Valganciclovir Apotex

Valganciclovir Apotex Uses, Dosage, Side Effects, Food Interaction and all others data.

Valganciclovir Apotex is an L-valyl ester (prodrug) of ganciclovir, which after oral administration is rapidly converted to ganciclovir by intestinal and hepatic esterases. Ganciclovir is a synthetic analogue of 2’-deoxyguanosine, which inhibits replication of herpes viruses in vitro and in vivo. Sensitive human viruses include human cytomegalovirus (HCMV), herpes simplex virus-1 and -2 (HSV-1 and HSV-2), human herpes virus 6, 7 and 8 (HHV-6, HHV-7, HHV-8), Epstein-Barr virus (EBV), varicella-zoster virus (VZV) and hepatitis B virus.In CMV-infected cells ganciclovir is initially phosphorylated to ganciclovir mono-phosphate by the viral protein kinase, UL97. Further phosphorylation occurs by cellular kinases to produce ganciclovir triphosphate, which is then slowly metabolized intracellularly. This has been shown to occur in HSV- and HCMV-infected cells with half-lives of 18 and between 6 and 24 hours respectively after removal of extracellular ganciclovir. As phosphorylation is largely dependent on the viral kinase, the phosphorylation of ganciclovir occurs preferentially in virus-infected cells.The virustatic activity of ganciclovir is due to inhibition of viral DNA synthesis by: (a) competitive inhibition of incorporation of deoxyguanosine-triphosphate into DNA by viral DNA polymerase and (b) incorporation of ganciclovir triphosphate into viral DNA causing termination of, or very limited further viral DNA elongation. Typical antiviral IC 50 against CMV in vitro is in the range 0.08 μM (0.02 μg/ml) to 14 μM (3.5 μg/ml).The clinical antiviral effect of Valganciclovir Apotex has been demonstrated in the treatment of AIDS patients with newly diagnosed CMV retinitis (clinical trial WV15376). CMV shedding was decreased from 46% (32/69) of patients at study entry to 7% (4/55) of patients following 4 weeks of Valganciclovir Apotex treatment.

Valganciclovir Apotex is an antiviral medication used to treat cytomegalovirus infections. As the L-valyl ester of ganciclovir, it is actually a prodrug for ganciclovir. After oral administration, it is rapidly converted to ganciclovir by intestinal and hepatic esterases. After this, it (being an analogue of guanosine) gets incorporated into DNA and thus cannot be properly read by DNA polymerase. This results in the termination of the elongation of viral DNA.

Trade Name Valganciclovir Apotex
Availability Prescription only
Generic Valganciclovir
Valganciclovir Other Names Valganciclovir
Related Drugs valacyclovir, ganciclovir ophthalmic, ganciclovir, Valcyte, letermovir, cidofovir, foscarnet, Prevymis, Cytovene
Type
Formula C14H22N6O5
Weight Average: 354.3617
Monoisotopic: 354.165167844
Protein binding

Plasma protein binding of ganciclovir is 1% to 2% over concentrations of 0.5 and 51 mg/mL.

Groups Approved, Investigational
Therapeutic Class Anti-viral drugs
Manufacturer
Available Country Netherlands
Last Updated: September 19, 2023 at 7:00 am
Valganciclovir Apotex
Valganciclovir Apotex

Uses

Valganciclovir Apotex is used for the treatment of cytomegalovirus (CMV) retinitis in adult patients with acquired immunodeficiency syndrome (AIDS). Valganciclovir Apotex is used for the prevention of CMV disease in adult and pediatric solid organ transplant (SOT) patients who are at risk.

Valganciclovir Apotex is also used to associated treatment for these conditions: Cytomegalovirus (CMV) Infection, Cytomegalovirus Retinitis

How Valganciclovir Apotex works

Valganciclovir Apotex is a prodrug of ganciclovir that exists as a mixture of two diastereomers. After administration, these diastereomers are rapidly converted to ganciclovir by hepatic and intestinal esterases. In cytomegalovirus (CMV)-infected cells, ganciclovir is initially phosphorylated to the monophosphate form by viral protein kinase, then it is further phosphorylated via cellular kinases to produce the triphosphate form. This triphosphate form is slowly metabolized intracellularly. The phosphorylation is dependent upon the viral kinase and occurs preferentially in virus-infected cells. The virustatic activity of ganciclovir is due to the inhibition of viral DNA synthesis by ganciclovir triphosphate. Ganciclovir triphosphate is incorporated into the DNA strand replacing many of the adenosine bases. This results in the prevention of DNA synthesis, as phosphodiester bridges can longer to be built, destabilizing the strand. Ganciclovir inhibits viral DNA polymerases more effectively than it does cellular polymerase, and chain elongation resumes when ganciclovir is removed.

Dosage

Valganciclovir Apotex dosage

Standard Dosage: Valganciclovir Apotex is administered orally, and should be taken with food. Valganciclovir Apotex is rapidly and extensively converted into the active ingredient ganciclovir. The bioavailability of ganciclovir from Valganciclovir Apotex is up to 10-fold higher than from oral ganciclovir.The dosage and administration of Valganciclovir Apotex tablets or powder for oral solution as described below should be closely followed. The ganciclovir systemic exposure following administration of 900 mg Valganciclovir Apotex powder for oral solution is equivalent to a 900 mg Valganciclovir Apotex dose administered as two 450 mg tablets.An oral dosing dispenser with 25 mg graduations up to 500 mg is provided with the powder for oral solution. It is recommended that this dispenser is used to measure and administer the dose.

Treatment of cytomegalovirus (CMV) retinitis-

Adult patients

:

  • Induction treatment of CMV retinitis: For patients with active CMV retinitis, the recommended dose is 900 mg twice a day for 21 days. Prolonged induction treatment may increase the risk of bone marrow toxicity
  • Maintenance treatment of CMV retinitis: Following induction treatment, or in adult patients with inactive CMV retinitis, the recommended dose is 900 mg once daily. Patients whose retinitis worsens may repeat induction treatment. The duration of maintenance treatment should be determined on an individual basis.

Pediatric patients

: The safety and efficacy of Valganciclovir Apotex in the treatment of CMV retinitis have not been established in adequate and well-controlled clinical studies in pediatric patients.

Prevention of CMV disease in transplantation-

Adult patients

: For kidney transplant patients, the recommended dose is 900 mg once daily starting within 10 days post-transplantation and continuing until 200 days post-transplantation. For patients who have received a solid organ transplant other than kidney, the recommended dose is 900 mg once daily starting within 10 days post-transplantation and continuing until 100 days post-transplantation.

Pediatric patients

: In pediatric solid organ transplant patients from birth, who are at risk of developing CMV disease, the recommended once daily dose of Valganciclovir Apotex is based on body surface area (BSA) and creatinine clearance (ClCr) derived from Schwartz formula (ClCr), and is calculated using the equation below:Pediatric dose (mg)= 7 x BSA x ClCr. If the creatinine clearance exceeds 150 ml/min/1.73 m2, then a maximum value of 150 ml/min/1.73 m2

Side Effects

The following serious adverse reactions are discussed in greater detail in other sections of the labeling:

  • Hematologic Toxicity
  • Acute Renal Failure
  • Impairment of Fertility
  • Fetal Toxicity
  • Mutagenesis and Carcinogenesis

Toxicity

It is expected that an overdose of valganciclovir could also possibly result in increased renal toxicity.

Interaction

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 Apotex. Drug-drug interaction studies with ganciclovir were conducted in patients with normal renal function. Following concomitant administration of Valganciclovir Apotex and other renally excreted drugs, patients with impaired renal function may have increased concentrations of ganciclovir and the coadministered drug. Therefore, these patients should be closely monitored for toxicity of ganciclovir and the coadministered drug.

Food Interaction

  • Take with food.

[Moderate] ADJUST DOSING INTERVAL: Food increases the bioavailability of ganciclovir from the prodrug, valganciclovir.

In 16 HIV-positive subjects, the administration of valganciclovir 875 mg once daily with a high-fat meal containing approximately 600 calories resulted in a 30% increase in the steady-state area under the plasma concentration-time curve (AUC) and a 14% increase in the peak plasma concentration (Cmax) of ganciclovir, with no delay in the time to reach peak plasma concentration (Tmax).

The mechanism is unknown.



MANAGEMENT: The manufacturer recommends that valganciclovir be taken with meals.

Volume of Distribution

  • 0.703 ± 0.134 L/kg

Elimination Route

Valganciclovir Apotex is well absorbed from the gastrointestinal tract and the absolute bioavailability from valganciclovir tablets (following administration with food) is approximately 60%.

Half Life

Approximately 4.08 hours. Increased in patients with renal function impairment.

Clearance

  • 3.07+/- 0.64 mL/min/kg [IV administration]
  • 5.3 L/hr [Patient with creatinine clearance of 70.4 mL/min]

Elimination Route

The major route of elimination of valganciclovir is by renal excretion as ganciclovir through glomerular filtration and active tubular secretion.

Pregnancy & Breastfeeding use

Pregnancy: The safety of Valganciclovir Apotex for use in pregnant women has not been established. However, ganciclovir readily diffuses across the human placenta. The use of Valganciclovir Apotex should be avoided in pregnant women unless the benefit to the mother outweighs the potential risk to the fetus. Reprotoxicity studies have not been repeated with valganciclovir because of the rapid and extensive conversion to ganciclovir. In animal studies ganciclovir was associated with reproductive toxicity and teratogenicity (see section 3.3.4 Reproductive Toxicity). The safe use of Valganciclovir Apotex during labor and delivery has not been established.Lactation: Peri- and postnatal development has not been studied with valganciclovir or with ganciclovir but the possibility of ganciclovir being excreted in breast milk and causing serious adverse reactions in the nursing infant cannot be discounted. Human data are not available but animal data indicates that ganciclovir is excreted in the milk of lactating rats. Therefore, a decision should be made to discontinue the drug or discontinue nursing taking into consideration the potential benefit of Valganciclovir Apotex to the nursing mother.

Contraindication

Valganciclovir Apotex is contraindicated in patients with known hypersensitivity to valganciclovir, ganciclovir or to any of the excipients.

Special Warning

Pediatric Use: A higher risk of hematological cytopenias in neonates and infants warrants careful monitoring of blood counts in these age groups. Monitoring of liver function abnormalities, renal function and gastrointestinal fluid loss is also recommended in pediatric patients.Geriatric Use: Safety and efficacy have not been established in this patient populationRenal Impairment: In patients with impaired renal function, dosage adjustments based on creatinine clearance are required.Hepatic Impairment: Safety and efficacy have not been established in this patient population

Storage Condition

Store Valganciclovir Apotex tablets at 20°C to 25°C; excursions are permitted to 15°C to 30°C

Innovators Monograph

You find simplified version here Valganciclovir Apotex

FAQ

What is Valganciclovir Apotex used for?

Valganciclovir Apotex is used to treat cytomegalovirus retinitis (eye infection that can cause blindness) in people who have acquired immunodeficiency syndrome (AIDS).

How safe Valganciclovir Apotex is?

Valganciclovir Apotex is safe and effective as pre-emptive therapy for CMV infection in allogeneic hematopoietic stem cell transplantation.

What are the side effects of Valganciclovir Apotex?

Valganciclovir Apotex may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • diarrhea
  • nausea
  • vomiting
  • pain, tenderness, or swelling of the abdomen
  • eye pain
  • constipation
  • headache
  • weight loss
  • back, joint, or muscle pain
  • mouth ulcers
  • depression
  • anxiety

When should I take Valganciclovir Apotex?

Valganciclovir Apotex should be taken twice a day for 21 days and, whenever possible, taken with food.

How do I take Valganciclovir Apotex?

Take Valganciclovir Apotex with food. Drink plenty of liquids while you are taking Valganciclovir Apotex.Valganciclovir Apotex tablets are for adults or children, but Valganciclovir Apotex liquid is only for children. Adults should not use the oral solution or the dose may not be correct.

Is Valganciclovir Apotex safe during pregnancy?

Do not take Valganciclovir Apotex if you are pregnant or plan to become pregnant.You will need to take a pregnancy test before you start treatment and use effective birth control during your treatment and for 30 days after your final dose.

How do you take Valganciclovir Apotex?

The manufacturer recommends avoiding breastfeeding during Valganciclovir Apotex use because of the risk of infant drug toxicity, neonates with CMV infections are often treated directly with Valganciclovir Apotex.

Can you take Valganciclovir Apotex with food?

Valganciclovir Apotex should be administered with or immediately after a meal. This will make it easier for your body to absorb the medication.

Is Valganciclovir Apotex safe during breastfeeding?

the manufacturer recommends avoiding breastfeeding during Valganciclovir Apotex use because of the risk of infant drug toxicity, neonates with CMV infections are often treated directly with Valganciclovir Apotex.

Can you overdose on Valganciclovir Apotex ?

You could overdose and become very sick if Valganciclovir Apotex is taken with ganciclovir capsules or Cytovene-IV. Talk to your doctor or pharmacist if you have questions about your medicine.

Can I drive after taking Valganciclovir Apotex?

After taking Valganciclovir Apotex do not drive or use any tools or machines if you feel dizzy, tired, shaky or confused while taking this medicine.

How long does Valganciclovir Apotex stay in your system?

Valganciclovir Apotex only active in your body for a short period of time after it's taken. On its own, its half-life is approximately 30 minutes. Oonce Valganciclovir Apotex has converted into acyclovir, it has a half-life of 2.5 to 3.3 hours in people with normal renal function.

Is Valganciclovir Apotex an antiviral?

Valganciclovir Apotex is an antiviral. It is used to treat infections caused by viruses.This medicine is also used to prevent CMV disease in patients who have received an organ transplant .

Is Valganciclovir Apotex cytotoxic?

bnrand is classed as a cytotoxic medicine and will therefore require special handling. These medications are often identified by a purple label and the nurses/pharmacists at your hospital/pharmacy will also identify them for you.

Can I crush Valganciclovir Apotex?

Do not break or crush Valganciclovir Apotex.Avoid contact with your skin or eyes. If you come in contact with the contents of the tablet or oral solution, wash your skin well with soap and water or rinse your eyes well with plain water.

Is Valganciclovir Apotex an immunosuppressant?

No, Valganciclovir Apotex is not an immunosuppressant.Valganciclovir Apotex is often prescribed to people taking immunosuppressants after a transplant to prevent a CMV infection.

How long can you take Valganciclovir Apotex?

The usual dose Valganciclovir Apotex is two tablets taken twice a day for 21 days . Do not take this dose for more than 21 days unless your doctor tells you to, as this may increase your risk of possible side effects.

Is Valganciclovir Apotex an antibiotic?

Valganciclovir Apotex is an antiviral drug. It works by preventing viral cells from multiplying in your body.

Is Valganciclovir Apotex a prodrug?

Valganciclovir Apotex an oral prodrug that is rapidly converted to ganciclovir, also plays a major role in the treatment and prevention of CMV infections in immunocompromised hosts.

How many days should I take Valganciclovir Apotex?

Valganciclovir Apotex comes as a tablet to take by mouth. It is usually taken every 8 hours (three times a day) for 7 days to treat shingles. To treat genital herpes it is usually taken twice a day for 5 days.

*** Taking medicines without doctor's advice can cause long-term problems.
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