Cidofovir

Brand names: Vistide®

Chemical formula:

Español:
• Cidofovir, Solución para inyección

Cidofovir Solution for injection

What is this medicine?

CIDOFOVIR (si DOF o veer) is an antiviral medicine. It is used to treat or prevent infections caused by certain kinds of viruses. It is commonly used to treat cytomegalovirus (CMV) infections of the eye.
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•chronic diarrhea
•dehydration
•diabetes
•kidney disease
•low levels of white cells in the blood
•previous treatment with foscarnet
•an unusual or allergic reaction to cidofovir, probenecid, other medicines, foods, dyes, or preservatives
•pregnancy or recent attempts to get pregnant
•breast-feeding

How should I use this medicine?

This medicine is for infusion into a vein. It is given by a health care professional in a hospital or clinic setting.

You will need to take another medicine, probenecid, with this medicine. Take all of your medicine as directed. Do not skip doses or stop your medicine early.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

Do not take this medicine with any of the following medications:
•medicines for infection like acyclovir, adefovir, amphoterin B, bacitracin, cidofovir, foscarnet, ganciclovir, gentamicin, pentamidine, vancomycin
•NSAIDS, medicines for pain and inflammation, like ibuprofen or naproxen
•tacrolimus

This medicine may also interact with the following medications:
•aspirin and aspirin-like medicines
•cisplatin
•cyclosporine
•pamidronate
•zidovudine
•zoledronic acid

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress. You will need regular blood checks. Tell your doctor or healthcare professional if your symptoms do not start to get better or if they get worse.

This medicine is used to treat cytomegalovirus (CMV) infections of the eye(s). This medicine is not a cure for CMV. Life long therapy may be needed.

Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Talk to your health care professional or pharmacist for more information. Women: use effective birth control methods during treatment with this medicine and for 1 month after stopping therapy. Men: use barrier contraceptive methods during treatment with this medicine and for 3 months after stopping therapy.

This medicine has caused breast cancer in animal studies. Talk to your doctor about the risks and benefits of taking this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•breathing problems
•changes in hearing, 'ringing' in the ears
•changes in vision
•fast, irregular heartbeat
•fever or chills, sore throat
•general ill feeling or flu-like symptoms
•swelling of the ankles, hands, feet
•trouble passing urine or change in the amount of urine
•unusually weak or tired
•yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•aches, pains
•dry skin
•loss of hair
•nausea, vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

This drug is given in a hospital or clinic and will not be stored at home.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Cidofovir
Systematic (IUPAC) name
({[(S)-1-(4-amino-2-oxo-1,2-dihydropyrimidin-1-yl)-3-hydroxypropan-2-yl]oxy}methyl)phosphonic acid
Identifiers
CAS number	113852-37-2
ATC code	J05AB12
PubChem	60613
DrugBank	APRD00148
ChemSpider	54636
Chemical data
Formula	C8H14N3O6P
Mol. mass	279.187 g/mol
SMILES	eMolecules & PubChem
Physical data
Melt. point	260 °C (500 °F)
Spec. rot	-97.3
Pharmacokinetic data
Bioavailability	complete
Protein binding	6%
Metabolism	?
Half life	2.4 to 3.2 hours
Excretion	renal
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	intravenous
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Cidofovir is an injectable antiviral medication for the treatment of cytomegalovirus (CMV) retinitis^[1] in patients with AIDS. It suppresses CMV replication by selective inhibition of viral DNA synthesis. It is an acyclic nucleoside phosphonate, and is therefore independent of phosphorylation by viral enzymes^[2], in contrast to, for instance, acyclovir.

Contents 1 Administration 2 Side effects 3 Uses 3.1 DNA virus 3.2 Other 4 History 5 References

Administration

Maintenance therapy with cidofovir involves an infusion only once every two weeks, making it a convenient treatment option. Because dosing is relatively infrequent, a permanent catheter is not necessary for infusions.

Side effects

The major side effect of cidofovir is that it can be nephrotoxic.^[3]

Uses

DNA virus

Cidofovir demonstrated a statistically significant effect in delaying the progression of CMV retinitis lesions in newly diagnosed patients, as well as in previously treated patients who had failed other therapies.

Cidofovir has also shown efficacy in the treatment of acyclovir resistant herpes

Cidofovir has also been investigated as a treatment for progressive multifocal leukoencephalopathy,^[4] but as of 2005^[update] studies are inconclusive.

Cidofovir might have anti-smallpox efficacy^[5] and might be used on a limited basis in the event of a bioterror incident involving smallpox cases.

Cidofovir shows anti-BK virus activity in a subgroup of transplant patients.^[6]

Cidofovir is being investigated as a complementary intralesional therapy against papillomatosis caused by HPV.^[7][8]

Other

It has been suggested as an antitumor agent, due to its suppression of FGF2.^[9][10]

History

Cidofovir was discovered at the Institute of Organic Chemistry and Biochemistry, Prague, by Antonín Holý, and developed by Gilead Sciences^[11] and is marketed with the brand name Vistide by Gilead in the USA, and by Pfizer elsewhere.

References

1. ^ Becker MN, Obraztsova M, Kern ER, et al. (2008). "Isolation and characterization of cidofovir resistant vaccinia viruses". Virol. J. 5: 58. doi:10.1186/1743-422X-5-58. PMID 18479513. PMC 2397383. http://www.virologyj.com/content/5//58. 
2. ^ The mechanism of action of cidofovir and HSV helicase–primase complex inhibitors. Nature reviews
3. ^ Kazory A, Singapuri S, Wadhwa A, Ejaz AA (July 2007). "Simultaneous development of Fanconi syndrome and acute renal failure associated with cidofovir". J. Antimicrob. Chemother. 60 (1): 193–4. doi:10.1093/jac/dkm143. PMID 17496056. http://jac.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17496056. 
4. ^ Segarra-Newnham M, Vodolo KM (June 2001). "Use of cidofovir in progressive multifocal leukoencephalopathy". Ann Pharmacother 35 (6): 741–4. PMID 11408993. http://www.theannals.com/cgi/pmidlookup?view=long&pmid=11408993. 
5. ^ De Clercq E (July 2002). "Cidofovir in the treatment of poxvirus infections". Antiviral Res. 55 (1): 1–13. PMID 12076747. http://linkinghub.elsevier.com/retrieve/pii/S0166354202000086. 
6. ^ Araya CE, Lew JF, Fennell RS, Neiberger RE, Dharnidharka VR (February 2006). "Intermediate-dose cidofovir without probenecid in the treatment of BK virus allograft nephropathy". Pediatr Transplant 10 (1): 32–7. doi:10.1111/j.1399-3046.2005.00391.x. PMID 16499584. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1397-3142&date=2006&volume=10&issue=1&spage=32. 
7. ^ Broekema FI, Dikkers FG (August 2008). "Side-effects of cidofovir in the treatment of recurrent respiratory papillomatosis". Eur Arch Otorhinolaryngol 265 (8): 871–9. doi:10.1007/s00405-008-0658-0. PMID 18458927. PMC 2441494. http://dx.doi.org/10.1007/s00405-008-0658-0. 
8. ^ Soma MA, Albert DM (February 2008). "Cidofovir: to use or not to use?". Curr Opin Otolaryngol Head Neck Surg 16 (1): 86–90. doi:10.1097/MOO.0b013e3282f43408. PMID 18197029. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00020840-200802000-00019. 
9. ^ Liekens S, Gijsbers S, Vanstreels E, Daelemans D, De Clercq E, Hatse S (March 2007). "The nucleotide analog cidofovir suppresses basic fibroblast growth factor (FGF2) expression and signaling and induces apoptosis in FGF2-overexpressing endothelial cells". Mol. Pharmacol. 71 (3): 695–703. doi:10.1124/mol.106.026559. PMID 17158200. http://molpharm.aspetjournals.org/cgi/pmidlookup?view=long&pmid=17158200. 
10. ^ Liekens S (2008). "Regulation of cancer progression by inhibition of angiogenesis and induction of apoptosis". Verh. K. Acad. Geneeskd. Belg. 70 (3): 175–91. PMID 18669159. 
11. ^ "Press Releases: Gilead". http://www.gilead.com/pr_881577. Retrieved 2007-12-05. 

v • d • e DNA virus Antivirals (primarily J05, also S01AD and D06BB) Baltimore I Herpesvirus DNA synthesis inhibitor TK activated Purine analogue guanine (Aciclovir#/Valaciclovir, Ganciclovir/Valganciclovir, Penciclovir/Famciclovir) adenine (Vidarabine, Cytarabine) Pyrimidine analogue uridine (Idoxuridine, Trifluridine, Edoxudine) thymine (Brivudine) Not TK activated Foscarnet Other Docosanol · early protein (Fomivirsen) · Tromantadine HPV/MC Imiquimod/Resiquimod · Podophyllotoxin Vaccinia assembly: Rifampicin Poxviridae Methisazone Hepatitis B (VII) Nucleoside analogues/NARTIs: Entecavir · Lamivudine · Telbivudine · Clevudine Nucleotide analogues/NtRTIs: Adefovir · Tenofovir Multiple/general Nucleic acid inhibitors Cidofovir Interferon Interferon alfa-2b · Peginterferon alfa-2a Multiple/unknown Ribavirin#/Taribavirin† ErbB2/PI3K Pathway NOV-205§ · NOV-002† #WHO-EM. ‡Withdrawn from market. CLINICAL TRIALS: †Phase III. §Never to phase III

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