Indications: life-threatening or sight-threatening cytomegalovirus infections in immunocompromised patients only; prevention of cytomegalovirus disease during immunosuppressive therapy following organ transplantation; local treatment of CMV retinitis.

Cautions: close monitoring of full blood count (severe deterioration may require correction and possibly treatment interruption); history of cytopenia; potential carcinogen and teratogen; radiotherapy; ensure adequate hydration during intravenous administration; vesicant— infuse into vein with adequate flow preferably using plastic cannula; children (possible risk of long-term carcinogenic or reproductive toxicity);

Contra-indications: hypersensitivity to valganciclovir, ganciclovir, acyclovir, or valaciclovir; abnormally low hemoglobin, neutrophil, or platelet counts.

Renal impairment: reduce dose if eGFR less than 70 ml/minute/1.73 m2.

Hepatic Impairment: No dosage adjustment provided in manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.

Pregnancy avoid—teratogenic risk; ensure effective contraception during treatment and barrier contraception for men during and for at least 90 days after treatment Breast-feeding avoid—no information available.

Side Effects: diarrhoea, nausea, vomiting, dyspepsia, abdominal pain, constipation, flatulence, dysphagia, taste disturbance, hepatic dysfunction; dyspnea, chest pain, cough; headache, insomnia, convulsions, dizziness, peripheral neuropathy, depression, anxiety, confusion, abnormal thinking, fatigue, weight loss, anorexia; infection, pyrexia, night sweats; anemia, leucopenia, thrombocytopenia, pancytopenia, renal impairment; myalgia, arthralgia; macular oedema, retinal detachment, vitreous floaters, eye pain; ear pain; dermatitis, pruritus; injection-site reactions; less commonly mouth ulcers, pancreatitis, arrhythmias, hypotension, anaphylactic reactions, psychosis, tremor, male infertility, hematuria, disturbances in hearing and vision, and alopecia Sepsis.

Dose: By intravenous infusion initially (induction) 5 mg/kg every 12 hours for 14–21 days for treatment or for 7–14 days for prevention.

maintenance (for patients at risk of relapse of retinitis): 6 mg/kg daily on 5 days per week or 5 mg/kg daily until adequate recovery of immunity (if retinitis progresses initial induction treatment may be repeated)