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Nucleotide analogue antiviral

Cidofovir

Brand names: Vistide

Cidofovir is an intravenous nucleotide analogue antiviral, used mainly for cytomegalovirus retinitis in immunocompromised patients and occasionally for other resistant DNA-virus infections.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is phosphorylated intracellularly to its active diphosphate, which inhibits viral DNA polymerase and so suppresses viral DNA replication.

Prescribing in practice

  • Markedly nephrotoxic; mandatory pre-hydration with intravenous saline and co-administration of oral probenecid are required with each dose to reduce renal tubular injury.
  • Contraindicated in significant renal impairment and where nephrotoxic drugs cannot be avoided around the dosing window.
  • Associated with neutropenia and ocular toxicity (uveitis, hypotony), so concurrent ophthalmic review is appropriate in retinitis.

Monitoring

Monitor renal function and urine protein before each dose, alongside full blood count and regular ophthalmological assessment.

Counselling the patient

  • Explain that probenecid tablets and a fluid infusion are given with every treatment to protect the kidneys.
  • Report reduced urine output, visual changes, or eye pain promptly.

Evidence & guidelines

Use is supported by established product information and specialist HIV/ophthalmology guidance for CMV retinitis.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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