Ganciclovir dosing in renal dysfunction

To get CMV under control, sometimes a more aggressive approach to IV ganciclovir dosing in renal dysfunction is necessary than that recommended in the package insert. Here is what we use:

IV Ganciclovir Renal Dosing Recommendations: Johns Hopkins

 

Ganciclovir (IV) Induction Maintenance
CrCl >50 mL/min 5 mg/kg IV q 12hr 5 mg/kg IV q 24hr
CrCl 25-50 mL/min 2.5 mg/kg IV q 12hr 2.5 mg/kg IV q 24hr
CrCl 10-25 mL/min 2.5 mg/kg IV q 24hr 1.25 mg/kg IV q 24hr
CrCl <10 mL/min 1.25 mg/kg IV q 24hr 0.625 mg/kg IV q 24hr
Hemodialysis (HD) 1.25 mg/kg IV three times weekly following HD 0.625 mg/kg IV three times weekly following HD
The major elimination pathway of ganciclovir is by renal excretion and the major toxicity seen in patients with hematologic malignancies and solid organ transplantation are cytopenias. However, aggressive dosing may be necessary for efficacy; therefore, dose reduce with caution. Growth factor support can be considered.