The activated compound competitively inhibits viral DNA polymerase, causing an unstable complex, but does not result in chain termination. Ganciclovir has activity against CMV, HSV, VZV, and EBV; its activity against CMV is up to 100 times greater than that of acyclovir.
Clinical Uses: Intravenous ganciclovir is indicated for the treatment of CMV retinitis in patients with AIDS. The drug also reduces the incidence of symptomatic CMV disease if administered before organ transplantation. Administration of intravenous ganciclovir to treat CMV pneumonitis in immunocompromised patients is often beneficial, particularly in combination with intravenous cytomegalovirus immunoglobulin. Intravenous ganciclovir has also been used to treat CMV colitis and esophagitis.
Adverse Reactions: The most common side effect of treatment with ganciclovir is myelosuppression, particularly neutropenia. Myelosuppression may be additive in patients receiving both ganciclovir and zidovudine. Central nervous system toxicity (changes in mental status, seizures) has been rarely reported.
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