Injection: 375 mg/5ml
Topical: 1% cidofovir cream (special manufacturing)
CMV retinitis: 5 mg/kg IV once a week for 2 weeks (induction dose) followed by 5 mg/kg IV every 2 weeks (maintenance).The dose should be administered over one hour and in strict concordance with the manufacturers’ recommendations regarding co-administration of oral probenecid and additional IV saline prior to and during cidofovir hydration
Aciclovir-resistant HSV: 1% cidofovir cream
Nephrotoxicity, proteinuria, neutropenia, iritis, uveitis, decreased intraocular pressure, alopecia, and asthenia.
Check renal function prior to receiving subsequent doses
Other nephrotoxic drugs contraindicated e.g. aminoglycosides, vancomycin, amphotericin, IV pentamidine, foscarnet.
Cidofovir should not be administered concurrently with medicinal products containing tenofovir disoproxil fumarate due to the risk of Fanconi syndrome
Probenecid – delays secretion of cidofovir into renal tubules reducing potential for renal toxicity
Can cause decreases in intraocular pressure and impairment of vision – regular ophthalmological examination is recommended. Direct intraocular injection is contraindicated
Cidofovir is contraindicated in patients with renal impairment serum creatinine> 133 µmol/l or a creatinine clearance ≤5 ml/min) or proteinuria ≥100 mg/dl (≥2+ proteinuria).
Seek advice from a specialist pharmacist if patient’s creatinine clearance is less than 55ml/min Proteinuria as measured by urinalysis may be an early indicator of nephrotoxicity and should be used in conjunction with changes in creatinine clearance to monitor safety.
The safety and efficacy of cidofovir has not been established in patients with hepatic disease.
Compatible – Maternal Benefit >> Embryo-Foetal Risk
Made by individual pharmacy production units (seek specialist HIV pharmacist advice)
Discuss all possible requests for cidofovir with specialist HIV pharmacist to allow as much time as possible to arrange for preparation. Not all units are able to prepare cidofovir on site
Must be administered with IV hydration and oral probenecid according to a strict protocol, to avoid renal toxicity – see product literature for details.
Probenecid administration is associated with a high incidence of nausea and vomiting and should be taken with food and an anti-emetic.
Preparation of cidofovir should be done in a laminar flow biological safety cabinet.