Table 4.

Anti-CMV medications and common associated side effects

Agent	Mechanism of action	Common side effects
Ganciclovir	Competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of viral DNA synthesis	Thrombocytopenia, leukopenia, increased creatinine, fever, vomiting, diarrhea
Valganciclovir	Converted to ganciclovir in the body, much higher bioavailability of ganciclovir compared to oral ganciclovir	As ganciclovir
Foscarnet	Non-competitive inhibitor of many viral RNA and DNA polymerases	Electrolyte abnormalities, fever, vomiting, diarrhea, anemia, granulocytopenia, renal insufficiency, cardiotoxicity, central nervous system toxicity, hepatic toxicity
Cidofovir	Suppresses CMV replication by selective inhibition of viral DNA synthesis	Fever, alopecia, rash, ocular, renal, and gastrointestinal toxicity, cough, dyspnea