Valganciclovir for the prevention and treatment of cytomegalovirus disease in immunocompromised hosts

Raymund R. Razonable, Carlos V. Paya

Research output: Contribution to journalReview article

43 Scopus citations

Abstract

Valganciclovir (Valcyte®, Roche), a prodrug of the deoxyguanosine analog ganciclovir (Cytovene®, Roche), is indicated for induction and maintenance treatment of cytomegalovirus retinitis in patients with AIDS and for prevention of cytomegalovirus disease in selected high-risk solid organ transplant recipients. After oral administration, valganciclovir is rapidly absorbed and converted to ganciclovir by intestinal and hepatic esterases. Valganciclovir is a highly recognized substrate of the intestinal peptide transporter PEPT1, which underlies the tenfold higher bioavailability of ganciclovir after valganciclovir compared to oral ganciclovir administration. At oral dose of 900 mg, valganciclovir provides a systemic ganciclovir exposure that is comparable to intravenous ganciclovir, at the standard dose of 5 mg/kg of body weight. Subsequent phosphorylation of ganciclovir, which occurs preferentially within cytomegalovirus-infected cells, results in the active metabolite, ganciclovir triphosphate, which is responsible for suppressing viral DNA synthesis by competitively inhibiting the incorporation of the natural substrate deoxyguanosine into viral DNA and thereby, terminating cytomegalovirus replication.

Original languageEnglish (US)
Pages (from-to)27-41
Number of pages15
JournalExpert Review of Anti-Infective Therapy
Volume2
Issue number1
StatePublished - Feb 2004

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Keywords

  • AIDS
  • Congenital CMV infection
  • Cytomegalovirus
  • Ganciclovir
  • HIV prevention
  • Hematopoietic stem cell transplantation
  • Solid organ transplantation
  • Therapy
  • Valganciclovir

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)
  • Virology
  • Infectious Diseases

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