TABLE 9.

Approved drugs for treatment of CMV^d

Treatment (reference)	Formulation(s)	Target	Drug class	Indication	Induction dosagea	Maintenance dosagea	Major side effect(s)	Note(s)
Ganciclovir	i.v.	UL97 kinase	Nucleoside analog	First-line treatment	5 mg/kg of body wt i.v. BID	5 mg/kg i.v. daily	Myelosuppression, fever, headache, liver toxicity
Valganciclovir	p.o.	UL97 kinase	Nucleoside analog	First-line treatment	900 mg p.o. BID	900 mg p.o. daily	Myelosuppression
Foscarnet	i.v.	Viral DNA polymerase	Pyrophosphate analog	Second-line treatment, resistant CMV	90 mg/kg BID	90 mg/kg daily	Nephrotoxicity, electrolyte disturbances	i.v. fluids are administered to mitigate nephrotoxicity; electrolyte disturbances require close monitoring
Cidofovir	i.v.	Viral DNA polymerase	Nucleotide analog	Third-line treatment, resistant CMV	5 mg/kg weekly	5 mg/kg every other wk	Nephrotoxicity	Probenecid is administered before/after to mitigate nephrotoxicity
Experimental treatments
Maribavir (153)	p.o.	UL97 kinase	Benzimidazole riboside	Off-label, resistant CMV	400–1,200 mg BID	400–1,200 mg BID	GI symptoms, particularly dysgeusia
Letermovir	p.o., i.v.	CMV terminase	DNA terminase complex inhibitor	Off-label, resistant CMV	NRb	NRb	Peripheral edema, headache, GI symptoms
Brincidofovir (224)	p.o.	Viral DNA polymerase	Nucleotide analog	Off-label, resistant CMV	NRc	NRc	GI symptoms

^aNormal renal function.

^bNot reported; 480 mg/daily is the prophylaxis dosing. Case series have reported this dosing in off-label use.

^cNot reported; 100 to 300 mg biweekly.

^di.v., intravenous; p.o., oral; BID, twice daily; NR, not reported; GI, gastrointestinal.