Usual Dose & Administration
Prophylaxis
480 mg PO daily
Prophylaxis (on cyclosporine)
240 mg PO daily
Adjustment of Dose & Administration
Renal Adjustment
PO letermovir is preferred over IV in patients able to tolerate oral intake or where administration via tube is feasible. Though letermovir is not routinely recommended in patients with severe renal dysfunction (CrCl < 10 mL/min), tolerability and safety of oral letermovir in renal impairment has been described.
Drug-Specific Information
Letermovir is a time-dependent inhibitor and inducer of CYP3A. Please see attached protocol on the HCT ppx page for drug interactions.
Letermovir may increase tacrolimus concentrations
Letermovir may decrease voriconazole concentrations
Restricted Use
Restricted to Adult BMT clinicians & kidney transplant clinicians (see HCT CMV protocol here & CMV Management in Solid Organ Transplantation Policy #4465):
•Prophylaxis of CMV infection in CMV-seropositive recipients [R+] of an allo HSCT
•Prophylaxis of CMV infection in CMV-seronegative allo HSCT with CMV seropositive donors [D+]
•Prophylaxis of CMV infection in CMV-seronegative kidney transplant recipients with seropositive donors [D+/R-]
ID Telephone Approval Required:
•Secondary prophylaxis in HSCT following CMV infection
•Prophylaxis of CMV in SOT recipients (except D+/R- kidney transplant recipients)
•Treatment of CMV in HSCT or SOT recipients
General Notes
- Up-to-date cost information, click here
- IV antimicrobials outpatient (OPAT) dosing, click here
- Obesity dosing weight recommendations here
- Helpful drug-drug interaction check website here
- When dosing guidance is provided it is important to note the following:
Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.