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Ganciclovir (ophthalmic): Drug information

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

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Zirgan
Brand Names: Canada
  • Eyezirgan
Pharmacologic Category
  • Antiviral Agent, Ophthalmic
Dosing: Adult
Herpetic keratitis

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.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Ganciclovir (ophthalmic): Pediatric drug information")

Herpetic keratitis

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.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.

Adverse Reactions

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%)

Contraindications

There are no contraindications listed in the manufacturer's US labeling.

Canadian labeling: Hypersensitivity to ganciclovir, valganciclovir, acyclovir, or any component of the formulation.

Warnings/Precautions

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.

Warnings: Additional Pediatric Considerations

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.

Dosage Forms: US

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

Gel, Ophthalmic:

Zirgan: 0.15% (5 g) [contains benzalkonium chloride]

Generic Equivalent Available: US

No

Pricing: US

Gel (Zirgan Ophthalmic)

0.15% (per gram): $112.82

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.

Gel, Ophthalmic:

Eyezirgan: 0.15% (5 g) [contains benzalkonium chloride]

Administration: Adult

For ophthalmic application only; avoid touching tip of applicator to eye or other surfaces.

Administration: Pediatric

Topical: For topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 2]).

Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends double gloving and a protective gown for administration (NIOSH 2016). Facilities may perform assessment of some (non-antineoplastic) hazardous drugs to determine if appropriate for alternative containment strategies and handling requirements; assess risk to determine appropriate containment strategy (USP-NF 2017).

Use: Labeled Indications

Herpetic keratitis: Treatment of acute herpetic keratitis (dendritic ulcers)

Medication Safety Issues
Sound-alike/look-alike issues:

Ganciclovir may be confused with acyclovir, valGANciclovir

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Reproductive Considerations

Canadian product labeling recommends patients who may become pregnant use effective contraception during therapy. Patients with partners who may become pregnant should use barrier contraception during therapy and for up to 3 months after the last dose.

Pregnancy Considerations

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.

Breastfeeding Considerations

The amount of ganciclovir available systemically following ophthalmic application is not known.

The manufacturer recommends that caution be used with administration of the ophthalmic gel to patients who are breastfeeding.

Monitoring Parameters

Ophthalmologic exams

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

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).

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

  • (AE) United Arab Emirates: Virgan;
  • (AR) Argentina: Neagel;
  • (AU) Australia: Virgan;
  • (BD) Bangladesh: Genclovir | Herpigel | Xoviral | Zirgan;
  • (CL) Chile: Virgan;
  • (CN) China: Li ke ming;
  • (CO) Colombia: Gancivir | Virgan;
  • (CZ) Czech Republic: Virgan;
  • (DE) Germany: Virgan;
  • (ES) Spain: Virgan;
  • (GR) Greece: Virgan;
  • (HK) Hong Kong: Virgan;
  • (IE) Ireland: Virgan;
  • (IN) India: Clovir | Gancigel | Ganov | Gb vir | Gelovir | Vira g | Virson;
  • (IT) Italy: Virgan;
  • (KR) Korea, Republic of: Virgan;
  • (KW) Kuwait: Virgan;
  • (LB) Lebanon: Virgan;
  • (LT) Lithuania: Virgan;
  • (LU) Luxembourg: Virgan;
  • (MA) Morocco: Virgan;
  • (MX) Mexico: Virgangel;
  • (MY) Malaysia: Virgan;
  • (NO) Norway: Virgan;
  • (NZ) New Zealand: Virgan;
  • (PE) Peru: Gancivir;
  • (PL) Poland: Virgan;
  • (PT) Portugal: Virgan;
  • (PY) Paraguay: Gancivir;
  • (RO) Romania: Virgan;
  • (RU) Russian Federation: Zyrgan;
  • (SA) Saudi Arabia: Ganvir | Virgan;
  • (SG) Singapore: Virgan;
  • (SI) Slovenia: Virgan;
  • (TR) Turkey: Virgan
  1. <800> Hazardous Drugs—Handling in Healthcare Settings. United States Pharmacopeia and National Formulary (USP 40-NF 35). Rockville, MD: United States Pharmacopeia Convention; 2017:83-102.
  2. Eyezirgan (ganciclovir ophthalmic gel) [product monograph]. Oakville, Ontario, Canada: Thea Pharma Inc; September 2022.
  3. US Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. https://www.cdc.gov/niosh/docs/2016-161/default.html. Updated September 2016. Accessed October 5, 2016.
  4. Zirgan (ganciclovir ophthalmic) [prescribing information]. Bridgewater, NJ: Bausch & Lomb; September 2019.
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