Ganciclovir and Valganciclovir Use in Children

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


Pediatr Pharm. 2009;15(10) 

In This Article

Dosing Recommendations

Ganciclovir prophylaxis is typically initiated at a dose of 5 mg/kg IV over 1 hr every 12 hours for 7 to 14 days post-transplant, followed by 5 mg/kg given once daily. Maintenance prophylaxis with oral ganciclovir in adults and children 13 years and older is 1,000 mg given three times daily with food. The dose of valganciclovir for CMV prophylaxis in adults is 900 mg (two 450 mg tablets) given once daily with food; pediatric patients should receive a dose of 15 to 18 mg/kg once daily. Duration varies among transplantation protocols. Children with CMV infection, including infants with congenital CMV, should be treated with IV ganciclovir 5–6 mg/kg given every 12 to 24 hours or valganciclovir 15 to 18 mg/kg given orally twice daily.[1–12] The manufacturer recommends that doses be calculated based on body surface area and creatinine clearance. The formula is provided in the prescribing information and on the product website at

Patients with renal impairment require lower ganciclovir or valganciclovir doses. In patients receiving IV ganciclovir who have mild renal dysfunction, the dose should be reduced by 50% to a daily dose of 2.5 mg/kg. Patients with moderate renal dysfunction should receive 25% of the regular dose (1.25 mg/kg) daily, and patients with severe renal impairment should receive 0.625 mg/kg three times per week after hemodialysis, or on a schedule determined by their ability to eliminate the drug. For patients with mild renal dysfunction who are being treated with valganciclovir, the dosing interval should be reduced to once daily. For moderate impairment, the dose should also be reduced by 50%. For severe renal dysfunction (estimated creatinine clearance < 25 mL/min), the dose should be reduced by 50% and be administered twice weekly. Valganciclovir is not recommended in patients requiring dialysis.[1–4]


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