy in females of reproductive potential before initiating treatment
Females: Because of ganciclovir?s mutagenic and teratogenic potential, use effective contraception during treatment and for at least 30 days following treatment
Males: Because of ganciclovir?s mutagenic and teratogenic potential, use barrier contraception during treatment and for at least 90 days following treatment
Infertility
Based on animal data and limited human data, may cause temporary or permanent inhibition of spermatogenesis in males, and may cause suppression of fertility in females at recommended human dose (RHD); advise patients that fertility may be impaired with use
Lactation
No data are available regarding the presence of ganciclovir in human milk, the effects on the breastfed infant, or the effects on milk production
Ganciclovir was present in milk in lactating rats following administration
Breastfeeding is not recommended during treatment owing to the potential for serious adverse reactions in nursing infants
Adult Dose
Ophthalmic
Herpes simplex keratitis
Adult: As 0.15% gel: Apply 1 drop in the inferior conjunctival sac of the affected eye 5 times daily (approx 3 hrly while awake) until corneal healing occurs.
Maintenance: 1 drop tid for 7 days after healing.
Intravenous
CMV Retinitis
Initial: 5 mg/kg IV q12hr, over 1 hr x14-21d
Maintenance
5 mg/kg IV qD OR
6 mg/kg IV qD for 5 d/week
CMV Prevention in Transplant Recipients
Induction: 10 mg/kg/d div q12hr IV x7-14 d
Maintenance
5 mg/kg IV qD x100-120 d after transplant OR
6 mg/kg IV qD for 5 d/week x100-120 d after transplant
CMV Prevention in HIV Infected
5-6 mg/kg 5-7x/week IV (recurrence)
Child Dose
Ophthalmic
Herpes simplex keratitis
<2 years: Safety and efficacy not established
2 years or older: Apply 1 drop in the inferior conjunctival sac of the affected eye 5 times daily (approx 3 hrly while awake) until corneal healing occurs.
Maintenance: 1 drop tid for 7 days after healing.
Renal Dose
Renal Impairment (IV Induction)
CrCl 50-69 mL/min: 2.5 mg/kg IV q12hr
CrCl 25-49 mL/min: 2.5 mg/kg IV qD
CrCl <25 mL/min: 1.25 mg/kg IV qD
Renal impairment: Dialysis patients: 1.25 mg/kg for induction or 0.625 mg/kg for maintenance, to be given post dialysis on days when dialysis is performed.
CrCl (ml/min) Dosage Recommendation
10-24 1.25 mg/kg/day for induction, then 0.625 mg/kg/day for maintenance.
25-49 2.5 mg/kg/day for induction, then 1.25 mg/kg/day for maintenance.
50-69 2.5 mg/kg 12 hrly for induction, then 2.5 mg/kg/day for maintenance.
Administration
Reconstitution: Add 10 mL of sterile water for inj to the vial labelled as containing 500 mg to provide a soln containing 50 mg/mL. Withdraw the appropriate dose of reconstituted soln from the vial and further dilute in 50-250 (usually 100) mL of a compatible IV infusion soln.
Disclaimer
The information provided herein are for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please note that this information should not be treated as a replacement for physical medical consultation or advice. Great effort has been placed to provide accurate and comprehensive data. However, Medicart along with its authors and editors make no representations or warranties and specifically disclaim all liability for any medical information provided on the site. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company.