Nursing Implications of Valcyte (Valganciclovir Hydrochloride)

Valganciclovir Hydrochloride

(val-gan-ci′clo-vir)

Valcyte

Classification: ANTIVIRAL

Therapeutic: ANTIVIRAL

Prototype: Acyclovir

Pregnancy Category: C

AVAILABILITY Tablet; powder for oral solution

ACTION & THERAPEUTIC EFFECT

Rapidly converted to ganciclovir by intestinal and hepatic enzymes. In cells infected with cytomegalovirus (CMV), ganciclovir is converted to ganciclovir triphosphate that inhibits viral DNA synthesis. Effective antiviral that prevents replication of viral CMV DNA.

USES

Treatment or prevention of CMV retinitis; prevention of CMV disease in high-risk kidney, kidney-pancreas, and heart transplant patients (not effective in liver transplants).

UNLABELED USES

Esophagitis, herpesvirus infection.

CONTRAINDICATIONS

Hypersensitivity to valganciclovir, ganciclovir, or acyclovir; dental work; antimicrobial resistance; neutropenia, thrombocytopenia; females of childbearing age; lactation.

CAUTIOUS USE

Impaired kidney function; dental disease; anemia; leukopenia; bone marrow depression; irradiation; older adults; pregnancy (category C). Safe use in infants younger than 4 mo not established.

ROUTE & DOSAGE

Cytomegalovirus Prophylaxis

Adult/Adolescent:

PO 900 mg once daily, starting within 10 days of transplantation until 100–200 days post-transplantation

Child/Infant (over 4 mo):

See package insert for dose calculation formula (max: 900 mg)

Cytomegalovirus Retinitis Treatment

Adult:

 PO 900 mg b.i.d. × 21 days then 900 mg daily

Renal Impairment Dosage Adjustment

CrCl 40–59 mL/min: 450 mg b.i.d. (induction) or daily (maintenance); 25–39 mL/min: 450 mg daily (induction) or q2days (maintenance); 10–24 mL/ min: 450 mg q2days (induction) or twice weekly (maintenance)

ADMINISTRATION

Oral

• Exercise caution in handling tablets, powder for oral solution, and the oral solution. Do not crush or break tablets. Avoid direct contact of any form of the drug with skin or mucous membranes. Note that adults should receive tablets, not the oral solution.
• Give with food.
• Do not give to patients on hemodialysis.
• Store tablets at 25°–30° C (77°– 86° F). Store oral solution at 2º– 8º C (36º–46º F) for no longer than 49 days.

Nursing Implications of Valcyte (Valganciclovir Hydrochloride)

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ADVERSE EFFECTS (≥1%)

Body as a Whole: Fever, local and systemic infections, hypersensitivity reactions. CNS: Headache, insomnia, peripheral neuropathy, paresthesia, convulsions, psychosis, confusion, hallucinations, agitation. GI: Diarrhea, nausea, vomiting,  bdominal pain. Hematologic: Neutropenia, anemia, thrombocytopenia, pancytopenia, bone marrow suppression, aplastic anemia. Special Senses: Retinal detachment.

INTERACTIONS

Drug: ANTINEOPLASTIC AGENTS, amphotericin B, didanosine, trimethoprimsulfamethoxazole (TMP-SMZ), dapsone, pentamidine, probenecid, zidovudine may increase bone marrow suppression and other toxic effects of valganciclovir; may increase risk of nephrotoxicity from cyclosporine; ANTIRETROVIRAL AGENTS may decrease valganciclovir levels; valganciclovir may increase levels and toxicity of ANTIRETROVIRAL AGENTS; may increase risk of seizures due to imipenem-cilastatin.

PHARMACOKINETICS

Absorption: 60% reaches systemic circulation as ganciclovir. Onset: 3–8 days. Peak: 1–3h. Duration: Clinical relapse can occur 14 days to 3.5 mo after stopping therapy; positive blood and urine cultures recur 12–60 days after therapy. Distribution: Distributes throughout body including CSF, eye, lungs, liver, and kidneys; crosses placenta in animals; not known if distributed into breast milk. Metabolism:  Metabolized in intestinal wall to ganciclovir, ganciclovir is not metabolized. Elimination: 94–99% of dose is excreted unchanged in urine. Half-Life: 4 h.

NURSING IMPLICATIONS

Black Box Warning

Valganciclovir has been associated with granulocytopenia, anemia, and thrombocytopenia.

Assessment & Drug Effects

• Withhold drug and notify prescriber for any of the following: Absolute neutrophil count less than 500 cells/mm3, platelet count less than 25,000/mm3, hemoglobin less than 8 g/dL, declining creatinine clearance.
• Monitor for S&S of bronchospasm in asthma patients; notify prescriber immediately.
• Montior lab tests: Baseline and frequent serum creatinine or creatinine clearance, CBC with differential, platelet count, Hct and Hgb.

Patient & Family Education

• Schedule ophthalmologic followup examinations at least every 4–6 wk while being treated with valganciclovir.
• Keep all scheduled appointments for laboratory tests.
• Do not drive or engage in potentially hazardous activities until response to drug is known.
• Report any of the following immediately: Unexpected bleeding, infection.
• Use effective methods of contraception (barrier and other types) during and for at least 90 days following treatment.
• Discontinue drug and notify prescriber immediately in the event of pregnancy.

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Ditulis oleh Unknown pada tanggal Friday, August 21, 2015