What is the role of valganciclovir in the treatment of cytomegalovirus (CMV)?

Updated: Jul 07, 2021
  • Author: Ricardo Cedeno-Mendoza, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Valganciclovir is a prodrug of ganciclovir that is activated in the gut and liver to ganciclovir.

Valganciclovir has 60% bioavailability. Valganciclovir 900 mg orally once daily is equivalent to once-daily intravenous ganciclovir 5 mg/kg.

One meta-analysis showed equivalent efficacies between 900 mg of valganciclovir and 450 mg for cytomegalovirus prophylaxis in transplantation, though the 900 mg daily was associated with 3 times increased risk of leucopenia and 2 times increased risk of rejection. [66, 67]

Valganciclovir is used for treatment in selected CMV cases. [68] Most experience has been established in renal and pancreas transplant recipients and patients with AIDS who have CMV retinitis.

It is also the drug of choice now for preemptive or universal CMV prophylaxis. [2] Routine valganciclovir prophylaxis was favored over preemptive therapy in a randomized controlled trial of CMV-positive renal allograft recipients.

A glomerular filtration rate (GFR) below 10 is a contraindication to valganciclovir use.

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