DRUG	SUPPLIED	DOSE	COMMENTS
VALGANCICLOVIR (Paeds) (Valcyte) Mechanism of action: Antiviral pro-drug, converted to ganciclovir in the body. Ref: 6, 9, 44, 100, 137 Last update: 2022-09-13	tablet: 450 mg solution: 50 mg/mL	Organ transplant recipients aged 4 months to 16 yrs: CMV PROPHYLAXIS: Dose (mg) = 7 x BSA x CrCl to a maximum dose of 900 mg per day, where: BSA = body surface area (m2 ; see m2 calculation inside front cover of hard copy) and CrCl is calculated as per the new modified Schwartz equation: CrCL (mL/min/1.73 m2 ) = [0.413 x height (cm) x 88.4]/[serum creatinine (umol/L)]. Use a maximum of 120 mL/min/1.73 2 m2 in the dosing calculation, if calculated CrCl exceeds this. CMV TREATMENT: Same dose as for prophylaxis, given BID Organ transplant recipients >16 yrs: CMV PROPHYLAXIS: 900 mg PO once daily CMV TREATMENT: (in children with mild or asymptomatic CMV infection): 900 mg PO BID CONGENITAL CMV Infection in INFANTS: 16 mg/kg/dose BID, adjusted for renal function. For renal impairment (adolescents > 16 yrs, adults): CrCl 40-59 mL/min/1.73m2  : 450 mg PO once daily. CrCl 25-39 mL/min/1.73m2  : 450 mg PO every second day CrCl 10-24 mL/min/1.73m2 : 450 mg PO twice weekly CrCl < 10 mL/min/1.73m2 or hemodialysis or CVVH: not recommended, refer to ganciclovir dosing.	Valganciclovir is rapidly converted to ganciclovir in the body. Hazardous drug: (medium level) valganciclovir is a potential teratogen and carcinogen; use chemotherapy precautions when handling and disposing. See "CMV prophylaxis and treatment regimens" in the BC Transplant guidelines (available online at: www.transplant.bc.ca) Monitor: CBC with differential, ALT and creatinine. Oral solution contains sodium benzoate, a metabolite of benzyl alcohol which may be toxic in neonates. Give with food (enhances absorption). Consult Infectious Diseases for questions. Standard Prescription: valganciclovir__mg PO Q__H