Ganciclovir

How it works

It is phosphorylated by viral protein kinase and cellular kinases to ganciclovir triphosphate, which inhibits viral DNA polymerase and terminates viral DNA chain elongation.

Prescribing in practice

• Profound, dose-related myelosuppression (neutropenia, anaemia and thrombocytopenia) is the principal toxicity and mandates close haematological monitoring with dose interruption if counts fall.
• It is potentially teratogenic and carcinogenic and impairs fertility, so cytotoxic-handling precautions apply and effective contraception is required.
• Renally excreted, so the dose must be adjusted to renal function and adequate hydration maintained.

Monitoring

Monitor full blood count frequently throughout treatment together with renal function to guide dosing.

Counselling the patient

• Regular blood tests are essential to check your blood counts during treatment.
• Use reliable contraception during and for a period after treatment, as this drug can harm a developing baby.
• Report fever, sore throat, bruising or unusual bleeding promptly.

Evidence & guidelines

Ganciclovir is the established standard of care for CMV end-organ disease in immunocompromised patients, supported by long-standing transplant and HIV management guidance.