Valganciclovir Hydrochloride

Generalized seizures have been reported in patients receiving ganciclovir and imipenem-cilastatin. Coadministration is not recommended.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Potential increase in serum creatinine and nephrotoxicity risk when coadministered with valganciclovir. Monitor renal function.

Potential increase in serum creatinine and nephrotoxicity risk when coadministered with valganciclovir. Monitor renal function.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Increased risk of hematological and renal toxicity. Monitor for ganciclovir and MMF toxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

Co-administration with valganciclovir should be considered only if potential benefits outweigh risks due to potential for higher toxicity from myelosuppression or nephrotoxicity.

May increase didanosine concentration. Patients should be closely monitored for didanosine toxicity including pancreatitis.

Increases ganciclovir concentration. Valganciclovir dose may need to be reduced. Monitor for ganciclovir toxicity.

Table 9 Established and Other Potentially Significant Drug Interactions with Ganciclovir Name of the Concomit a nt Drug Change in the Concentration of Ganciclovir or Concomitant Drug Clinical Comment Imipenem-cilastatin Unknown Coadministration with imipenem­ cilastatin is not recommended because generalized seizures have been reported in patients who received ganciclovir and imipenem-cilastatin. Imipenem-cilastatin: Seizures were reported in patients receiving ganciclovir and imipenem-cilastatin.

7 DRUG INTERACTIONS In vivo drug-drug interaction studies were not conducted with valganciclovir. However, because valganciclovir is rapidly and extensively converted to ganciclovir, drug-drug interactions associated with ganciclovir will be expected for valganciclovir. Drug-drug interaction studies with ganciclovir were conducted in patients with normal renal function.

Other drugs associated with myelosuppression or nephrotoxicity (e.g., adriamycin, dapsone, doxorubicin, flucytosine, hydroxyurea, pentamidine, tacrolimus, trimethoprim/ sulfamethoxazole, vinblastine, vincristine, and zidovudine) Unknown Because of potential for higher toxicity, coadministration with valganciclovir should be considered only if the potential benefits are judged to outweigh the risks.

7 DRUG INTERACTIONS In vivo drug-drug interaction studies were not conducted with valganciclovir. However, because valganciclovir is rapidly and extensively converted to ganciclovir, drug-drug interactions associated with ganciclovir will be expected for valganciclovir. Following concomitant administration of valganciclovir and other renally excreted drugs, patients with impaired renal function may have increased concentrations of ganciclovir and the coadministered drug.