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Foscarnet Sodium

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Anaesthetics and Critical Care

Obstetrics Gynaecology

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Urology

Version Jan 2023

Prescribing and dosing only by those familiar with the drug. Generally used for induction and maintenance therapy of cytomegalovirus (CMV) retinitis in patients with AIDS.

About: Always check the BNF link here

Great care taken in those with renal failure
Antiviral medication

Mode of action

A pyrophosphate analog DNA polymerase inhibitor.

Indications/Dose

CMV retinitis in AIDS: Foscarnet intermittent infusions every 8 hours at a dose of 60 mg/kg in patients with normal renal function.
Dosage must be individualised for the patient's renal function (see dosing chart below).
Induction therapy of mucocutaneous HSV infections unresponsive to Aciclovir: Foscavir is administered for 2-3 weeks or until healing of lesions, as intermittent infusions at a dose of 40 mg/kg over one hour every 8 hours in patients with normal renal function.

Dose Range: Needs expert dosing and monitoring

Name	CMV disease	Frequency	Route
Foscarnet	60 mg/kg	8-hourly	IV infusion over at least one hour for 2-3 weeks
Foscarnet	90 mg/kg	12-hourly	IV infusion over at least one hour for 2-3 weeks
Foscarnet	60-120 mg/kg/day	Daily	IV infusion over at least one hour Maintenance
Name	Mucocutaneous HSV infection unresponsive to 10 days of IV Aciclovir in Immunocompromised patient	Frequency	Route
Foscarnet	40 mg/kg	8-hourly	IV infusion over at least one hour for 2-3 weeks

Interactions

Cautions with other nephrotoxic drugs - additive toxicity may occur when used in combination with other nephrotoxic drugs
Such as aminoglycosides, amphotericin B, Ciclosporin A, aciclovir, methotrexate and tacrolimus

Cautions

Caution: Do not administer Foscavir by rapid intravenous injection.
Renal toxicity can be reduced by adequate hydration of the patient.
It is recommended to establish diuresis by hydration with 0.5-1.0 litre of normal saline at each infusion.
In compliant patients, oral hydration with similar hydration regimens have been used.
Clinically dehydrated patients should have their condition corrected before initiating therapy.

Contraindications

Dehydration, Hypersensitivity to the active substance
Cautions in Renal failure

Side effects

Nephrotoxicity, pancytopenia, marrow depression watch FBC and symptoms
Sepsis, Diabetes Insipidus, ataxia, neuropathy

References

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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