Cidofovir
VISTIDE
What it isIV nucleotide analog that inhibits viral DNA polymerase without requiring viral kinase activation; used for CMV retinitis in patients with AIDS.
Why this oneRetains activity against CMV resistant to ganciclovir because activation is host-cell dependent.
What limits itDose-limiting proximal tubular nephrotoxicity mandates saline prehydration, probenecid, and renal testing before every dose; avoid other nephrotoxins.
FDA-approved for
- CMV retinitis (AIDS) (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| CMV retinitis in AIDS — induction | Adults (SCr ≤1.5, CrCl >55, urine protein <100 mg/dL) | 5 mg/kg IV over 1h once weekly ×2 weeks | 5 mg/kg IV weekly ×2 | 5 mg/kg |
| CMV retinitis in AIDS — maintenance | Adults | 5 mg/kg IV over 1h every 2 weeks | 5 mg/kg IV q2 weeks | 5 mg/kg |
Renal Contraindicated to initiate if SCr >1.5 mg/dL, CrCl ≤55 mL/min, or urine protein ≥2+ (≥100 mg/dL); reduce maintenance from 5 to 3 mg/kg for SCr rise of 0.3–0.4 mg/dL; discontinue for SCr ≥0.5 mg/dL rise or ≥3+ proteinuria
Hepatic Undefined
Monitor renal function (serum creatinine and urine protein) within 48h prior to each dose
Instructions
- Must dilute in 100 mL normal saline before administration
- IV saline prehydration and probenecid must be given with each infusion
- Do not exceed recommended dose, frequency, or infusion rate
- Never administer by intraocular injection
Contraindications
- Serum creatinine >1.5 mg/dL, CrCl ≤55 mL/min, or urine protein ≥100 mg/dL (≥2+)
- Concomitant nephrotoxic agents (must be discontinued ≥7 days prior)
- History of clinically severe hypersensitivity to probenecid or other sulfa-containing medications
- Direct intraocular injection
Cautions
- Nephrotoxicity — the major dose-limiting toxicity; monitor renal function before each dose
- Neutropenia — monitor neutrophil counts
- Ocular hypotony (decreased intraocular pressure); anterior uveitis/iritis
- Metabolic acidosis / Fanconi syndrome
Adverse reactions
- Nephrotoxicity (proteinuria, elevated creatinine) — ~59%
- Neutropenia (ANC ≤500 in ~24%)
- Decreased intraocular pressure/ocular hypotony; uveitis/iritis
- Metabolic acidosis (Fanconi's syndrome)
Pregnancy Category C; embryotoxic/teratogenic in animals — use only if benefit justifies fetal risk
Lactation Undefined
⚠ BOXED WARNINGS
- Dose-dependent nephrotoxicity, acute renal failure, dialysis, and death; give saline plus probenecid and monitor creatinine and urine protein before every dose
- Use is restricted to CMV retinitis in patients with AIDS
- Neutropenia, ocular hypotony, and carcinogenic/teratogenic risk
Cost, est. cash$10–$500/month
Generic entry2012
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityAgent-specific renal, hepatic, hematologic, metabolic and drug-interaction toxicity.
Mechanism of action: Cidofovir ballicule
Open Cidofovir in the interactive console ↗
Memory aids: mascots and interaction avatars
"Vis" from "vision" (for treating CMV retinitis)
Cidofovir is nephro“cidal”
