Ganciclovir and Valganciclovir Use in Children

Marcia L. Buck, Pharm.D., FCCP, FPPAG

Disclosures

Pediatr Pharm. 2009;15(10) 

In This Article

Precautions

Ganciclovir and valganciclovir can produce significant neutropenia, anemia, and thrombocytopenia. They should be used with caution in patients with underlying blood dyscrasias and should not be administered to patients with an absolute neutrophil count less than 500 cells/mcL, a platelet count less than 25,000 cells/mcL, or a hemoglobin less than 8 g/dL. If neutropenia occurs, it typically resolves within a week of discontinuation.[1–4]

High concentrations of ganciclovir have produced carcinogenic effects in animal models. As a result, ganciclovir is considered a potential carcinogen in humans. The drug should be handled with appropriate personal protective equipment, according to institutional policies. Families preparing valganciclovir suspension should understand the potential risk of direct contact with the drug and should be aware of steps to minimize exposure. After direct contact with the suspension, broken or crushed tablets, patients or caregivers should wash thoroughly with soap and water. Ganciclovir should also be considered as potentially teratogenic and may adversely affect sperm production. All patients should be informed of these risks and the importance of contraceptive use.[1–4]

Rapid administration of IV doses may result in elevated plasma concentrations and a greater likelihood for toxicity. Because of the alkaline nature of the drug (pH 11), dilution to concentrations less than 10 mg/mL is necessary to minimize the risk for pain and phlebitis. Ganciclovir should never be administered intramuscularly or subcutaneously.[1–4]

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