Foscarnet

Generic name
Foscarnet
Brand name
ATC Code
J05AD01
Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Follow-on therapy for retinitis based on cytomegalovirus (CMV)
  • Intravenous
    • 1 month up to 18 years
      • 90 - 120 mg/kg/day in 1 dose

      • When administering via peripheral veins, use a diluted solution (dilute to 12 mg/ml) because of thrombophlebitis. This is not needed for administration via a central venous catheter (then 24 mg/ml).
        Adjust the dose in cases of renal insufficiency as per the package leaflet.

         

    • 1 month up to 18 years
      [1] [2]
      • 90 - 120 mg/kg/day in 1 dose

      • When administering via peripheral veins, use a diluted solution (dilute to 12 mg/ml) because of thrombophlebitis. This is not needed for administration via a central venous catheter (then 24 mg/ml).
        Adjust the dose in cases of renal insufficiency as per the package leaflet.

         

Renal impaiment in children > 3 months

Application in cases of reduced renal function (creatinine clearance less than 30 ml/min) is contraindicated.

In cases of reduced renal function (creatinine clearance 30-80 ml/min) in adults: the manufacturer’s recommendations are followed for determining the dosage.

The dose in reduced renal function varies depending on the indication. The manufacturer quotes the creatinine clearance in ml/min/kg bodyweight. This is based on the following formulae: for men, (140-age)/(72 x serum creatinine); for women, (140-age)/(72 x serum creatinine) x 0.85. Age is expressed as a number of years and serum creatinine in mg/dl, where 1 mg/dl creatinine = 88.4 μmol/l.

CMV retinitis in patients with HIV infections, CMV disease in patients with HRT:

  • creatinine clearance 1.0-1.4 ml/min/kg bodyweight: induction 135 mg/kg/day in 3 doses or 140 mg/kg/day in 2 doses; maintenance 70-90 mg/kg/day in a single dose;

  • creatinine clearance 0.8-1.0 ml/min/kg bodyweight: induction 105 mg/kg/day in 3 doses or 100 mg/kg/day in 2 doses; maintenance 50-65 mg/kg/day in a single dose;

  • creatinine clearance 0.6-0.8 ml/min/kg bodyweight: induction 80 mg/kg/day in 1-2 doses; maintenance 80-105 mg/kg every 48 hours;

  • creatinine clearance 0.5-0.6 ml/min/kg bodyweight: induction 60 mg/kg/day in 1-2 doses; maintenance 60-80 mg/kg every 48 hours;
  • creatinine clearance 0.4-0.5 ml/min/kg bodyweight: induction 50 mg/kg/day in 1-2 doses; maintenance 50-65 mg/kg bodyweight every 48 hours;
  • creatinine clearance less than 0.4 ml/min/kg bodyweight: treatment with foscarnet is not recommended;
  • haemodialysis: treatment with foscarnet is not recommended.


CMV infection in the gastrointestinal tract in patients with HIV infections:

  • creatinine clearance 1.0-1.4 ml/min/kg bodyweight: induction 140 mg/kg/day in 2 doses;
  • creatinine clearance 0.8-1.0 ml/min/kg bodyweight: induction 100 mg/kg/day in 2 doses;
  • creatinine clearance 0.6-0.8 ml/min/kg bodyweight: induction 80 mg/kg/day in a single dose;
  • creatinine clearance 0.5-0.6 ml/min/kg bodyweight: induction 60 mg/kg/day in a single dose;
  • creatinine clearance 0.4-0.5 ml/min/kg bodyweight: induction 50 mg/kg/day in a single dose;
  • creatinine clearance less than 0.4 ml/min/kg bodyweight: treatment with foscarnet is not recommended;
  • haemodialysis: treatment with foscarnet is not recommended.


CMV viraemia in patients with HRT:

  • creatinine clearance 1.0-1.4 ml/min/kg bodyweight: induction 90 mg/kg/day in 2 doses; maintenance 70-90 mg/kg/day in a single dose;
  • creatinine clearance 0.8-1.0 ml/min/kg bodyweight: induction 70 mg/kg/day in 2 doses; maintenance 50-65 mg/kg/day in a single dose 
  • creatinine clearance 0.6-0.8 ml/min/kg bodyweight: induction 50 mg/kg/day in 2 doses; maintenance 80-105 mg/kg every 48 hours;
  • creatinine clearance 0.5-0.6 ml/min/kg bodyweight: induction 40 mg/kg/day in 2 doses; maintenance 60-80 mg/kg every 48 hours;
  • creatinine clearance 0.4-0.5 ml/min/kg bodyweight: induction 30 mg/kg/day in 2 doses; maintenance 50-65 mg/kg every 48 hours;
  • creatinine clearance less than 0.4 ml/min/kg bodyweight: treatment with foscarnet is not recommended;
  • haemodialysis: treatment with foscarnet is not recommended.


Aciclovir-resistant herpes simplex infection:

  • creatinine clearance 1.0-1.4 ml/min/kg bodyweight: induction 90 mg/kg/day in 3 doses;
  • creatinine clearance 0.8-1.0 ml/min/kg bodyweight: induction 60 mg/kg/day in 3 doses;
  • creatinine clearance 0.6-0.8 ml/min/kg bodyweight: induction 50 mg/kg/day in 2 doses;
  • creatinine clearance 0.5-0.6 ml/min/kg bodyweight: induction 40 mg/kg/day in 2 doses;
  • creatinine clearance 0.4-0.5 ml/min/kg bodyweight: induction 30 mg/kg/day in 2 doses;
  • creatinine clearance less than 0.4 ml/min/kg bodyweight: treatment with foscarnet is not recommended;
  • haemodialysis: treatment with foscarnet is not recommended.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects

No information is present at this moment.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Foscarnet should be reserved for children who are hypersensitive to ganciclovir, get severe bone marrow depression as a side effect, or in whom ganciclovir resistance is suspected or proven. Quantitative monitoring of CMV DNA concentrations in the blood and/or secreta is very important here, for as long as genetic determination of GCV resistance is technically not possible

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

DIRECT ACTING ANTIVIRALS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Nucleosides and nucleotides excl. reverse transcriptase inhibitors
J05AB01
J05AB12
J05AB06
J05AB16
J05AB04
J05AB11
J05AB14
Protease inhibitors
J05AE08
J05AE10
J05AE07
J05AE02
J05AE04
J05AE03
J05AE01
Nucleoside and nucleotide reverse transcriptase inhibitors
J05AF06
J05AF02
J05AF09
J05AF10
J05AF05
J05AF04
J05AF07
J05AF13
J05AF13
J05AF01
Non-nucleoside reverse transcriptase inhibitors
J05AG06
J05AG03
J05AG04
J05AG01
J05AG05
Neuraminidase inhibitors
J05AH02
J05AH01
Antivirals for treatment of HIV infections, combinations
J05AR02
J05AR20
J05AR13
J05AR25
J05AR18
J05AR19
J05AR03
J05AR09
J05AR10
Other antivirals
J05AX28
J05AX12
J05AX07
J05AX09
J05AX08
J05AX24
ANTIVIRALS FOR TREATMENT OF HIV INFECTIONS, COMBINATIONS
J05AR02
J05AR20
J05AR13
J05AR25
J05AR18
J05AR19
J05AR03
J05AR09
J05AR10
Integrase inhibitors
J05AJ04
Antivirals for treatment of HCV infections
J05AP54
J05AP57
J05AP51
J05AP08
J05AP55

References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. Furth van AM et al, Werkboek Infectieziekten bij Kinderen, VU Uitgeverij, 1999

Changes

Therapeutic Drug Monitoring


Overdose