Ganciclovir / Valganciclovir

• Symptomatic congenital CMV (neonatal valganciclovir × 6 months)
• CMV retinitis / pneumonitis / encephalitis in immunocompromised
• CMV prophylaxis post solid-organ transplant

Phosphorylated by CMV UL97 kinase to triphosphate → inhibits CMV DNA polymerase → chain termination.

• Neonatal valganciclovir × 6 mo improves hearing + NDI
• Use valaciclovir (not valganciclovir) for maternal HSV

Neonatal congenital CMV

Valganciclovir 16 mg/kg PO BD × 6 months

CMV retinitis (adult)

Valganciclovir 900 mg PO BD × 21 d, then 900 mg OD

• AbsoluteANC <500 / platelets <25,000
• CautionPregnancy — only if life-threatening
• AbsoluteHypersensitivity to (val)ganciclovir or aciclovir

• Myelosuppression (neutropenia ≫ anaemia ≫ thrombocytopenia)
• Nephrotoxicity
• Teratogenicity / carcinogenicity (animal data)
• Seizures (rare)

• • Teratogenic in animal models — reserve for life-threatening maternal CMV under specialist supervision
• • Avoid breastfeeding during therapy

• Zidovudine

  Avoid

  Additive marrow toxicity

• Mycophenolate

  Avoid

  ↑ neutropenia

• Imipenem

  Caution

  ↑ seizure risk

• Probenecid

  Caution

  ↑ levels

• 💡 Maternal antenatal valaciclovir (8 g/day) under trial for primary maternal CMV — NOT ganciclovir
• 💡 Hold dose if ANC <500; weekly CBC during induction