Neutropenia valganciclovir

Severe leukopenia, neutropenia, anemia, thrombocytopenia, pancytopenia, bone marrow depression, and aplastic anemia have been observed in patients treated with valganciclovir tablets (and ganciclovir) (see Precautions and Adverse Reactions). 

Ganciclovir Intravenous administration Intravitreal injection Intravitreal implant Oral administration (valganciclovir) Primary toxicity = neutropenia... 

In a retrospective case-series of 23 infants with culture-proven congenital cytomegalovirus infection who had been treated with ganciclovir for 6 weeks, followed by oral valganciclovir to the age of 12 months, the most common adverse reaction was neutropenia ( =12) it was severe in two infants, with absolute neutrophil counts below 500 X 10 /1 [12 ]. Treatment was withheld imtil the neutrophil count returned to normal no further intervention was required. Neutropenia occurred only within the first 3 months of treatment and mainly during the first 6 weeks of intravenous ganciclovir administration. 

Keles M, Yildirim R, Uyanik A, Turkmen M, Bilen Y, Aydinli B, Cetinkaya R, Polat KY. Neutropenia related to valacyclovir and valganciclovir in 2 renal transplant patients and treatment with granulocyte colony stimulating factor a case report. Exp Clin Transplant 2010 8(2) 181-3. 

A single-centre study assessed the use of high-dose intravenous GCV (7.5-10 mg/ kg twice daily) or high-dose oral valganciclovir (1350-1800 mg twice daily) for CMV treatment in six SOT patients where GCV-resistance-inducing mutations had been detected [24 ]. The authors reported that the safety of this higher dosing was acceptable four out of six patients had neutropenia, but only one required treatment. 

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