Letermovir parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusions of letermovir.
Drugs List
Therapeutic Indications
Uses
Prophylaxis of CMV infection in haematopoietic stem cell transplant pts
Prophylaxis of cytomegalovirus (CMV) reactivation and disease in adult CMV-seropositive recipients (R+) of an allogeneic haematopoietic stem cell transplant (HSCT).
Dosage
Adults
480mg once daily. Letermovir can be started any time between the day of transplant, and up to 28 days after transplant. Letermovir may be started before or after engraftment. Treatment should continue for 100 days post-transplant. Use beyond 100 days post-transplant may be of benefit in patients at high risk for late CMV reactivation, but has not been studied in clinical trials.
Additional Dosage Information
Ciclosporin
Ciclosporin co-administered with letermovir
240mg once daily.
Ciclosporin initiated after starting letermovir
Next dose of letermovir should be decreased to 240mg once daily.
Ciclosporin discontinued after starting letermovir
Next dose of letermovir should be increased to 480mg once daily.
Temporary interruption to ciclosporin treatment due to high ciclosporin levels
No dose adjustment needed.
Missed dose
If a dose is missed, the patient should take it as soon as they remember. If it is time for the next dose, skip the missed dose and resume the regular dosing schedule. Patients should not double their next dose.
Administration
For intravenous infusion only.
Contraindications
Children under 18 years
Breastfeeding
Moderate hepatic impairment with moderate or severe renal impairment
Pregnancy
Severe hepatic impairment - Child-Pugh score greater than or equal to 10
Precautions and Warnings
Females of childbearing potential
End stage renal disease
Advise ability to drive/operate machinery may be affected by side effects
Treatment to be initiated by specialist
Must be diluted before use
Monitor regularly for cytomegalovirus (CMV) infection
Monitor serum creatinine in patients with renal impairment
Advise patient not to take St John's wort concurrently
Female: Ensure adequate contraception during treatment
Pregnancy and Lactation
Pregnancy
Letermovir is contraindicated during pregnancy.
The manufacturer recommends that letermovir is not used during pregnancy. There is no data on the use of letermovir in pregnant women. Animal studies have shown reproductive toxicity.
Lactation
Letermovir is contraindicated during breastfeeding.
The manufacturer recommends either discontinuing breastfeeding or abstaining from letermovir treatment as a risk to the breast fed newborn cannot be excluded.
The presence of letermovir in human breast milk is unknown but due to its high plasma protein binding the amount present in breast milk would likely to be low.
Animal studies have shown excretion of letermovir in milk.
Side Effects
Abdominal pain
Alanine aminotransferase increased
Aspartate aminotransferase increased
Decreased appetite
Diarrhoea
Dysgeusia
Fatigue
Headache
Hypersensitivity reactions
Muscle spasm
Nausea
Peripheral oedema
Serum creatinine increased
Vertigo
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 2022
Reference Sources
Summary of Product Characteristics: Prevymis 240mg concentrate for solution for infusion. Merck Sharp & Dohme Limited. Revised January 2021.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK500949/
Letermovir. Last revised: 07 February 2019
Last accessed: 24 January 2022
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