Ganciclovir

How it works

It is phosphorylated initially by a viral kinase and then by host kinases to a triphosphate that inhibits viral DNA polymerase and is incorporated into viral DNA, terminating chain elongation.

Prescribing in practice

• Myelosuppression with neutropenia, anaemia and thrombocytopenia is the key dose-limiting toxicity and may require treatment interruption or dose modification.
• It is potentially teratogenic and carcinogenic; handle as a cytotoxic agent and ensure effective contraception during and after treatment as advised.
• Dose must be reduced in renal impairment and adjusted using the SPC and current prescribing references, with caution alongside other myelosuppressive drugs.

Monitoring

Monitor full blood count regularly for myelosuppression and check renal function to guide dosing throughout treatment.

Counselling the patient

• Attend regular blood tests so that effects on blood counts and kidneys can be checked.
• Report fever, sore throat, unusual bruising or bleeding promptly.
• Use reliable contraception as advised during and for the recommended period after treatment.

Evidence & guidelines

Ganciclovir and its oral prodrug valganciclovir are standard agents for CMV prophylaxis and treatment in transplantation, reflected in UK and international transplant guidance.