ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Foscarnet: Pediatric drug information

Foscarnet: Pediatric drug information
(For additional information see "Foscarnet: Drug information" and see "Foscarnet: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Renal impairment:

Renal impairment is the major toxicity of foscarnet. Frequent monitoring of serum creatinine, with dose adjustment for changes in renal function, and adequate hydration with administration of foscarnet is imperative.

Seizures:

Seizures, related to alterations in plasma minerals and electrolytes, have been associated with foscarnet treatment. Therefore, patients must be carefully monitored for such changes and their potential sequelae. Mineral and electrolyte supplementation may be required.

Appropriate use:

Foscarnet is indicated for use only in immunocompromised patients with cytomegalovirus (CMV) retinitis and mucocutaneous acyclovir-resistant herpes simplex virus (HSV) infections.

Brand Names: US
  • Foscavir
Brand Names: Canada
  • Vocarvi
Therapeutic Category
  • Antiviral Agent, Parenteral
Dosing: Pediatric
Cytomegalovirus infection, HIV-exposed/-infected

Cytomegalovirus (CMV) infection, HIV-exposed/-infected: Limited data available (Ref):

Treatment; induction: In addition to antiviral therapy, antiretroviral therapy (ART) should be optimized.

CNS, neurological disease: Infants, Children, and Adolescents: IV: 180 mg/kg/day in divided doses every 8 or 12 hours; use in combination with ganciclovir; begin treatment promptly and continue until symptom improvement; follow with chronic suppression

GI disease (esophagitis or colitis); ganciclovir-intolerant or -resistant: Adolescents: IV: 180 mg/kg/day in divided doses every 8 or 12 hours for 21 to 42 days or until resolution of symptoms

Retinitis: Use as a component of initial therapy if immediate, sight-threatening lesions are present.

Infants and Children: IV: 180 mg/kg/day in divided doses every 8 or 12 hours; continue for 14 to 21 days. Use in combination with ganciclovir if monotherapy fails or in sight-threatening illnesses. Follow treatment with chronic suppression (Ref).

Adolescents: Combination therapy with intravitreal and intravenous antiviral therapy recommended; follow treatment/induction with chronic suppression (Ref).

IV: 180 mg/kg/day in divided doses every 8 or 12 hours for 14 to 21 days

Intravitreal: 2.4 mg/dose for 1 to 4 doses administered over 7 to 10 days in combination with valganciclovir (oral), ganciclovir (IV), foscarnet (IV), or cidofovir (IV)

Chronic suppressive (maintenance) therapy:

Secondary prophylaxis (following treatment for prior disseminated disease, retinitis, or neurologic disease or GI disease with relapse): Infants, Children, and Adolescents: IV: 90 to 120 mg/kg/dose once daily; duration of therapy dependent on multiple factors (eg, infection, age, CD4 cell count, response) and is typically several months (Ref).

Cytomegalovirus infection after stem cell transplantation; alternate agent

Cytomegalovirus (CMV) infection after stem cell transplantation (HSCT); alternate agent: Limited data available (Ref): Infants, Children, and Adolescents: IV:

Preemptive therapy:

Induction:

<100 days post-transplant: Induction: 60 mg/kg/dose every 12 hours for 7 to 14 days; follow with maintenance therapy if CMV is still detectable and declining

>100 days post-transplant: 60 mg/kg/dose every 12 hours for 14 days; follow with maintenance therapy

Maintenance: 90 mg/kg/dose once daily; duration dependent on post-transplant days:

<100 days post-transplant: Minimum duration is at least 7 days and continue daily until CMV indicator test is negative

>100 days post-transplant: Continue for 7 to 14 days or until CMV indicator test is negative

Prophylactic therapy: Engraftment to <100 days post-transplant: 60 mg/kg/dose every 12 hours for 7 days, followed by 90 to 120 mg/kg/dose once daily until day 100 after HSCT

Herpes simplex virus infection acyclovir-resistant; treatment, HIV-exposed/-infected

Herpes simplex virus (HSV) infection acyclovir-resistant; treatment, HIV-exposed/-infected: Limited data available:

Infants and Children: IV: 120 mg/kg/day in divided doses every 8 or 12 hours; duration depends on infection site (Ref).

Adolescents: IV: 80 to 120 mg/kg/day in divided doses every 8 or 12 hours; continue until clinical response (Ref).

Varicella zoster virus infection, HIV-exposed/-infected

Varicella zoster virus (VZ) infection, HIV-exposed/-infected: Limited data available:

Chickenpox not responding to acyclovir; treatment: Infants and Children: IV: 120 to 180 mg/kg/day in divided doses every 8 hours for 7 to 10 days or until no new lesions have appeared for 48 hours (Ref).

Zoster: Progressive outer retinal necrosis; treatment (Ref): Infants, Children, and Adolescents: Note: In addition to antiviral therapy, optimize ART.

IV: 90 mg/kg/dose every 12 hours in combination with ganciclovir (systemic, IV) and intravitreal foscarnet and/or ganciclovir

Intravitreal: 1.2 mg/0.05 mL per dose twice weekly in combination with systemic foscarnet and ganciclovir and/or intravitreal ganciclovir

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no pediatric specific dosage adjustments available; based on experience in adult patients, dosage adjustment is suggested. Foscarnet is highly removed by hemodialysis (up to ~38% in 2.5 hours HD with high-flux membrane in adults) (Ref).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Foscarnet: Drug information")

Cytomegalovirus, treatment

Cytomegalovirus, treatment:

Gastrointestinal disease (esophagitis, colitis) (alternative agent) (off-label use): IV: 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours for 21 to 42 days or until symptom resolution (Ref).

Neurological disease (off-label use): IV: 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours in combination with ganciclovir; optimal duration not established (Ref).

Ophthalmic disease (retinitis):

IV (alternative agent):

Induction treatment: 60 mg/kg/dose every 8 hours or 90 mg/kg/dose every 12 hours for 14 to 21 days; for immediate sight-threatening lesions, administer in combination with intravitreal therapy (Ref).

Maintenance therapy: 90 to 120 mg/kg/dose once daily; due to lower toxicity, begin with 90 mg/kg/dose once daily, may escalate to 120 mg/kg/dose once daily if lower dose tolerated or for retinitis progression (Ref). Duration of maintenance therapy is ≥3 to 6 months and until lesions are inactive and until CD4 count is >100 cells/mm3 for 3 to 6 months in response to antiretroviral therapy in patients with HIV (Ref).

Intravitreal (off label):

Induction treatment: 2.4 mg per 0.1 mL injected into vitreum (Ref) for 1 to 4 doses administered over 7 to 10 days for immediate sight-threatening lesions; must be used in combination with systemic antiviral therapy (Ref).

Cytomegalovirus prevention, allogeneic hematopoietic cell transplant recipients

Cytomegalovirus prevention, allogeneic hematopoietic cell transplant recipients (off-label use; alternative agent):

Preemptive therapy: IV:

<100 days post-transplant: Induction: 60 mg/kg/dose every 12 hours for 7 to 14 days, followed by maintenance therapy: 90 mg/kg/dose once daily if CMV is still detectable and declining, continue until indicator test is negative. Minimum total duration (induction and maintenance) is 2 weeks (Ref).

>100 days post-transplant: 60 mg/kg/dose every 12 hours for 14 days, continue treatment with 90 mg/kg/dose once daily for 7 to 14 days or until indicator test is negative (Ref).

Prophylactic therapy: IV: 60 mg/kg/dose every 12 hours for 7 days, followed by 90 to 120 mg/kg/dose once daily until day 100 after HCT (Ref).

Herpes simplex infection, mucocutaneous

Herpes simplex infection, mucocutaneous (acyclovir-resistant):

IV: 40 mg/kg/dose every 8 to 12 hours for 14 to 21 days or until healed.

Topical (off label): Patients with HIV: Apply foscarnet 1% (extemporaneously prepared) 5 times daily for ≥21 to 28 days, based on clinical response (Ref).

Varicella zoster virus, progressive outer retinal necrosis

Varicella zoster virus, progressive outer retinal necrosis (off-label use):

Intravitreal (off-label): 1.2 mg per 0.05 mL injected in the vitreum twice weekly; must be used in combination with systemic antiviral therapy (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

See tables. Note: Renal function may be estimated by dividing actual 24-hour CrCl (mL/minute) by body weight (kg) or by using the modified Cockcroft-Gault formula ([140 − age]/[serum creatinine in mg/dL × 72] [× 0.85 for females]) for dosage adjustment purposes.

Induction Dosing of Foscarnet in Patients With Abnormal Renal Function

CrCl (mL/min/kg)

HSV

HSV

CMV

CMV

Equivalent to 40 mg/kg every 12 hours

Equivalent to 40 mg/kg every 8 hours

Equivalent to 60 mg/kg every 8 hours

Equivalent to 90 mg/kg every 12 hours

<0.4

Not recommended

Not recommended

Not recommended

Not recommended

≥0.4-0.5

20 mg/kg every 24 hours

35 mg/kg every 24 hours

50 mg/kg every 24 hours

50 mg/kg every 24 hours

>0.5-0.6

25 mg/kg every 24 hours

40 mg/kg every 24 hours

60 mg/kg every 24 hours

60 mg/kg every 24 hours

>0.6-0.8

35 mg/kg every 24 hours

25 mg/kg every 12 hours

40 mg/kg every 12 hours

80 mg/kg every 24 hours

>0.8-1

20 mg/kg every 12 hours

35 mg/kg every 12 hours

50 mg/kg every 12 hours

50 mg/kg every 12 hours

>1-1.4

30 mg/kg every 12 hours

30 mg/kg every 8 hours

45 mg/kg every 8 hours

70 mg/kg every 12 hours

>1.4

40 mg/kg every 12 hours

40 mg/kg every 8 hours

60 mg/kg every 8 hours

90 mg/kg every 12 hours

Maintenance Dosing of Foscarnet in Patients With Abnormal Renal Function

CrCl (mL/min/kg)

CMV

CMV

Equivalent to 90 mg/kg every 24 hours

Equivalent to 120 mg/kg every 24 hours

<0.4

Not recommended

Not recommended

≥0.4-0.5

50 mg/kg every 48 hours

65 mg/kg every 48 hours

>0.5-0.6

60 mg/kg every 48 hours

80 mg/kg every 48 hours

>0.6-0.8

80 mg/kg every 48 hours

105 mg/kg every 48 hours

>0.8-1

50 mg/kg every 24 hours

65 mg/kg every 24 hours

>1-1.4

70 mg/kg every 24 hours

90 mg/kg every 24 hours

>1.4

90 mg/kg every 24 hours

120 mg/kg every 24 hours

Hemodialysis:

Foscarnet is highly removed by hemodialysis (up to ~38% in 2.5 hours HD with high-flux membrane) (Ref)

Doses of 45 to 60 mg/kg/dose posthemodialysis (3 times/week) with the monitoring of weekly plasma concentrations to maintain peak plasma concentrations in the range of 500 to 800 micromolar for the treatment of CMV infection have been recommended (Ref).

Peritoneal dialysis: HSV infection (localized or disseminated): IV: 60 mg/kg/dose every 48 to 72 hours; higher doses may be necessary for herpes encephalitis or herpes zoster infection (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Central nervous system: Headache (26%)

Endocrine & metabolic: Hypokalemia (16% to 48%), hypocalcemia (15% to 30%), hypomagnesemia (15% to 30%), hypophosphatemia (8% to 26%)

Gastrointestinal: Nausea (47%), diarrhea (30%), vomiting (26%)

Hematologic & oncologic: Anemia (33%), granulocytopenia (17%)

Renal: Renal insufficiency (27%)

Miscellaneous: Fever (65%)

1% to 10%:

Cardiovascular: Chest pain (1% to 5%; including transient chest pain as part of infusion reactions), edema (1% to 5%), facial edema (1% to 5%), first degree atrioventricular block (1% to 5%), flushing (1% to 5%), hypertension (1% to 5%), hypotension (1% to 5%), palpitations (1% to 5%), sinus tachycardia (1% to 5%), ST segment changes on ECG (1% to 5%), thrombosis (1% to 5%)

Central nervous system: Seizure (10%), anxiety (≥5%), confusion (≥5%), depression (≥5%), dizziness (≥5%), fatigue (≥5%), hypoesthesia (≥5%), malaise (≥5%), neuropathy (≥5%), pain (≥5%), paresthesia (≥5%), rigors (≥5%), abnormal electroencephalogram (1% to 5%), aggressive behavior (1% to 5%), agitation (1% to 5%), amnesia (1% to 5%), aphasia (1% to 5%), ataxia (1% to 5%), cerebrovascular disease (1% to 5%), dementia (1% to 5%), hallucination (1% to 5%), insomnia (1% to 5%), meningitis (1% to 5%), nervousness (1% to 5%), sensory disturbance (1% to 5%), somnolence (1% to 5%), stupor (1% to 5%)

Dermatologic: Diaphoresis (≥5%), skin rash (≥5%), dermal ulcer (1% to 5%), erythematous rash (1% to 5%), maculopapular rash (1% to 5%), pruritus (1% to 5%), seborrhea (1% to 5%), skin discoloration (1% to 5%)

Endocrine & metabolic: Hyperphosphatemia (6%), electrolyte disturbance (≥5%), abnormal albumin-Globulin ratio (1% to 5%), acidosis (1% to 5%), albuminuria (1% to 5%), cachexia (1% to 5%), hyponatremia (1% to 5%), increased lactate dehydrogenase (1% to 5%), increased thirst (1% to 5%), weight loss (1% to 5%)

Gastrointestinal: Abdominal pain (≥5%), anorexia (≥5%), aphthous stomatitis (1% to 5%), cachexia (1% to 5%), constipation (1% to 5%), dysgeusia (1% to 5%), dyspepsia (1% to 5%), dysphagia (1% to 5%), flatulence (1% to 5%), melena (1% to 5%), pancreatitis (1% to 5%), xerostomia (1% to 5%)

Genitourinary: Nephrotoxicity (8%), dysuria (1% to 5%), nocturia (1% to 5%), urinary retention (1% to 5%), urinary tract infection (1% to 5%)

Hematologic & oncologic: Bone marrow suppression (10%), leukopenia (≥5%), mineral abnormalities (≥5%), neutropenia (≥5%), abnormal white cell differential (1% to 5%), altered platelet function (1% to 5%), lymphadenopathy (1% to 5%), pseudolymphoma (1% to 5%), rectal hemorrhage (1% to 5%), sarcoma (1% to 5%), thrombocytopenia (1% to 5%)

Hepatic: Abnormal hepatic function tests (1% to 5%), increased lactate dehydrogenase (1% to 5%), increased serum alkaline phosphatase (1% to 5%), increased serum ALT (1% to 5%), increased serum AST (1% to 5%)

Infection: Infection (≥5%), sepsis (≥5%), abscess, bacterial infection (1% to 5%), fungal infection (1% to 5%)

Local: Inflammation at injection site (1% to 5%), pain at injection site (1% to 5%)

Neuromuscular & skeletal: Muscle spasm (≥5%), neuropathy (peripheral; ≥5%), weakness (≥5%), arthralgia (1% to 5%), back pain (1% to 5%), leg cramps (1% to 5%), myalgia (1% to 5%), tremor (1% to 5%)

Ophthalmic: Visual disturbance (≥5%), conjunctivitis (1% to 5%), eye pain (1% to 5%)

Renal: Decreased creatinine clearance (≥5%), increased serum creatinine (≥5%), acute renal failure (1% to 5%), increased blood urea nitrogen (1% to 5%), polyuria (1% to 5%)

Respiratory: Cough (≥5%), dyspnea (≥5%), bronchospasm (1% to 5%), flu-like symptoms (1% to 5%), hemoptysis (1% to 5%), pharyngitis (1% to 5%), pneumonia (1% to 5%), pneumothorax (1% to 5%), pulmonary infiltrates (1% to 5%), respiratory failure (1% to 5%), respiratory insufficiency (1% to 5%), rhinitis (1% to 5%), sinusitis (1% to 5%), stridor (1% to 5%)

<1%, postmarketing, and/or case reports: Coma, dehydration, diabetes insipidus (usually nephrogenic), erythema multiforme, esophageal ulcer, extravasation, Fanconi syndrome, gastrointestinal hemorrhage, glomerulonephritis, hematuria, hypercalcemia, hypersensitivity reaction (including anaphylactic shock, angioedema, urticaria), hypoproteinemia, increased amylase, increased creatine phosphokinase, increased gamma-glutamyl transferase, increased serum lipase, local irritation (genitals), localized edema, myasthenia, myopathy, myositis, nephrolithiasis, nephrotic syndrome, pancytopenia, penile ulceration, prolonged QT interval on ECG, proteinuria, renal disease (crystal-induced), renal tubular acidosis, renal tubular necrosis, rhabdomyolysis, SIADH, status epilepticus, Stevens-Johnson syndrome, torsades de pointes, toxic epidermal necrolysis, vaginal ulcer, ventricular arrhythmia

Contraindications

Clinically significant hypersensitivity to foscarnet or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Dental effects: Foscarnet is deposited in teeth and bone of young, growing animals; it has adversely affected tooth enamel development in rats.

• Electrolyte imbalance: Imbalance of serum electrolytes or minerals occurs in at least 15% of patients (hypocalcemia, low ionized calcium, hyper/hypophosphatemia, hypomagnesemia, or hypokalemia); reducing infusion rate may decrease/prevent symptoms. Patients with low ionized calcium may experience perioral tingling, numbness, paresthesias, tetany, and seizures. Correct electrolytes before initiating therapy; use caution in patients who have any underlying electrolyte imbalances, those with neurologic or cardiac abnormalities, and those receiving medications that are influenced by calcium levels. Use caution when administering other medications that cause electrolyte imbalances. Patients who experience signs or symptoms of an electrolyte imbalance should be assessed immediately.

• Hematologic effects: May cause anemia and granulocytopenia.

• Hypersensitivity: Serious hypersensitivity reactions, including anaphylactic shock and angioedema, have been reported. Discontinue immediately and institute appropriate medical therapy if an acute reaction occurs.

• Renal impairment: [US Boxed Warning]: Renal impairment occurs to some degree in the majority of patients treated with foscarnet; renal impairment may occur at any time (though typically during second week of induction therapy) and is usually reversible within 1 week following dose adjustment or discontinuation of therapy, however, several patients have died with renal failure within 4 weeks of stopping foscarnet; therefore, renal function should be closely monitored during both induction and maintenance therapy. To reduce the risk of nephrotoxicity and the potential to administer a relative overdose, always calculate the CrCl even if serum creatinine is within the normal range. Dosage adjustments are recommended for renal dysfunction; safety and efficacy in patients with a baseline Scr >2.8 mg/dL or CrCl <50 mL/minute are limited. Use in patients with CrCl <0.4 mL/kg/minute is not recommended. Adequate hydration may reduce the risk of nephrotoxicity; the manufacturer makes specific recommendations regarding this (see Administration).

• QT prolongation: QT prolongation, including torsades de pointes, has been reported; some reports occurred in patients with confounding risk factors (eg, underlying cardiac disease, electrolyte abnormalities, concomitant medications). Use with caution in patients with a history of QT prolongation or those at increased risk for QT prolongation.

• Seizures: [US Boxed Warning]: Seizures related to plasma electrolyte/mineral imbalance may occur; incidence has been reported in up to 10% of HIV patients. Risk factors for seizures include impaired baseline renal function, low total serum calcium, and underlying CNS condition. Some patients who have experienced seizures have been able to continue or resume foscarnet treatment after their mineral or electrolyte abnormality has been corrected, their underlying disease state treated, or their dose decreased.

• Vascular irritant: Administer only into vein with adequate blood flow to prevent tissue irritation/ulceration. Genital vascular tissue damage has been reported; adequate hydration recommended.

Disease related concerns:

• Heart failure: Due to sodium content, use with caution in patients with heart failure.

Other warnings/precautions:

• Appropriate use: [US Boxed Warning]: Indicated only for immunocompromised patients with CMV retinitis and mucocutaneous acyclovir-resistant HSV infection.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Foscavir: 24 mg/mL (250 mL)

Generic: 24 mg/mL (250 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Foscarnet Sodium Intravenous)

6000 mg/250 mL (per mL): $1.73 - $2.27

Solution (Foscavir Intravenous)

6000 mg/250 mL (per mL): $2.30

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Vocarvi: 24 mg/mL (250 mL)

Administration: Pediatric

Parenteral:

IV: Administer using an infusion pump at a rate not to exceed 1 mg/kg/minute (ie, 60 mg/kg/dose over 1 hour or 120 mg/kg/dose over 2 hours) (Ref).

Hydration:

Initial: Prehydration prior to initial infusion: Children: 10 to 20 mL/kg (maximum: 1,000 mL) of age-appropriate fluid (usually NS); adults: 750 to 1,000 mL NS or D5W

Subsequent foscarnet doses: Concurrent hydration: Children: 10 to 20 mL/kg (maximum: 1,000 mL) of age-appropriate fluid; adults: 500 to 1,000 mL NS or D5W; concurrent hydration volume is dependent on foscarnet dose

Intravitreal: Administer undiluted (24 mg/mL) in appropriate sterile setting by health care professional experienced in administration of intravitreal ophthalmic injections.

Administration: Adult

IV: Foscarnet is administered by intravenous infusion, using an infusion pump, at a rate not exceeding 1 mg/kg/minute. Adult induction doses of 60 mg/kg are administered over 1 hour. Adult maintenance doses of 90 to 120 mg/kg are infused over 2 hours. Undiluted (24 mg/mL) solution can be administered without further dilution when using a central venous catheter for infusion. For peripheral vein administration, the solution must be diluted to a final concentration of 12 mg/mL. The manufacturer recommends 750 to 1,000 mL of NS or D5W be administered prior to first infusion to establish diuresis. With subsequent infusions of 90 to 120 mg/kg, this volume would be repeated. If the dose were 40 to 60 mg/kg, then the volume could be reduced to 500 mL. After the first dose, the hydration fluid should be administered concurrently with foscarnet.

Intravitreal: Off-label route: Withdraw solution directly from infusion container as it is already diluted to appropriate concentration for intravitreal administration. Pass through 0.22 micron filter prior to injection (Ref).

Storage/Stability

Store intact container at room temperature of 20°C to 25°C (68°F to 77°F) and protect from temperatures >40°C (>104°F) and from freezing. Following dilution in D5W or NS, solutions are stable for 24 hours.

Use

Treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) (FDA approved in adults); treatment of acyclovir-resistant mucocutaneous herpes simplex virus infections in immunocompromised patients and acyclovir-resistant herpes zoster infections (FDA approved in adults)

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acyclovir-Valacyclovir: Foscarnet may enhance the nephrotoxic effect of Acyclovir-Valacyclovir. Risk X: Avoid combination

Aminoglycosides: Foscarnet may enhance the nephrotoxic effect of Aminoglycosides. Risk X: Avoid combination

Amphotericin B: Foscarnet may enhance the nephrotoxic effect of Amphotericin B. Risk X: Avoid combination

CycloSPORINE (Systemic): Foscarnet may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Risk X: Avoid combination

Haloperidol: QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of Haloperidol. Risk C: Monitor therapy

Loop Diuretics: May increase the serum concentration of Foscarnet. Management: When diuretics are indicated during foscarnet treatment, thiazides are recommended over loop diuretics. If patients receive loop diuretics during foscarnet treatment, monitor closely for evidence of foscarnet toxicity. Risk D: Consider therapy modification

Methotrexate: Foscarnet may enhance the nephrotoxic effect of Methotrexate. Risk X: Avoid combination

Pentamidine (Systemic): May enhance the adverse/toxic effect of Foscarnet. The specific toxicities may include hypocalcemia, renal failure, and QT-prolongation. Management: Consider alternatives to this combination when possible. If this combination must be used, monitor patients more closely for hypocalcemia, renal dysfunction, and QT interval prolongation. Risk D: Consider therapy modification

QT-prolonging Agents (Highest Risk): QT-prolonging Agents (Indeterminate Risk - Caution) may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Tacrolimus (Systemic): Foscarnet may enhance the nephrotoxic effect of Tacrolimus (Systemic). Risk X: Avoid combination

Talimogene Laherparepvec: Antiherpetic Antivirals may diminish the therapeutic effect of Talimogene Laherparepvec. Risk C: Monitor therapy

Vasopressin: Drugs Suspected of Causing Diabetes Insipidus may diminish the therapeutic effect of Vasopressin. Specifically, the pressor and antidiuretic hormone effects of vasopressin may be decreased. Risk C: Monitor therapy

Dietary Considerations

Some products may contain sodium.

Pregnancy Considerations

Information related to use of foscarnet in pregnancy is limited (Alvarez-McLeod 1999).

Foscarnet is not the preferred treatment of cytomegalovirus infection in pregnant patients. Monitoring of amniotic fluid volumes by ultrasound is recommended weekly after 20 weeks of gestation to detect oligohydramnios if foscarnet is used. In general, intravitreous injections for local therapy are preferred for retinal disease to limit systemic exposure (HHS [OI adult 2020]).

Monitoring Parameters

24-hour creatinine clearance, ECG, and electrolytes at baseline and periodically thereafter (when clinically appropriate). During induction therapy: Obtain complete blood counts and electrolytes (including serum creatinine, calcium, magnesium, potassium, and phosphorus) twice weekly and then once weekly during maintenance therapy. More frequent monitoring may be required in some patients. Check hydration status before and after infusion.

Mechanism of Action

Pyrophosphate analogue which acts as a noncompetitive inhibitor of many viral RNA and DNA polymerases as well as HIV reverse transcriptase. Similar to ganciclovir, foscarnet is a virostatic agent. Foscarnet does not require activation by thymidine kinase.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Vd: ~0.5 L/kg; up to 28% of cumulative IV dose may be deposited in bone

Protein binding: 14% to 17%

Metabolism: Biotransformation does not occur

Half-life elimination: Elimination: ~3 to 4 hours; terminal: ~88 hours (due to bone deposition)

Excretion: Urine (≤28% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: CrCl of 50 to 80 mL/minute has a clearance of about 1.33 mL/minute/kg and a plasma half-life of about 3.35 hours. CrCl of 25 to 49 mL/minute has a clearance of about 0.46 mL/minute/kg and a plasma half-life of about 13 hours. CrCl of 10 to 24 mL/minute has a clearance of 0.43 mL/minute/kg and plasma half-life about 25.3 hours.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Foscarnet | Foscarnet Gemepe | Foscavir;
  • (AT) Austria: Foscavir;
  • (AU) Australia: Foscarnet | Foscavir;
  • (BE) Belgium: Foscavir;
  • (BG) Bulgaria: Foscavir;
  • (BR) Brazil: Foscavir;
  • (CH) Switzerland: Foscavir;
  • (CN) China: Carnet | Yi ke ya;
  • (CO) Colombia: Oscarnet;
  • (CZ) Czech Republic: Foscavir;
  • (DE) Germany: Foscarnet kabi | Foscavir;
  • (EE) Estonia: Foscavir;
  • (ES) Spain: Foscarnet kabi | Foscavir;
  • (FI) Finland: Foscarnet tillomed | Foscavir;
  • (FR) France: Foscarnet kabi | Foscavir;
  • (GB) United Kingdom: Foscavir;
  • (GR) Greece: Foscavir;
  • (HK) Hong Kong: Foscavir;
  • (HU) Hungary: Foscavir;
  • (IE) Ireland: Foscavir;
  • (IT) Italy: Foscavir;
  • (JP) Japan: Foscavir;
  • (KR) Korea, Republic of: Foscavir;
  • (LT) Lithuania: Foscavir;
  • (LV) Latvia: Foscavir;
  • (MY) Malaysia: Carnet | Foscavir;
  • (NL) Netherlands: Foscavir;
  • (NO) Norway: Foscavir;
  • (NZ) New Zealand: Foscarnet | Foscavir;
  • (PL) Poland: Foscavir;
  • (PR) Puerto Rico: Foscavir;
  • (PT) Portugal: Foscarnet | Foscarnet Sodio | Foscarneto sodico kabi | Foscavir;
  • (PY) Paraguay: Foscarnet richet;
  • (RU) Russian Federation: Foscavir;
  • (SE) Sweden: Foscarnet tillomed | Foscavir;
  • (SG) Singapore: Foscavir;
  • (SI) Slovenia: Foscavir;
  • (SK) Slovakia: Foscavir;
  • (TH) Thailand: Foscavir;
  • (TN) Tunisia: Foscavir;
  • (TW) Taiwan: Foscarnet Gemepe | Foscavir
  1. Alvarez-McLeod A, Havlik J, Drew KE. Foscarnet treatment of genital infection due to acyclovir-resistant herpes simplex virus type 2 in a pregnant patient with AIDS: case report. Clin Infect Dis. 1999;29(4):937-938. [PubMed 10589917]
  2. Aweeka FT, Jacobson MA, Martin-Munley S, et al. Effect of Renal Disease and Hemodialysis on Foscarnet Pharmacokinetics and Dosing Recommendations. J Acquir Immune Def Syndr Hum Retrovirol. 1999;20(4):350-357. [PubMed 10096579]
  3. Butler KM, DeSmet MD, Husson RN, et al. Treatment of Aggressive Cytomegalovirus Retinitis With Ganciclovir in Combination With Foscarnet in a Child Infected With Human Immunodeficiency Virus. J Pediatr. 1992;120(3):483-486. [PubMed 1311378]
  4. Calligaro KD, Stern J, DeLaurentis DA. Foscarnet: A Possible Cause of Ulnar Artery Thrombosis in a Patient With AIDS. J Vasc Surg. 1994;20(6):1007-1008. [PubMed 7990178]
  5. Chilukuri S, Rosen T. Management of Acyclovir-Resistant Herpes Simplex Virus. Dermatol Clin. 2003;21(2):311-320. [PubMed 12757254]
  6. Chrisp P, Clissold SP. Foscarnet. A Review of Its Antiviral Activity, Pharmacokinetic Properties and Therapeutic Use in Immunocompromised Patients With Cytomegalovirus Retinitis. Drugs. 1991;41(1):104-129. [PubMed 1706982]
  7. Deray G, Martinez F, Katlama C, et a. Foscarnet Nephrotoxicity: Mechanism, Incidence and Prevention. Am J Nephrol. 1989;9:316-321. [PubMed 2554731]
  8. Diaz-Llopis M, España E, Muñoz G, et al. High dose intravitreal foscarnet in the treatment of cytomegalovirus retinitis in AIDS. Br J Ophthalmol. 1994;78(2):120-124. [PubMed 8123619]
  9. Drugs for Non-HIV Viral Infections. Med Lett Drugs Ther. 1994;36(919):27. [PubMed 8127252]
  10. Foscavir (foscarnet) [prescribing information]. Lake Forest, IL: Hospira, Inc; November 2020.
  11. HHS Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-opportunistic-infection/0. Accessed June 15, 2020.
  12. HHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. December 2016. https://clinicalinfo.hiv.gov/en/news/updates-guidelines-prevention-and-treatment-opportunistic-infections-children-and-exposed-hiv. Accessed March 20, 2018.
  13. HHS Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines forthe prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections. Accessed March 20, 2018.
  14. Jacobson MA. Review of the Toxicities of Foscarnet. J Acquir Immune Defic Syndr. 1992;5(suppl 1):11-17.
  15. Jayasekara D, Aweeka FT, Rodriguez R, et al. Antiviral therapy for HIV patients with renal insufficiency. J Acquir Immune Defic Syndr. 1999;21:384-395. [PubMed 10458619]
  16. Jayaweera DT. Minimizing the Dosage-Limiting Toxicities of Foscarnet Induction Therapy. Drug Saf. 1997;16(4):258-266. [PubMed 9113493]
  17. Keating MR. Antiviral Agents. Mayo Clin Proc. 1992;67(2):160-178. [PubMed 1347578]
  18. MacGregor RR, Graziani AL, Weiss R, et al. Successful foscarnet therapy for cytomegalovirus retinitis in an AIDS patient undergoing hemodialysis: rationale for empiric dosing and plasma level monitoring. J Infect Dis. 1991;164:785-787. [PubMed 1654363]
  19. Martínez-Castillo S, Marín-Lambíes C, Gallego-Pinazo R, Arévalo JF, Díaz-Llopis M. Crystallization after intravitreous foscarnet injections. Arch Ophthalmol. 2012;130(5):658-659. [PubMed 22652858]
  20. Morales JM, Munoz MA, Fernandez Zatarain G, et al. Reversible Acute Renal Failure Caused by the Combined Use of Foscarnet and Cyclosporin in Organ Transplanted Patients. Nephrol Dial Transplant. 1995;10(6):882-883. [PubMed 7566623]
  21. Polis MA. Foscarnet and Ganciclovir in the Treatment of Cytomegalovirus Retinitis. J Acquir Immune Defic Syndr. 1992;5(suppl 1):3-10.
  22. Refer to manufacturer's labeling.
  23. Reusser P, Einsele H, Lee J, et al; Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Randomized multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood. 2002;15;99(4):1159-1164. [PubMed 11830461]
  24. Tomblyn M, Chiller T, Einsele H, et al; Center for International Blood and Marrow Research; National Marrow Donor program; European Blood and Marrow Transplant Group; American Society of Blood and Marrow Transplantation; Canadian Blood and Marrow Transplant Group; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America; Association of Medical Microbiology and Infectious Disease Canada; Centers for Disease Control and Prevention. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective [published correction appears in Biol Blood Marrow Transplant. 2010;16(2):294]. Biol Blood Marrow Transplant. 2009;15(10):1143-1238. [PubMed 19747629]
  25. US Department of Health and Human Services (HHS) Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new-guidelines. Updated December 30, 2021. Accessed January 3, 2022.
Topic 13325 Version 224.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟