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Valganciclovir is a cytotoxic agent
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| bet | 605/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Valganciclovir is a cytotoxic agent. Refer to your local policy in regards to safety precautions/facilities required to reconstitute the powder for oral solution.
Administration
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Valganciclovir is a cytotoxic agent. Follow full cytotoxic precautions as per local policy.
Should be given with feeds and can be given with other medications.
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Monitoring
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Full blood count, particularly neutrophil count, should be followed weekly for 6 weeks, then at week 8, then monthly for the duration of therapy.
Liver function tests monthly throughout therapy.
Renal function tests.
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Contraindications
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Hypersensitivity to ganciclovir, valganciclovir, aciclovir or valacyclovir.
Patients with:
absolute neutrophil count below 0.5 x 109/L, or
platelet count below 25 x 109/L unless thrombocytopenia is related to CMV disease, or
haemoglobin less than 80 g/L (8 g/dL).
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Precautions
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Active component of valganciclovir (i.e. ganciclovir) has both gonadal toxicity and carcinogenicity in animal models and its long-term safety after administration to young children is not established.
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Drug Interactions
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Convulsions have been reported in patients receiving ganciclovir (metabolite of valganciclovir) and imipenem-cilastatin concurrently.
Concurrent use of tacrolimus and ganciclovir increases nephrotoxicity.
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Adverse Reactions
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Commonly causes neutropenia. If absolute neutrophil count (ANC) falls below 0.5 x 109/L, and if it is thought not to be due to CMV disease, withhold medication until ANC is above 0.75 x 109/L, then restart medication at half dose. If ANC falls below 0.5 x 109/L again, consider discontinuing the medication.
Can also cause anaemia and thrombocytopenia. Discontinue medication if platelet count below 25 x 109/L or haemoglobin less than 80 g/L occurs and is thought not to be due to CMV disease.
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Stability
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The reconstituted solution should be discarded 49 days after reconstitution.
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Storage
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Store powder for reconstitution below 25°C.
After reconstitution, the solution should be stored in the refrigerator (2-8°C). Do not freeze.
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Special Comments
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Evidence summary
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Efficacy and safety:
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