Version July 2025
Herpetic keratitis: Children ≥2 years and Adolescents: Ophthalmic gel: Apply 1 drop in affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then 1 drop 3 times daily for 7 days.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
(For additional information see "Ganciclovir (ophthalmic): Drug information")
Herpetic keratitis: Ophthalmic: Apply 1 drop in affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then apply 1 drop 3 times daily for 7 days.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Ophthalmic: Blurred vision (60%), eye irritation (20%)
1% to 10%: Ophthalmic: Conjunctival hyperemia (5%), punctate keratitis (5%)
There are no contraindications listed in the manufacturer's US labeling.
Canadian labeling: Hypersensitivity to ganciclovir, valganciclovir, acyclovir, or any component of the formulation.
Concerns related to adverse effects:
• Ocular adverse events: Blurred vision commonly occurs; may also cause eye irritation.
Special populations:
• Contact lens wearers: Contact lenses should not be worn during the course of therapy or in any patient with signs/symptoms of herpetic keratitis.
Other warnings/precautions:
• Appropriate use: For topical ophthalmic use only.
Use with caution in children; long-term safety has not been determined; the potential long-term carcinogenic and adverse reproductive effects of ganciclovir should be considered.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Gel, Ophthalmic:
Zirgan: 0.15% (5 g) [contains benzalkonium chloride]
No
Gel (Zirgan Ophthalmic)
0.15% (per gram): $114.51
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Gel, Ophthalmic:
Eyezirgan: 0.15% (5 g) [contains benzalkonium chloride]
Topical: For topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces.
For ophthalmic application only; avoid touching tip of applicator to eye or other surfaces.
Hazardous agent (NIOSH 2024 [table 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2023; NIOSH 2024; USP-NF 2020).
Note: Facilities may perform risk assessment of some hazardous drugs to determine if appropriate for alternative handling and containment strategies (USP-NF 2020). Refer to institution-specific handling policies/procedures.
Store at 15°C to 25°C (59°F to 77°F). Do not freeze.
Eyezirgan [Canadian product]: Store at 15°C to 30°C (59°F to 86°F). Do not freeze. Discard any amount not used within 30 days of first opening.
Treatment of acute herpetic keratitis (dendritic ulcers) (FDA approved in ages ≥2 years and adults).
Ganciclovir may be confused with acyclovir, valGANciclovir
None known.
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 drug interactions program
There are no known significant interactions.
Canadian product labeling recommends patients who may become pregnant use effective contraception during therapy and for 6 months after ophthalmic ganciclovir is discontinued. Patients with partners who may become pregnant should use barrier contraception during therapy and for up to 3 months after the last dose of ophthalmic ganciclovir.
Adverse events were observed in animal reproduction studies conducted with systemic ganciclovir.
The amount of ganciclovir available systemically following topical application of the ophthalmic gel is ~0.1% of an IV dose.
Ophthalmologic exams.
Ganciclovir is phosphorylated to a substrate, which competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of DNA replication by herpes simplex viruses.
Absorption: Negligible systemic absorption (0.1% in comparison to IV doses and 0.04 % in comparison to oral valganciclovir).
Protein binding: 1% to 2% (Canadian labeling).
