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Pyrophosphate antiviral

Foscarnet sodium

Brand names: Foscavir

Adult dose

Dose: CMV induction: 60mg/kg every 8h or 90mg/kg every 12h IV for 14–21 days. Maintenance 60–120mg/kg/day
Route: IV
Frequency: q8-12h

Dose adjustments

Renal

Mandatory dose reduction per CrCl — refer to BNF

Clinical pearls

  • CMV retinitis in immunocompromised, aciclovir-resistant HSV/VZV
  • Pre-/post-hydration mandatory

Contraindications

  • Severe renal impairment without dose adjustment

Side effects

  • Severe nephrotoxicity (dose-limiting)
  • Hypocalcaemia/hypomagnesaemia
  • Genital ulceration
  • Anaemia
  • Seizures
  • Phlebitis

Interactions

  • Other nephrotoxins (aminoglycosides, ciclosporin, amphotericin)
  • IV pentamidine (severe hypocalcaemia)

Monitoring

  • U&E daily
  • Ca/Mg/PO4
  • FBC

Reference: BNF; SmPC; BHIVA; https://bnf.nice.org.uk/drugs/foscarnet-sodium/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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