Zalcitabine Ganciclovir

Zidovudine and probably other cytotoxic agents increase the risk of myelosuppression, as do nephrotoxic drugs that impair ganciclovir excretion. Probenecid and possibly acyclovir reduce renal clearance of ganciclovir. Zalcitabine increases oral ganciclovir exposure by -22%. Oral ganciclovir doubles the absorption and peak plasma concentrations of didanosine and increases zidovudine by -20%. 

Buffering agents that are compounded with didanosine to counteract its degradation by gastric acid may interfere with the absorption of other drugs that require acidity (e.g., indinavir, delavirdine, ketoconazole, fluoroquinolones, tetracyclines, dapsone). An enteric-coated formulation Videx EC) that dissolves in the basic pH of the small intestine is not susceptible to these interactions. Ganciclovir and valganciclovir can increase blood levels of didanosine. The use of zalcitabine with didanosine is not recommended because that combination carries an additive risk of peripheral neuropathy. The combination of didanosine with stavudine increases the risk of pancreatitis, hepatotoxicity, and peripheral neuropa-... 

Foscamet sodium should not be mixed with any intravenous infusion drug, since it interacts with glucose- and calcium-containing solutions and sodium, ganciclovir, certain antibacterials, amphotericin, pentamidine isethionate, and trimetrexate.18 Care must be taken to avoid inhalation and exposure of the skin to zalcitabine powder. 

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS GANCICLOVIRAfALGANCIC LOVIR 1. T adverse effects with tenofovir, zidovudine and possibly didanosine, lamivudine and zalcitabine 2. Possibly 1 efficacy of ganciclovir 1. Uncertain possibly additive toxicity. Lamivudine may compete for active tubular secretion in the kidneys 2. Uncertain L bioavailability 1. Avoid if possible otherwise monitor FBC and renal function weekly. It has been suggested that the dose of zidovudine should be halved from 600 mg to 300 mg daily. Monitor for peripheral neuropathy, particularly with zalcitabine 2. Uncertain clinical significance if in doubt, consider alternative cytomegalovirus prophylaxis... 

Transporter absorptive effects predominant Examples. Acyclovir, Amiloride -, Amoxicillin Atenolol Atropine, Bidisomide Bisphosphonates Captoprit, Cefazolin Cetirizine Cimetidine Ciprofloxacin, Cloxacillin Dicloxacillin Erythromycin - -, Famotidine Fexofenadine Folinic acid Furosemide, Ganciclovir Hydrochlorothiazide, Lisinopril Metformin Methotrexate, Nadolol Penicillins Pravastatin Ranitidine Tetracycline Trimethoprim Valsartan Zalcitabine... 

In a study in 10 HIV-positive patients, zalcitabine 750 micrograms every 8 hours increased the AUC of oral ganciclovir 1 g three times daily by 22%. There was no change in zalcitabine pharmacokinetics. There were no serious or severe adverse events attributed to the combination. ... 

Ganciclovir does not appear to alter the pharmacokinetics of stavudine or zalcitabine. Zalcitabine increased ganciclovir levels to a minor extent, although this is probably not clinically important. 

Jung D, AbdelHameed MH, Teitelbaum P, Dorr A, Griffy K. The pharmacokinetics and safety profile of oral ganciclovir combined with zalcitabine or stavudine in asymptomatic HIV-and CMV-seropositive patients. J Clin Pharmacol (1999) 39, 505-12. 

Simultaneous didanosine, folic acid, ganciclovir, lamivudine, nevirapine, pyrazinamide, ranitidine, rifampin, stavudine, sulfamethoxazole, trimethoprim, zidovudine Noninterfering adefovir, amprenavir, delavirdine, efavirenz, fluconazole, indinavir, itraconazole, methadone, nelfinavir, oxazepam, pyrimethamine, rifampin, ritonavir, saquinavir, zalcitabine... 

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