Ganciclovir (IV)

Adjustment of Dose & Administration

Renal Adjustment

Ganciclovir	CrCl (mL/min)
	>70	50-69	25-49	10-24	<10, HD	CRRT
5 mg/kg induction	5 mg/kg q12h	2.5 mg/kg q12h	2.5 mg/kg q24h	1.25 mg/kg q24h	1.25 mg/kg 3x/week (after each HD)	2.5 mg/kg q24h*
5 mg/kg maint.	5 mg/kg q24h	2.5 mg/kg q24h	1.25 mg/kg q24h	0.625 mg/kg q24h	0.625 mg/kg 3x/week (after each HD)	1.25 mg/kg q24h*

* Higher doses may be considered (2.5 mg/kg q12h for induction and 2.5 mg/kg q24h for maintenance) depending on severity of infection, if dialysis flow rate >2000ml/hr, or if patient is on ECMO

Note: this dosing scheme also applies for HHV-6 treatment (HHV-6 should only be treated in select clinical scenarios)

Horvatits et al. Antimicrobial Agents and Chemotherapy. 2014;58(1):94-101

Restricted Use

Unrestricted use in solid organ and bone marrow transplant patients. ID telephone approval required (page 970-GERM for adult patients or 970-7420 for pediatric patients) for all other patients. 

Cost Index

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General Notes

1. Up-to-date cost information, click here 
2. IV antimicrobials outpatient (OPAT) dosing, click here
3. Obesity dosing weight recommendations here
4. Helpful drug-drug interaction check website here 
5. 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.