Drugs List

Therapeutic Indications

Uses

Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS

Cytomegalovirus retinitis in adults with acquired immunodeficiency syndrome (AIDS) and without renal dysfunction.

Administration

For intravenous infusion only. Must be diluted in 100ml normal saline prior to administration.

Contraindications

Children under 18 years
Concomitant medication consider washout period, see prescribing information
Breastfeeding
Pregnancy
Proteinuria above 99 mg/dl
Renal impairment - creatinine clearance below 56 ml/minute

Precautions and Warnings

Females of childbearing potential
Patients over 60 years
Diabetes mellitus
Hepatic impairment

Treatment does not prevent risk of transmission of HIV
Advise ability to drive/operate machinery may be affected by side effects
Anti-emetics may be required during therapy
Concurrent probenecid is required to minimise potential nephrotoxicity
Discontinue potentially nephrotoxic drugs at least 7 days before starting
Patients must receive 1L of normal saline intravenously prior to each dose
Treatment should be initiated by doctor experienced in HIV management
Avoid contact of powder with skin and mucous membranes
Avoid contact of prepared solution with skin and mucous membranes
Staff: Not to be handled by pregnant staff
Use only if the solution is clear and colourless
Monitor serum creatinine levels and urine protein levels before each dose
Monitor ophthalmic function
Perform differential white blood cell count before each dose
Consider discontinuation if uveitis/iritis occurs
Suspend and rehydrate if serum creatinine increases by 44micromol/L or more
Discontinue if renal function deteriorates
Suspend therapy and rehydrate if proteinuria is equal to or more than 2+
Male: May cause infertility
Female: Contraception required during and for 1 month after treatment
Male: Use barrier contraception during and for 3 months after treatment

Pregnancy and Lactation

Pregnancy

Cidofovir is contraindicated during pregnancy.

The manufacturer does not recommend using cidofovir during pregnancy.

At the time of writing there is limited data regarding the use of cidofovir during pregnancy. Studies in animals have shown some reproductive toxicity. It is not known if cidofovir crosses the placenta, but its low molecular weight suggests a risk of passage to the foetus.

Lactation

Cidofovir is contraindicated during breastfeeding.

The manufacturer recommends discontinuing breastfeeding whilst taking cidofovir.

There is limited data on the use of cidofovir during breastfeeding. It is not known if cidofovir or its metabolites are excreted in breast milk. Effects on exposed infants are unknown.

Side Effects

Acute renal failure
Alopecia
Anaemia
Anorexia
Asthenia
Chills
Cough increased
Diarrhoea
Dyspnoea
Fanconi syndrome
Fever
Glycosuria
Headache
Hearing disturbances
Infections
Iritis
Nausea
Nephrotoxicity
Neutropenia
Ocular hypotony
Oral moniliasis
Pain - generalised
Pancreatitis
Proteinuria
Rash
Renal failure
Serum creatinine increased
Uveitis
Vomiting

Presentation

Parenteral formulations of cidofovir.

Drugs List

Therapeutic Indications

Uses

Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS

Cytomegalovirus retinitis in adults with acquired immunodeficiency syndrome (AIDS) and without renal dysfunction.

Dosage

Adults

Administration

For intravenous infusion only. Must be diluted in 100ml normal saline prior to administration.

Contraindications

Children under 18 years
Concomitant medication consider washout period, see prescribing information
Breastfeeding
Pregnancy
Proteinuria above 99 mg/dl
Renal impairment - creatinine clearance below 56 ml/minute

Precautions and Warnings

Females of childbearing potential
Patients over 60 years
Diabetes mellitus
Hepatic impairment

Treatment does not prevent risk of transmission of HIV
Advise ability to drive/operate machinery may be affected by side effects
Anti-emetics may be required during therapy
Concurrent probenecid is required to minimise potential nephrotoxicity
Discontinue potentially nephrotoxic drugs at least 7 days before starting
Patients must receive 1L of normal saline intravenously prior to each dose
Treatment should be initiated by doctor experienced in HIV management
Avoid contact of powder with skin and mucous membranes
Avoid contact of prepared solution with skin and mucous membranes
Staff: Not to be handled by pregnant staff
Use only if the solution is clear and colourless
Monitor serum creatinine levels and urine protein levels before each dose
Monitor ophthalmic function
Perform differential white blood cell count before each dose
Consider discontinuation if uveitis/iritis occurs
Suspend and rehydrate if serum creatinine increases by 44micromol/L or more
Discontinue if renal function deteriorates
Suspend therapy and rehydrate if proteinuria is equal to or more than 2+
Male: May cause infertility
Female: Contraception required during and for 1 month after treatment
Male: Use barrier contraception during and for 3 months after treatment

Pregnancy and Lactation

Pregnancy

Cidofovir is contraindicated during pregnancy.

The manufacturer does not recommend using cidofovir during pregnancy.

At the time of writing there is limited data regarding the use of cidofovir during pregnancy. Studies in animals have shown some reproductive toxicity. It is not known if cidofovir crosses the placenta, but its low molecular weight suggests a risk of passage to the foetus.

Lactation

Cidofovir is contraindicated during breastfeeding.

The manufacturer recommends discontinuing breastfeeding whilst taking cidofovir.

There is limited data on the use of cidofovir during breastfeeding. It is not known if cidofovir or its metabolites are excreted in breast milk. Effects on exposed infants are unknown.

Side Effects

Acute renal failure
Alopecia
Anaemia
Anorexia
Asthenia
Chills
Cough increased
Diarrhoea
Dyspnoea
Fanconi syndrome
Fever
Glycosuria
Headache
Hearing disturbances
Infections
Iritis
Nausea
Nephrotoxicity
Neutropenia
Ocular hypotony
Oral moniliasis
Pain - generalised
Pancreatitis
Proteinuria
Rash
Renal failure
Serum creatinine increased
Uveitis
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 2020

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Cidofovir Tillomed 75mg/ml concentrate for solution for infusion. Tillomed Laboratories Ltd. Revised October 2017.