valganciclovir and Hypertension

To report the use of topical valganciclovir for the treatment of hypertensive anterior uveitis associated with clinical signs of cytomegalovirus (CMV) iritis.. A case report and review of the literature.. A 37-year-old man was referred with a unilateral hypertensive anterior uveitis with keratic precipitates suggestive of CMV as the causative agent. After institution of oral valganciclovir and topical corticosteroids, the patient's ocular inflammation resolved and intraocular pressure normalized. Therapy was eventually changed from oral valganciclovir to ophthalmic 1% valganciclovir ointment, which was able to effectively control ocular inflammation and allow the patient to discontinue topical corticosteroids and antihypertensive medications. Topical application of valganciclovir did not result in clinically evident ocular surface toxicity.. 1% valganciclovir ointment may prove to be an effective treatment of hypertensive anterior uveitis associated with clinical signs of CMV iritis.

Topics: Administration, Topical; Adult; Antiviral Agents; Aqueous Humor; Cytomegalovirus Infections; Eye Infections, Viral; Ganciclovir; Humans; Hypertension; Intraocular Pressure; Iritis; Male; Ophthalmic Solutions; Polymerase Chain Reaction; Valganciclovir

As a result of the low oral bioavailability of ganciclovir, a prodrug was developed to improve the bioavailability of ganciclovir. This study was designed to investigate the fasting, single-dose pharmacokinetics as well as the absolute and relative bioavailability of a valine ester prodrug of ganciclovir, valganciclovir, as compared to oral and intravenous ganciclovir in asymptomatic HIV+ and CMV+ subjects. In this open-label, randomized, three-period crossover study, 18 subjects received, in random order, single oral doses of valganciclovir 360 mg and ganciclovir 1000 mg and an intravenous infusion of ganciclovir 5 mg/kg over 1 hour. Valganciclovir was rapidly and extensively hydrolyzed to ganciclovir, resulting in significantly greater bioavailability compared to 1000 mg oral ganciclovir (60.9% vs. 5.6%, respectively). Higher peak serum concentrations were reached earlier following valganciclovir (ganciclovir [2.98 +/- 0.77 micrograms/mL at 1.0 +/- 0.3 h]) than following oral ganciclovir (0.47 +/- 0.17 microgram/mL and 2.2 +/- 1.0 h). Mean total ganciclovir AUCs following oral ganciclovir (1000 mg) and 360 mg valganciclovir (3.8 +/- 1.2 and 10.8 +/- 1.9 micrograms-h/mL) were less than that following a standard 5 mg/kg intravenous infusion of ganciclovir (25.1 +/- 3.8 micrograms-h/mL). In summary, valganciclovir is a prodrug with a favorable safety profile with enhanced bioavailability and significantly higher serum concentrations of ganciclovir than following oral administration of ganciclovir itself.

Topics: Adult; Anti-HIV Agents; Antiviral Agents; Area Under Curve; Biological Availability; Cross-Over Studies; Cytomegalovirus Infections; Diarrhea; Dizziness; Dyspnea; Exanthema; Female; Fever; Ganciclovir; Headache; HIV Seropositivity; Humans; Hypertension; Male; Metabolic Clearance Rate; Middle Aged; Pain; Prodrugs; Syncope; Valganciclovir