Drug interactions -summary-

Nephrotoxic agents -

concomittant admin of cidofovir and agents with  nephrotoxic potential (eg IV aminoglycosides
eg tobramycin, gentamicin, and amikacin , amphotericin B , foscarnet, IV pentamidine,
vancomycin,and NSAIDs agents) is contraindicated.
Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir

CMV retinitis - Cytomegalovirus retinitis

Adverse reactions-

Nephrotoxicity - renal impairment is a major toxicity of cidofovir
Cidofovir is contraindicated in patients who are receiving other nephrotoxic agents.

Decreased IOP /Ocular hypotony- risk of ocular hypotony may be increased in patients with
pre-existing diabetes melitus.

Cardiovascular- cardiopathy, cardiovascular disorder, congestive heart failure,
                          hypertension, hypotension, migraine, pallor, peripheral vascular
                          disorder ,phlebitis, postural hypotension, shock,      

CNS-             Abnormal dreams, abnormal gait, acute brain syndrome, agitation, amnesia,
                     anxiety, ataxia, cerbrovascular disorder, confusion, convulsion, delirium

Dermatologic- acne, alopecia, angioedema, dry skin, eczema, exfoliative dermatitis,
                         herpes simplex, nil disoder, skin discoloration, skin hypertrophy, urticaria     

Endocrine- adrenal cotex insufficiency

GI - anorexia, abdominal pain, cholangitis, colitis, cponstipaion, diarrhea, dry mouth,
       dyspepsia, gastritis, GI haemorhage, gingivitis, hepatitis

GU- decreased creatinin  clearance, dysuria, glysuria, hematuria, kidney stone, mastitis,
metrorrhagia, noctiria, polyuria, uretthritis, urinary casts, urinary incontinuance,
urinary tract infection

Hematologic/lymphatic-  hypochromic anmia, leukocytosis, lymphasdenopathy,
thrombocytopenia, splenomegaly

Metabolic/nutrional - cachexia, dehydration, edema, hyperglycemia, hyperkalemia,
hypocalcalcemia, hypoglycemic reactions, increased BUN

Musculoskeletal - arthalgia, bone necrosis, bone pain, joint disorder. leg cramps,
myalgia, myasthenia gravis and pathological fractures,

Respiratory - asthma, bronchitis, coughing, hyperventilation,increased sputum,
larynx edema, pharyngitis, rhinitis, and sinusitis

Special senses- abnormal vision,blindness, cataract, conjuntivitis, corneal lesion,
corneal opacity, diplopia, dry eyes, ear disorder, ear pain, eye pain,

Miscellaneous- abdominal pain, accidental injury, allergic reactions, back pain, chest pain
face edema, neck pain

History of clinically severe hypersensitivity to probenecid

Special precautions-
Hematological toxcity - neutropenia may occur during cidofovir therapy. Neutrophil count
should be monitored while receiving cidofovir therapy

Decreased IOP - decreased intraocular pressure IOP may occur during cidofovir  therapy
and in some cases associated with decreased visual acuity.

Metabolic acidosis- metabolic acidosis in association with liver dysfunction and pancreatitis
resulting in death has been reported in patients with cidofovir

Nephrotoxicity - dose dependent nephrotoxicity is themajor limiting toxicity related to
cidofovir administration

Renal function impairment -renal impairment is a major toxicity of cidofovir

Pregnancy- cidofovir should be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus.

Lactation- cidofovir should not be administred to nursing mothers.

Children - safety and efficacy in children have not been established

Elderly- particular attention to be paid to assessment of renal function before and during
cidofovir administration

Monitoring- serum creatinine and urine protein must be monitored withi 48 hours prior to
each dose. White cells counts with differential should be monitoredprior to each dose

Indication-

CMV retinitis- Cytomegalovirus retinitis

Dosage-
Adults-  5mg/kg
To minimise potential nephrotoxicity probenecid and IV saline prehydration must be adminstered
with each cidofovir infusion.

1.Advice patients that toxicity of cidofovir administration is renal impairment
 
2. The importance of completing the full course of probenecid with each cidofovir dose
    should be emphasized.

3. Patients should be warned about the potential adverse reactions caused
    by probenecid eg headache, nausea, vomiting, hypersensitivity reactions
    which include rash, fever, chills, and anaphylaxis.

4. Administration of probenecid after a meal may decrease nausea

Pregnancy-
Cidofovir should be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus.

Lactation-
Cidofovir should not be administred to nursing mothers.

Children -
Safety and efficacy in children have not been established

Elderly-
 Particular attention to be paid to assessment of renal function before and during
cidofovir administration