Monitoring patients on ganciclovir
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Ganciclovir, an analog of acyclovir, demonstrates inhibitory action against some viruses including herpes virus, cytomegalovirus, and HIV. Therapeutic ranges have not been well-established for ganciclovir; current ranges are based on typical values seen during ganciclovir therapy and do not correlate well to toxicity or outcome. Monitoring of ganciclovir serum concentrations may be most useful in guiding therapy in patients with renal dysfunction. Myelosuppression is the major dose-limiting side effect of ganciclovir.
Valcyte (valganciclovir) is an oral prodrug of ganciclovir ester. It is immediately converted to ganciclovir once it enters the bloodstream. The oral dose is designed to deliver ganciclovir equivalent to intravenous ganciclovir at 5 mg/kg.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Trough: 1.0-3.0 mcg/mL
Peak: 3.0-12.5 mcg/mL
Serum concentrations of ganciclovir do not correlate well to toxicity or efficacy. Peak and trough levels provided are representative of typical serum concentrations seen during therapy, but individual values must be interpreted in conjunction with the clinical status of the individual patient and the specific characteristics of the infecting microorganism.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Usage should be discontinued if absolute neutropenia develops.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Perrottet N, Decosterd LA, Meylan P, et al: Valganciclovir in adult solid organ transplant recipients: pharmacokinetic and pharmacodynamic characteristics and clinical interpretation of plasma concentration measurements. Clin Pharmacokinet 2009;48(6):399-418
2. Uges D: Therapeutic and toxic drug concentrations. In The International Association of Forensic Toxicologists. 2009 Dec. Available from URL: www.tiaft.org