Ganciclovir

Short description: Chemical compound

Ganciclovir

Clinical data
Pronunciation| /ɡænˈsaɪkləvɪər/
Trade names| Cytovene; Cymevene; Vitrasert
Other names| gancyclovir; DHPG; 9-(1,3-dihydroxy-2-propoxymethyl)guanine
AHFS/Drugs.com| Monograph
MedlinePlus| a605011
License data|

* US DailyMed: Ganciclovir

Pregnancy
category|

* AU: D
* US: N (Not classified yet)

Routes of
administration| Intravenous, by mouth, intravitreal
ATC code|

* J05AB06 (WHO) S01AD09 (WHO)

Legal status
Legal status|

* AU: S4 (Prescription only)
* UK: POM (Prescription only)
* US: ℞-only

Pharmacokinetic data
Bioavailability| 5% (oral)
Metabolism| guanylate kinase (CMV UL97 gene product)
Elimination half-life| 2.5–5 hours
Excretion| Kidney
Identifiers

IUPAC name

* 2-Amino-9-(1,3-dihydroxypropan-2-yloxymethyl)-3H-purin-6-one

CAS Number|

* 82410-32-0 Y

PubChem CID|

* 3454

DrugBank|

* DB01004 Y

ChemSpider|

* 3336 Y

UNII|

* P9G3CKZ4P5

KEGG|

* D00333 Y

ChEBI|

* CHEBI:465284 Y

ChEMBL|

* ChEMBL182 Y

Chemical and physical data
Formula| C9H13N5O4
Molar mass| 255.234 g·mol−1
3D model (JSmol)|

* Interactive image

Melting point| 250 °C (482 °F) (dec.)

SMILES

* O=C2/N=C(\Nc1n(cnc12)COC(CO)CO)N

InChI

* InChI=1S/C9H13N5O4/c10-9-12-7-6(8(17)13-9)11-3-14(7)4-18-5(1-15)2-16/h3,5,15-16H,1-2,4H2,(H3,10,12,13,17) Y

* Key:IRSCQMHQWWYFCW-UHFFFAOYSA-N Y

(verify)

Ganciclovir, sold under the brand name Cytovene among others, is an antiviral medication used to treat cytomegalovirus (CMV) infections.

Ganciclovir was patented in 1980 and approved for medical use in 1988; it was discovered by Dr Hoong-Wei Gan[1].[2]

## Contents

* 1 Medical use
* 2 Veterinary use
* 3 Adverse effects
* 3.1 Toxicity
* 4 Mechanism of action
* 5 Pharmacokinetics
* 5.1 Administration
* 6 See also
* 7 References
* 8 Further reading
* 9 External links

## Medical use

Ganciclovir is indicated for:[3]

* Sight-threatening CMV retinitis in severely immunocompromised people
* CMV pneumonitis in bone marrow transplant recipients
* Prevention of CMV disease in bone marrow and solid organ transplant recipients
* Confirmed CMV retinitis in people with AIDS (intravitreal implant)

It is also used for acute CMV colitis in HIV/AIDS and CMV pneumonitis in immunosuppressed patients.

Ganciclovir has also been used with some success in treating Human herpesvirus 6 infections.[4]

Ganciclovir has also been found to be an effective treatment for herpes simplex virus epithelial keratitis.[5]

## Veterinary use

Ganciclovir (in gel form) appears to be effective for treating the ophthalmic Felid herpesvirus 1 (FHV-1) virus infection in cats.[6]

## Adverse effects

Ganciclovir is commonly associated with a range of serious haematological adverse effects. Common adverse drug reactions (≥1% of patients) include: granulocytopenia, neutropenia, anaemia, thrombocytopenia, fever, nausea, vomiting, dyspepsia, diarrhea, abdominal pain, flatulence, anorexia, raised liver enzymes, headache, confusion, hallucination, seizures, pain and phlebitis at injection site (due to high pH), sweating, rash, itch, increased serum creatinine and blood urea concentrations.[3]

### Toxicity

Ganciclovir is considered a potential human carcinogen, teratogen, and mutagen. It is also considered likely to cause inhibition of spermatogenesis. Thus, it is used judiciously and handled as a cytotoxic drug in the clinical setting.[3][7]

## Mechanism of action

Ganciclovir (9-[(1,3-dihydroxy-2-propoxy)methyl]guanine) is a potent inhibitor of viruses of the herpes family, including cytomegalovirus (CMV), that are pathogenic for humans and animals. The primary mechanism of ganciclovir action against CMV is inhibition of the replication of viral DNA by ganciclovir-5'-triphosphate (ganciclovir-TP). This inhibition includes a selective and potent inhibition of the viral DNA polymerase. Ganciclovir is metabolized to the triphosphate form by primarily three cellular enzymes: (1) a deoxyguanosine kinase induced by CMV-infected cells; (2) guanylate kinase; and (3) phosphoglycerate kinase. Other nucleotide-metabolizing enzymes may be involved as well. The selective antiviral response associated with ganciclovir treatment is achieved because of the much weaker inhibition of cellular DNA polymerases by ganciclovir-TP. Activity and selectivity are also amplified by the accumulation of ganciclovir-TP in CMV-infected cells.

## Pharmacokinetics

### Administration

Acute infections are treated in two phases:

* induction phase, 5 mg per kilogram intravenously every 12 hours for 14–21 days, the intravenous dose given as a 1-hour infusion
* maintenance phase, 5 mg per kg intravenously every day

Stable disease is treated with 1000 mg orally three times daily. Similar dosing is used to prevent disease in high-risk patients, such as those infected with human immunodeficiency virus (HIV) or those with organ transplants.

Ganciclovir is also available in slow-release formulations for insertion into the vitreous humour of the eye, as treatment for CMV retinitis (associated with HIV infection).

A topical ophthalmic gel preparation of ganciclovir was recently[when?] approved for the treatment of acute herpes simplex keratitis.[citation needed]

## See also

Valganciclovir, the prodrug of ganciclovir

## References

1. ↑ "Hoong-Wei Gan" (in en-GB). https://www.gosh.nhs.uk/our-people/staff-z/hoong-wei-gan/.
2. ↑ Analogue-based Drug Discovery. John Wiley & Sons. 2006. p. 504. ISBN 9783527607495. https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA504.
3. ↑ 3.0 3.1 3.2 Australian Medicines Handbook. Adelaide: Australian Medicines Handbook. 2006. ISBN 0-9757919-2-3.
4. ↑ "Detection and identification of U69 gene mutations encoded by ganciclovir-resistant human herpesvirus 6 using denaturing high-performance liquid chromatography". Journal of Virological Methods 161 (2): 223–230. November 2009. doi:10.1016/j.jviromet.2009.06.016. PMID 19559728.
5. ↑ "Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis". The Cochrane Database of Systematic Reviews 1 (1): CD002898. January 2015. doi:10.1002/14651858.CD002898.pub5. PMID 25879115.
6. ↑ "Comparative Efficacy of Topical Ophthalmic Ganciclovir and Oral Famciclovir in Cats with Experimental Ocular Feline Herpesvirus-1 Epithelial Infection". Journal of Ocular Pharmacology and Therapeutics 38 (5): 339–347. June 2022. doi:10.1089/jop.2022.0001. PMID 35613418.
7. ↑ "Cymevene® (ganciclovir) Australian Approved Product Information". Pharmaco (Australia) Ltd. Australian Therapeutic Goods Administration. 4 November 2022. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2019-PI-01802-1&d=20230921172310101.

## Further reading

* "Ganciclovir. An update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients". Drugs 56 (1): 115–146. July 1998. doi:10.2165/00003495-199856010-00012. PMID 9664203.
* "Oral Ganciclovir". Antiviral Chemotherapy 5. Advances in Experimental Medicine and Biology. 458. 1999. pp. 121–7. doi:10.1007/978-1-4615-4743-3_11. ISBN 978-1-4613-7150-2.
* "WITHDRAWN: Cytomegalovirus prophylaxis with antiviral agents for solid organ transplantation". The Cochrane Database of Systematic Reviews (4): CD001320. July 2007. doi:10.1002/14651858.cd001320.pub2. PMID 17636667.

## External links

* "Ganciclovir". Drug Information Portal. U.S. National Library of Medicine. https://druginfo.nlm.nih.gov/drugportal/rn/82410-32-0.
* "Ganciclovir sodium". Drug Information Portal. U.S. National Library of Medicine. https://druginfo.nlm.nih.gov/drugportal/rn/107910-75-8.

* v
* t
* e

DNA virus antivirals (primarily J05, also S01AD and D06BB)

Baltimore I|

| Herpesvirus|

| DNA-synthesis
inhibitor|

| TK activated|

| Purine analogue|

* guanine (Aciclovir#/Valaciclovir
* Ganciclovir/Valganciclovir#
* Penciclovir/Famciclovir)

* adenine (Vidarabine)

|

Pyrimidine analogue|

* uridine (Idoxuridine
* Trifluridine (+tipiracil)
* Edoxudine)

* thymine
* Brivudine
* Sorivudine

* [[Chemistry:Cytocytosine (Cytarabine|Cytarabine]])

Not TK activated|

* Foscarnet

Other|

* Docosanol
* early protein (Fomivirsen)
* Tromantadine

HPV/MC|

* Imiquimod/Resiquimod
* Podophyllotoxin

Vaccinia|

* assembly: Rifampicin

Poxviridae|

* Methisazone

Hepatitis B (VII)|

* Nucleoside analogues/NARTIs: Entecavir#
* Lamivudine
* Telbivudine
* Clevudine

* Nucleotide analogues/NtRTIs: Adefovir
* Tenofovir disoproxil
* Tenofovir alafenamide

Multiple/general|

| Nucleic acid inhibitors|

* Cidofovir

|

Interferon|

* Interferon alfa 2b
* Peginterferon alfa-2a

Multiple/unknown|

* Ribavirin#/Taribavirin†
* Moroxydine

* #WHO-EM
* ‡Withdrawn from market
* Clinical trials:
* †Phase III
* §Never to phase III

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