Ganciclovir

Ganciclovir.

Didanosine: When didanosine was taken 2 hours before or concurrently with oral ganciclovir, steady-state dianosine AUC0-12 increased by 111±114% (range 10% to 493%) (n=12 patients, 23 observations). When didanosine was taken 2 hours before oral ganciclovir, steady-state ganciclovir AUC decreased by 12±17% (-44% to 5%), but concomitant use of the two drugs was not affected by ganciclovir AUC (n=12). Renal clearance of either drug was not significantly altered. When a standard IV ganciclovir initial dose (5 mg/kg IV infusion for 1 hour every 12 hours) was coadministered with didanosine 200 mg orally every 12 hours, steady-state didanosine increased by 70±40% (range 3% to 121%, n= 11), Cmax increased by 49±42% (range: -28 to 125%). In another study, when standard intravenous maintenance doses of ganciclovir (5 mg/kg intravenous drip for 1 hour, once every 24 hours) were co-administered with didanosine 200 mg orally every 12 hours, the plasma concentration of didanosine (AUC12-24) remained unchanged during the first dose interval of didanosine. The pharmacokinetic parameters of ganciclovir were not affected by didanosine. There was no significant change in the renal clearance of the two drugs in each study. Azidothymidine: When the oral dose of ganciclovir was 1000 mg once every 8 hours and combined with azidothymidine 100 mg every 4 hours, the mean steady-state ganciclovir AUC0-8 decreased by -17±25% (range: -52% to 23%) (n=12). Azidothymidine was stable in the presence of ganciclovir. The mean steady-state AUC0-4 of ganciclovir decreased by 19±27% (range: -11% to 74%). Because both azidothymidine and ganciclovir may cause neutropenia and anemia, some patients may not be able to tolerate the full-dose combination of the two drugs. Propanecil: When the oral dose of ganciclovir is 1000 mg once every 8 hours, combined with Propanecil 500 mg once every 6 hours, the mean steady-state ganciclovir AUC0-8 decreased by 53±91% (range: -14% to 299%) (n=10). The renal clearance of ganciclovir was reduced by 22±20% (range: -54% to -4%), and this interaction is related to competition for renal tubular secretion. Imipenem-cilastatin: There have been reports of non-significant seizures in patients receiving ganciclovir and imipenem-cilastatin at the same time, so these drugs should not be used unless the potential benefits outweigh the risks. Can be used simultaneously. Other drugs: Drugs that inhibit the replication of rapidly dividing cell populations, such as bone marrow, spermatogonia, and skin germinal layer and gastrointestinal mucosal cells, can increase toxicity when used in combination with ganciclovir. Therefore, such drugs, such as dapsone, pentamidine, 5-fluorocytosine, vincristine, vinblastine, doxorubicin, amphotericin B, trimethoprim/sulfamethoxazole complex or other nucleoside antagonists, can only be used simultaneously with ganciclovir when the potential benefits outweigh the risks. There are no formal studies on the interaction of ganciclovir with commonly used drugs for organ transplant recipients. The simultaneous use of ganciclovir with drugs known to have potential nephrotoxicity, such as cyclosporine or amphotericin B, can increase serum inosine levels. In a retrospective analysis, 91 patients with heterotopic liver transplantation received ganciclovir (5 mg/kg intravenous drip for 1 hour, once every 12 hours) and oral cyclosporine (therapeutic dose), and no effect on the whole blood concentration of cyclosporine was observed.

Ganciclovir.

Didanosine: When didanosine was taken 2 hours before or concurrently with oral ganciclovir, steady-state dianosine AUC0-12 increased by 111±114% (range 10% to 493%) (n=12 patients, 23 observations). When didanosine was taken 2 hours before oral ganciclovir, steady-state ganciclovir AUC decreased by 12±17% (-44% to 5%), but concomitant use of the two drugs was not affected by ganciclovir AUC (n=12). Renal clearance of either drug was not significantly altered. When a standard IV ganciclovir initial dose (5 mg/kg IV infusion for 1 hour every 12 hours) was coadministered with didanosine 200 mg orally every 12 hours, steady-state didanosine increased by 70±40% (range 3% to 121%, n= 11), Cmax increased by 49±42% (range: -28 to 125%). In another study, when standard intravenous maintenance doses of ganciclovir (5 mg/kg intravenous drip for 1 hour, once every 24 hours) were co-administered with didanosine 200 mg orally every 12 hours, the plasma concentration of didanosine (AUC12-24) remained unchanged during the first dose interval of didanosine. The pharmacokinetic parameters of ganciclovir were not affected by didanosine. There was no significant change in the renal clearance of the two drugs in each study. Azidothymidine: When the oral dose of ganciclovir was 1000 mg once every 8 hours and combined with azidothymidine 100 mg every 4 hours, the mean steady-state ganciclovir AUC0-8 decreased by -17±25% (range: -52% to 23%) (n=12). Azidothymidine was stable in the presence of ganciclovir. The mean steady-state AUC0-4 of ganciclovir decreased by 19±27% (range: -11% to 74%). Because both azidothymidine and ganciclovir may cause neutropenia and anemia, some patients may not be able to tolerate the full-dose combination of the two drugs. Propanecil: When the oral dose of ganciclovir is 1000 mg once every 8 hours, combined with Propanecil 500 mg once every 6 hours, the mean steady-state ganciclovir AUC0-8 decreased by 53±91% (range: -14% to 299%) (n=10). The renal clearance of ganciclovir was reduced by 22±20% (range: -54% to -4%), and this interaction is related to competition for renal tubular secretion. Imipenem-cilastatin: There have been reports of non-significant seizures in patients receiving ganciclovir and imipenem-cilastatin at the same time, so these drugs should not be used unless the potential benefits outweigh the risks. Can be used simultaneously. Other drugs: Drugs that inhibit the replication of rapidly dividing cell populations, such as bone marrow, spermatogonia, and skin germinal layer and gastrointestinal mucosal cells, can increase toxicity when used in combination with ganciclovir. Therefore, such drugs, such as dapsone, pentamidine, 5-fluorocytosine, vincristine, vinblastine, doxorubicin, amphotericin B, trimethoprim/sulfamethoxazole complex or other nucleoside antagonists, can only be used simultaneously with ganciclovir when the potential benefits outweigh the risks. There are no formal studies on the interaction of ganciclovir with commonly used drugs for organ transplant recipients. The simultaneous use of ganciclovir with drugs known to have potential nephrotoxicity, such as cyclosporine or amphotericin B, can increase serum inosine levels. In a retrospective analysis, 91 patients with heterotopic liver transplantation received ganciclovir (5 mg/kg intravenous drip for 1 hour, once every 12 hours) and oral cyclosporine (therapeutic dose), and no effect on the whole blood concentration of cyclosporine was observed.