Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 75mg/mL (375mg/5mL vial); generic
Cytomegalovirus Retinitis
Induction treatment: 5 mg/kg IV over 1 hour, once/week x2 weeks
Maintenance treatment: 5 mg/kg IV q2Weeks
Concomitant therapy
Must administer probenecid orally with each dose of cidofovir
Probenecid dose: 2 g PO 3 hr before each cidofovir dose and 1 g at 2 hr and again at 8 hr after completion of 1 hr cidofovir infusion (total of 4 g); give each dose with food to reduce drug-related nausea and vomiting
Hydration: Must receive at least 1 L of 0.9% NaCl IV before each infusion; administer over 1-2 hr; may administer second liter over 1-3 hr at start of cidofovir infusion or immediately following infusion if tolerated
Dosage Modifications
Renal impairment
- CrCl >55 mL/min and urine protein <100 mg/dL (equivalent to <2+ proteinuria): No dosage adjustment required
- Serum creatinine increases 0.3-0.4 mg/dL above baseline: Reduce maintenance dose to 3 mg/kg
- Serum creatinine increases ≥0.5 mg/dL above baseline or ≥3+ proteinuria: Discontinue
-
Preexisting renal impairment
- Serum creatinine >1.5 mg/dL(creatinine clearance ≤55 mL/min) or urine protein ≥100 mg/dL (equivalent to ≥2+ proteinuria): Contraindicated
Monkeypox (Off-label)
Data are not available on efficacy in treating cases of monkeypox in people
Has shown to be effective against orthopoxviruses in in vitro and animal studies
CDC holds an expanded access protocol that allows for the use of stockpiled cidofovir for the treatment of orthopoxviruses (including monkeypox) in an outbreak
Serious renal toxicity or other adverse events have not been observed during treatment of cytomegalovirus infections with brincidofovir (cidofovir prodrug) compared with treatment using cidofovir
State and territorial health authorities can direct requests for medical countermeasures for monkeypox treatment to the CDC Emergency Operations Center (770-488-7100)
Dosing Considerations
Monitoring
- Obtain SCr, urine protein, WBC with differential before each dose
- IOP, visual acuity
<18 years old: Safety & efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (8)
- amikacin
amikacin and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- amphotericin B deoxycholate
amphotericin B deoxycholate and cidofovir both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- contrast media (iodinated)
cidofovir and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- cyclosporine
cidofovir and cyclosporine both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- ioversol
cidofovir and ioversol both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- neomycin PO
cidofovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- tacrolimus
cidofovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Contraindicated.
- teicoplanin
cidofovir and teicoplanin both increase nephrotoxicity and/or ototoxicity. Contraindicated.
Serious - Use Alternative (16)
- acyclovir
acyclovir and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- bacitracin
cidofovir and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- capreomycin
capreomycin and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- carboplatin
carboplatin and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.
- cephaloridine
cephaloridine and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- cisplatin
cidofovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.
- colistin
cidofovir and colistin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- deferiprone
deferiprone, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- gentamicin
cidofovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- oxaliplatin
cidofovir and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.
- pacritinib
pacritinib will increase the level or effect of cidofovir by Other (see comment). Avoid or Use Alternate Drug. Concomitant administration of pacritinib (OCT1 inhibitor) with OCT1 substrates may increase the plasma concentrations of these substrates.
- polymyxin B
cidofovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, cidofovir. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- streptozocin
cidofovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Concomitant use of cidofovir and agents with nephrotoxic potential is contraindicated. Such agents must be discontinued at least 7 days prior to starting therapy with cidofovir.
- tobramycin
cidofovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- zidovudine
cidofovir, zidovudine. Either increases levels of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: When cidofovir is administered concurrently with probenecid, zidovudine clearance may be decreased. Reduce dose of zidovudine by 50% on days of cidofovir/probenecid administration. .
Monitor Closely (22)
- acalabrutinib
acalabrutinib, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects.
- adefovir
adefovir and cidofovir both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cabozantinib
cidofovir will increase the level or effect of cabozantinib by Other (see comment). Use Caution/Monitor. MRP2 inhibitors increase cabozantinib toxicity
- dichlorphenamide
dichlorphenamide and cidofovir both decrease serum potassium. Use Caution/Monitor.
dichlorphenamide, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis. - elvitegravir/cobicistat/emtricitabine/tenofovir DF
cidofovir, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Either increases toxicity of the other by decreasing renal clearance. Use Caution/Monitor. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion .
cidofovir and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. - emtricitabine
cidofovir increases levels of emtricitabine by Other (see comment). Use Caution/Monitor. Comment: Coadministration of emtricitabine with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of emtricitabine.
- foscarnet
cidofovir and foscarnet both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- hydroxyurea
cidofovir, hydroxyurea. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of myelosuppression.
- ifosfamide
ifosfamide, cidofovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Ifosfamide may enhance renal toxicity. .
- lomustine
lomustine, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Lomustine may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.
- methotrexate
cidofovir and methotrexate both decrease immunosuppressive effects; risk of infection. Use Caution/Monitor. May increase myelosupression.
- methoxyflurane
cidofovir and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- paromomycin
cidofovir and paromomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- pentamidine
cidofovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- peramivir
cidofovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.
- streptomycin
cidofovir and streptomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- tenofovir DF
cidofovir and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
cidofovir increases levels of tenofovir DF by Other (see comment). Use Caution/Monitor. Comment: Coadministration of tenofovir with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of tenofovir. - tobramycin inhaled
tobramycin inhaled and cidofovir both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- ublituximab
ublituximab decreases effects of cidofovir by immunosuppressive effects; risk of infection. Use Caution/Monitor.
- vancomycin
cidofovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- voclosporin
voclosporin, cidofovir. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- zidovudine
cidofovir, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of myelosuppression.
Minor (1)
- entecavir
cidofovir, entecavir. Either increases levels of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
Adverse Effects
>10%
Infection
Chills
Fever
Headache
Amnesia
Anxiety
Confusion
Seizures
Insomnia
Weakness
Paresthesia
Alopecia
Rash
Acne
Skin discoloration
Nausea
Vomiting
Diarrhea
Anorexia
Abdominal pain
Constipation
Dyspepsia
Gastritis
Thrombocytopenia
Neutropenia
Anemia
Amblyopia
Conjunctivitis
Ocular hypotony
Tubular damage
Proteinuria
Elevated creatinine
1-10%
Hypotension
Diaphoresis
Pallor
Syncope
Tachycardia
Dizziness
Hallucinations
Depression
Somnolence
Malaise
Pruritus
Urticaria
Hyperglycemia
Hyperlipidemia
Hypocalcemia
Hypokalemia
Dehydration
Abnormal taste
Stomatitis
Glycosuria
Hematuria
Urinary incontinence
Urinary tract infections
Skeletal pain
Retinal detachment
Iritis
Uveitis
Abnormal vision
Pneumonia
Rhinitis
Sinusitis
Allergic reactions
Warnings
Black Box Warnings
Renal impairment is the major toxicity, and acute renal failure resulting in dialysis or contributing to death have occurred with as few as 1 or 2 doses
Reduce nephrotoxicity risk by IV prehydration with normal saline, and administration of probenecid must be used with each infusion
Renal function (serum creatinine and urine protein) must be monitored within 48 hr prior to each dose, and, if necessary, modify dose in renal function as appropriate
Contraindicated if taking other nephrotoxic agents
Neutropenia observed; monitor neutrophil counts
Indicated only for the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS)
Animal studies showed cidofovir was carcinogenic, teratogenic, and caused hypospermia
Contraindications
Hypersensitivity to cidofovir or probenecid
SCr >1.5 mg/dL, CrCl <55 mL/min, urine protein >100 mg/dL (2+ proteinuria)
Direct intraocular injection
Concomitant nephrotoxic drugs
Cautions
Risk of nephrotoxicity (dose-limiting)
Risk of neutropenia
Probenecid must be administered w/each dose: 2 g PO 3 hr before cidofovir, 1 g at 2 hr & 8 hr after completion of cidofovir infusion
1 L saline IV with each cidofovir infusion; 1 add'l liter if pt can tolerate
Pregnancy & Lactation
Pregnancy Category: C
Lactation: It is not known whether cidofovir is excreted in milk. It should not be administered to nursing mothers. The CDC advises HIV-infected women not to breast-feed to avoid postnatal transmission of HIV.
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Distribution: Vd: 0.54 L/kg; does not cross significantly into CSF
Protein Bound: <6%
Half-life elimination: 2.6 hr
Metabolism: minimal; phosphorylation occurs intracellularly
Excretion: urine
Mechanism of Action
Inhibits viral DNA synthesis in CMV
Administration
IV Preparation
Administer within 24 hr of dilution; refrigerate if not used immediately but still use within 24 hr
Admixtures should be allowed to equilibrate to room temp prior to use
IV Administration
For IV infusion only
Infuse in 100 mL NS over 1 hr
Prehydrate with 1 L of NS IV over 1-2 hr prior to cidofovir infusion; a second liter may be administered over a 1-3 hr period immediately following infusion, if tolerated
Storage
Store at controlled room temp
Store admixtures under refrigeration
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| cidofovir intravenous - | 75 mg/mL vial |  | |
| cidofovir intravenous - | 75 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
cidofovir intravenous
CIDOFOVIR - INJECTION
(sye-DOH-foh-veer)
COMMON BRAND NAME(S): Vistide
WARNING: This medication may cause serious (possibly fatal) kidney problems. To prevent kidney problems, your doctor will usually prescribe another medication (probenecid) and direct you to receive fluids into a vein. Avoid other medications that may also damage your kidneys (see also Drug Interactions section). Tell your doctor right away if you have any signs of kidney problems, such as change in the amount of urine, frothy urine, or bloody/pink urine.This medication can lower the body's ability to fight an infection. Tell your doctor promptly if you develop any signs of an infection such as sore throat that doesn't go away, fever, or chills.Laboratory and/or medical tests (such as kidney function tests, complete blood counts) should be performed before each dose to check for these side effects. Consult your doctor for more details. Keep all medical and laboratory appointments.Cidofovir has caused tumors in laboratory animals. Although there is no information in humans, cidofovir should be considered cancer-causing (carcinogenic). See also How to Use section.
USES: This drug is used with probenecid to treat a certain viral eye infection (retinitis due to cytomegalovirus-CMV) in people with AIDS. It lowers your risk of blindness and other vision problems. Cidofovir belongs to a class of drugs known as antivirals. It works by stopping the growth of the virus.Cidofovir is not a cure for CMV retinitis, and your disease may still worsen during and after treatment.
HOW TO USE: This medication is given into a vein as directed by your doctor, usually over 1 hour. It is usually given every 1 to 2 weeks or as directed by your doctor. This medication should not be injected into the eyes. Permanent loss of vision may occur.Dosage is based on your medical condition, body weight, and response to treatment. You will usually receive IV fluids before your dose of cidofovir. Your doctor will also direct you to take probenecid by mouth before and after you receive cidofovir. To prevent kidney problems, drink plenty of fluids unless otherwise directed by your doctor. This is especially important if you are vomiting or having diarrhea.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.It is very important to use the probenecid with this medication exactly as prescribed by your doctor. Nausea and vomiting due to probenecid may be prevented by taking it after meals. Your doctor may also prescribe another medication to prevent nausea, and may direct you to take antihistamines (such as diphenhydramine) and/or acetaminophen to prevent allergic reactions to probenecid.This medication works best when it is used regularly. Keep all your medical appointments. You may want to mark a calendar to help you remember.Do not use more or less of this drug than prescribed or stop using it (or your HIV medicines) even for a short time unless directed to do so by your doctor. Doing so may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.Avoid direct contact of this medicine with the skin/eyes/mouth. If contact occurs, wash thoroughly with soap and water. For eyes, rinse with a steady stream of tap water for at least 5 minutes.
SIDE EFFECTS: See also Warning section.Nausea may occur. Headache, nausea, and vomiting may occur with probenecid use. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: nausea/vomiting that doesn't stop, dark urine, swelling, loss of appetite, unusual tiredness/sluggishness, stomach/abdominal pain, muscle loss, signs of infection (such as sore throat/cough that doesn't go away, fever), vision changes, new/increased eye redness or irritation, new/increased eye pain, mental/mood changes (such as confusion), yellowing eyes/skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using cidofovir, tell your doctor or pharmacist if you are allergic to it; or to other antivirals (such as ganciclovir); or to probenecid; or to other sulfa drugs (such as sulfamethoxazole); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, ganciclovir eye implant, kidney disease.This drug may cause vision changes. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.Older adults may be at a greater risk for kidney damage while using this drug.During pregnancy, cidofovir should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. The manufacturer recommends avoiding pregnancy. To prevent pregnancy, men with female partners should use effective barrier protections (such as latex or polyurethane condoms) during all sexual activity during treatment and for at least 90 days after stopping the medication. Women should use effective forms of birth control (such as birth control pills and condoms) during treatment and for at least 1 month after stopping the medication.It is not known if this medication passes into breast milk. Because of the possible risks to the infant and because breast milk can transmit HIV, do not breast-feed.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: acyclovir, ACE inhibitors (such as captopril, lisinopril), aminosalicylic acid, barbiturates (such as phenobarbital), benzodiazepines (such as triazolam), bumetanide, clofibrate, methotrexate, furosemide, nonsteroidal anti-inflammatory drugs-NSAIDs (such as ibuprofen), zidovudine.If you are taking probenecid and any of the medications listed above, ask your doctor if you should temporarily stop the other medication or decrease its dosage because probenecid may affect how well those medications are removed from your body. This is very important for zidovudine.Tell your doctor if you have had previous use of foscarnet.Avoid taking other medications that may damage your kidneys (such as amphotericin B, foscarnet, pentamidine, vancomycin, aminoglycosides including tobramycin, nonsteroidal anti-inflammatory drugs-NSAIDs including ibuprofen) within 7 days before and during treatment with this medication. In some cases, serious (possibly fatal) kidney damage may occur. See also Warning section.Check the labels on all your medicines because they may contain NSAIDs (such as ibuprofen, naproxen). Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: change in the amount of urine.
NOTES: Lab and/or medical tests (such as eye exams) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.To decrease your risk of spreading HIV disease to others, use an effective barrier method (such as latex or polyurethane condoms/dental dams) during sexual activity. Consult your doctor or pharmacist for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose of cidofovir, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up. If you miss a dose of the probenecid, tell your doctor or pharmacist right away. You may have to reschedule your cidofovir dose.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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