cidofovir anhydrous: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cidofovir anhydrous: clinical details
Prescribing considerations
- Restrict initiation to physicians experienced in managing HIV infection.
- Use only for the licensed CMV-retinitis population when alternatives are unsuitable.
- Probenecid and adequate intravenous saline hydration are essential for nephroprotection.
- Review concomitant treatment for nephrotoxicity and probenecid-mediated interactions.
- Use caution in hepatic disease, diabetes and older adults. Use in children is not recommended because evidence is unavailable.
- Arrange regular ophthalmological follow-up.
Contraindications and cautions
- Hypersensitivity to cidofovir or an excipient
- Renal insufficiency, including creatinine clearance of 55 mL/min or less, or proteinuria of at least 2+
- Inability to receive probenecid or other sulfonamide-containing medication
- Concurrent potentially nephrotoxic treatment
- Direct intraocular administration
Monitoring
- Check serum creatinine and urine protein shortly before every administration.
- Obtain a differential white-cell count before every administration.
- Assess for proximal tubular dysfunction when indicated.
- Monitor for uveitis, iritis and ocular hypotony through ophthalmological review.
- Interrupt or discontinue treatment according to product-specific renal-toxicity criteria.
Clinical pharmacology
Cidofovir is a cytidine nucleotide analogue. Its intracellular diphosphate metabolite inhibits viral DNA polymerases and slows viral DNA synthesis. Unchanged cidofovir is eliminated mainly through glomerular filtration and tubular secretion.
Formulation and product differences
- Clear, colourless, preservative-free concentrate requiring dilution in normal saline before intravenous infusion.
- Supplied in a single-use vial; any remainder must be discarded.
- Contains sodium, which may matter for people following a controlled-sodium diet.
- Preparation requires aseptic technique and protective handling because cidofovir is considered potentially carcinogenic.
cidofovir anhydrous preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 75 mg/mL
cidofovir anhydrous interactions
Cidofovir is given with probenecid, which has numerous interactions. The specialist team should review every medicine before treatment.
Tenofovir disoproxil
Concurrent use increases the risk of kidney tubular injury and Fanconi syndrome and is contraindicated.
Other potentially nephrotoxic medicines
Aminoglycosides, amphotericin B, foscarnet, intravenous pentamidine, adefovir and vancomycin may add to kidney toxicity and must not be given concurrently.
Zidovudine
Probenecid increases zidovudine exposure, requiring specialist review and monitoring for blood toxicity.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.