Revisions for Cidofovir

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Dosing: Adult Antimicrobial Dosing, Non-dialysis

Adenovirus* 

High Dose Strategy Criteria to initiate: CrCl >55 mL/min, SCr<1.5 mg/dL, urine protein <100mg/dL Increase in SCr of 0.3-0.4 mg/dL Increase in SCr of >0.5 mg/L or 3+ proteinuria
 Induction (initial dosing) 5 mg/kg IV once weekly WITH probenecid x 2 doses 3 mg/kg IV once weekly WITH probenecid x 2 doses Discontinue
 Maintenance 5 mg/kg IV once every 2 weeks WITH probenecid 3 mg/kg IV every 2 weeks WITH probenecid Discontinue

*There may be alternative dosing available.  Discuss with ID pharmacist to evaluate if patient meets criteria.

At UCSF, there is an adult inpatient order set available for use – IP Adult Cidofovir (VISTIDE) Order set

 BK virus*

High Dose Strategy Criteria to initiate: CrCl >55 mL/min, SCr<1.5 mg/dL, urine protein <100mg/dL Increase in SCr of 0.3-0.4 mg/dL Increase in SCr of >0.5 mg/L or 3+ proteinuria
 Induction (initial dosing)  for BK viruria (hemorrhagic cystitis) in hematopoietic cell transplant recipients 5 mg/kg IV once weekly WITH probenecid x 2 doses 3 mg/kg IV once weekly WITH probenecid x 2 doses Discontinue
 Maintenance for BK viruria (hemorrhagic cystitis) in hematopoietic cell transplant recipients 5 mg/kg IV once every 2 weeks WITH probenecid 3 mg/kg IV every 2 weeks WITH probenecid Discontinue
Low Dose Strategy Criteria to initiate: CrCl >55 mL/min, SCr<1.5 mg/dL, urine protein <100mg/dL Increase in SCr of 0.3-0.4 mg/dL Increase in SCr of >0.5 mg/L or 3+ proteinuria

BK viremia (BK nephropathy) in kidney transplant

0.25 - 0.5 mg/kg IV once weekly WITHOUT probenecid 0.25 - 0.5 mg/kg IV once weekly WITHOUT probenecid Discontinue

*There may be alternative dosing available.  Discuss with ID pharmacist to evaluate if patient meets criteria.

At UCSF, there is an adult inpatient order set available for use – IP Adult Cidofovir (VISTIDE) Order set

Cytomegalovirus (CMV)

  Criteria to initiate: CrCl >55 mL/min, SCr<1.5 mg/dL, urine protein <100mg/dL Increase in SCr of 0.3-0.4 mg/dL Increase in SCr of >0.5 mg/L or 3+ proteinuria
 Induction (initial dosing) 5 mg/kg IV once weekly WITH probenecid x 2 doses 3 mg/kg IV once weekly WITH probenecid x 2 doses Discontinue
 Maintenance 5 mg/kg IV once every 2 weeks WITH probenecid 3 mg/kg IV every 2 weeks WITH probenecid Discontinue

At UCSF, there is an adult inpatient order set available for use – IP Adult Cidofovir (VISTIDE) Order set

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis

Indication

Intermittent Hemodialysis

Continuous Hemodialysis
All Indications Minimal data; consult ID pharmacy for assistance

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  

IV Fluids: Give 1L NS over 30 minutes prior to cidofovir administration.  If able to tolerate, give an additional 1L NS at the start or immediately after cidofovir administration.

Probenecid: 2g PO 3 hours prior to cidofovir, then 1g PO 2 and 8 hours after cidofovir (total 4g)

Restrict to ID or Antimicrobial Stewardship except:

1) For treatment or prophylaxis against viral infection in a BMT patient

References: