Ganciclovir and Valganciclovir

Q: What is the difference between Ganciclovir and Valganciclovir?

Answer: 

Ganciclovir and Valganciclovir are the mainstay of cytomegalovirus (CMV) viremia treatments.

Valganciclovir, an L-valyl ester of ganciclovir. Its most significant advantage is that it can be given orally with an excellent bioavailability. It is well absorbed and rapidly hydrolyzed to ganciclovir hepatically and in the intestinal wall. The best equivalent can be described as: The systemic exposure of a 900 mg dose of valganciclovir in adults is similar to a single dose of 5 mg/kg of IV ganciclovir, with absolute bioavailability of about 60 percent. It is usually given with food.

Ganciclovir given as an IV has an intracellular half-life of 16.5 hours as ganciclovir triphosphate. Clearance is directly correlated to glomerular filtration rate (GFR). Ganciclovir's oral form has poor bioavailability and has been replaced by Valganciclovir.

Hemodialysis (HD) decreases serum concentration of ganciclovir and valganciclovir by about 50 percent.

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References:

1. Markham A, Faulds D. Ganciclovir. An update of its therapeutic use in cytomegalovirus infection. Drugs 1994; 48:455.

2. Cvetković RS, Wellington K. Valganciclovir: a review of its use in the management of CMV infection and disease in immunocompromised patients. Drugs 2005; 65:859.

3. Curran M, Noble S. Valganciclovir. Drugs 2001; 61:1145.