Valganciclovir Dosage for CMV Infection

Adult Dosing Recommendations

The Centers for Disease Control and Prevention recommends valganciclovir 900 mg orally twice daily for 21 days for induction therapy, followed by 900 mg once daily for maintenance therapy in adults with CMV retinitis 1
Valganciclovir is well absorbed from the gastrointestinal tract and rapidly metabolized to ganciclovir in the intestine and liver 1
For CMV colitis, initial treatment with intravenous ganciclovir 5 mg/kg twice daily for 3-5 days, followed by oral valganciclovir 900 mg twice daily for 2-3 weeks is recommended 2, 3
Consider consultation with an infectious disease specialist early in treatment for CMV colitis 2

Limited data exists on appropriate valganciclovir dosing for children with CMV infection, and for children old enough to receive the adult dosage, valganciclovir is preferred over oral ganciclovir 1, 4

Regular monitoring of complete blood count is essential due to the risk of myelosuppression, and renal function should be monitored regularly as renal toxicity can occur 1, 5
For CMV retinitis, regular ophthalmologic examinations are required 1, 6

Major adverse effect is myelosuppression (neutropenia, anemia, thrombocytopenia), and dose reduction or interruption might be necessary in up to 40% of patients due to hematologic toxicity 1, 5
Combination therapy with ganciclovir and foscarnet may be considered for sight-threatening disease or in cases of treatment failure 1, 5

For CMV colitis, initial treatment with intravenous ganciclovir 5 mg/kg twice daily for 3-5 days is recommended, followed by oral valganciclovir 900 mg twice daily for the remainder of the 2-3 week course, as suggested by the World Journal of Emergency Surgery guidelines 7

Valganciclovir is a highly acceptable oral option for pre-emptive therapy for CMV in allogeneic hematopoietic stem cell transplant (HCT) recipients in the absence of substantial gastrointestinal graft-versus-host disease (GVHD), according to the National Comprehensive Cancer Network (NCCN) guidelines 8
The NCCN guidelines also suggest that valganciclovir should not be used in patients with hepatic dysfunction, particularly liver transplant patients, due to higher rates of CMV disease compared with intravenous ganciclovir 8
For patients who cannot tolerate valganciclovir or ganciclovir due to neutropenia or thrombocytopenia, foscarnet is commonly used as an alternative, as recommended by the NCCN guidelines 8
For CMV infections that are refractory or resistant to valganciclovir, ganciclovir, foscarnet, or cidofovir, maribavir has shown promise in clinical trials, according to the NCCN guidelines 8