Acyclovir with ganciclovir

For example, acyclovir with TI — 10 against herpes simplex virus is safer or more selective [9] than its derivative, ganciclovir (TI = 2-3 against cytomegalovirus) [10]. 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Antiviral actions of purine and pyrimidine analogs. Acyclovir and ganciclovir (top) are phosphorylated first by viral kinase to the monophosphate. This intermediate and the drugs shown on the left are then phosphorylated by host cell kinases to the nucleotide analogs that inhibit viral replication. (Modified and reproduced, with permission, from Trevor AT, Katzung BG, Masters SM Pharmacology Examination Board Review, 6th ed. McGraw-Hill, 2002.)... 

Once potential structural analogues are found, their physical-chemical properties, such as log/) (hydrophobicity) vs. pH, can be calculated and compared with those of the analyte using software (e.g., Pallas) prior to being experimentally tested. As shown in Fig. 2, both acyclovir and ganciclovir could be used as the internal standard for penciclovir, particularly the latter due to the same number of hydroxy... 

Amsacrine Amsacrine is incompatible with sodium chloride mixtures and glucose-containing injections with acyclovir sodium, ganciclovir sodium, aztreonam, amphotericin, cimetidine hydrochloride, ceftazidime, frusemide, ceftriaxone sodium, heparin sodium, methylprednisolone sodium succinate, metoclopramide hydrochloride, and some antineoplastics.204 Asparaginase is incompatible with many drugs and rubber, and should be stored at 2° to 8 °C for stability. 

Cidofovir is an acyclic nucleotide analogue of the monophosphate of cytosine. When phosphoiylated by host cellular enzymes, the active compound cidofovir diphosphate has broad activity against the herpes viruses, including CMV, HSV 1 and 2, VZV, Epstein-Barr virus, and the BK polyomavirus. Cidofovir has primarily been used in the treatment of CMV retinitis in patients who have failed treatment with ganciclovir or foscarnet and in acyclovir-resistant herpes simplex infections. More recently, there is also a growing experience with the use of this medication in kidney transplant patients who have BK virus-associated nephropathy [31], although this interest has been dampened by significant toxicity and only modest clinical activity [32]... 

Gancidovir. Ganciclovir, 9-l(l.3-diliydroxy-2-propox-y)mcthyl guaninc) or DHPG (Cytovcnc). is an analogue of acyclovir, with an additional hydroxymethyl group on the acyclic side chain. 

Foscamet is an antiviral agent that inhibits replication of all known herpes viruses, including cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1, HSV-2), human herpes virus 6 (HHV-6), Epstein-Barr virus (EBV) and varicella-zoster virus (VZV). It is indicated in the treatment of CMV retinitis in patients with AIDS treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised patients and as combination therapy with ganciclovir for patients who have relapsed after monotherapy with either drug. 

Rubsam LZ, Davidson BL, Shewach DS. Superior cytotoxicity with ganciclovir compared with acyclovir and l-fS-D-aiabinofuianosyilhymine in herpes sunjiex virus-thymidine kinase expressing cells a novel paradigm for cell killing. Cancer Res 1998 58 3873-3882. 

Drugs eliminated by the kidneys Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase serum concentrations of tenofovir and/or the coadministered drug. Some examples include, but are not limited to, acyclovir, adefovir dipivoxil, cidofovir, ganciclovir, valacyclovir, and valganciclovir. Drugs that decrease renal function also may increase serum concentrations of tenofovir. 

Drug interactions In a randomized, double-blind study, Zenapax or placebo was added to an immunosuppressive regimen of cyclosporine, mycophenolate mofetil, and steroids to assess tolerability, pharmacokinetics, and drug interactions. The addition of Zenapax did not result in an increased incidence of adverse events or a change in the types of adverse events reported. The following medications have been administered in clinical trials with Zenapax with no incremental increase in adverse reactions cyclosporine, mycophenolate mofetil, ganciclovir, acyclovir, azathioprine, and corticosteroids. 

Pharmacokinetics Ganciclovir is administered intravenously and distributed throughout the body, including the cerebrospinal fluid. Excretion into the urine occurs through glomerular filtration and tubular secretion. Like acyclovir, ganciclovir accumulates in patients with renal failure. 

Intravenous foscarnet and ganciclovir, routinely used for CMV retinitis, resulted in significantly better preservation of vision when used either in combination or individually, combined with intravenous acyclovir. Many patients retained 20/100 or better vision and retinal detachment was less frequent, although outcomes were not unifiarmly successful and all patients did not retain functional vision. The regimen most often used was 5 mg/kg ganciclovir twice a day plus 60 mg/kg foscarnet three times a day, fallowed by maintenance therapy of 5 mg/kg ganciclovir daily plus 120 mg/kg foscarnet daily. Intravitreal ganciclovir... 

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