Nucleoside antiviral (CMV)

Ganciclovir

Brand names: Cymevene, Virgan

Adult dose

Dose: CMV induction: 5mg/kg IV every 12h for 14–21 days. Maintenance: 5mg/kg OD or 6mg/kg 5×/week. Eye gel: 1 drop 5×/day

Route: IV/Topical/PO (valganciclovir oral form)

Frequency: q12h

Dose adjustments

Renal

Mandatory reduction per CrCl — refer to BNF

Clinical pearls

CMV infection in immunocompromised; topical for CMV/HSV keratitis
Cytotoxic handling required

Contraindications

Severe neutropenia (ANC <500)
Severe thrombocytopenia (<25)
Pregnancy/breastfeeding
Hypersensitivity to aciclovir

Side effects

Severe myelosuppression
Nephrotoxicity
Carcinogenic/teratogenic (handling precautions)
Seizures
Phlebitis

Interactions

Zidovudine (additive myelosuppression)
Probenecid
Imipenem (seizures)
Mycophenolate

Monitoring

FBC twice weekly initially
U&E
LFTs

Reference: BNF; BHIVA OI guidance; https://bnf.nice.org.uk/drugs/ganciclovir/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways