In individuals treated with the DNA polymerase inhibitors aciclovir or ganciclovir, HSV or CMV particles can develop mutant protein kinases (thymidine kinase or UL97 protein kinase, respectively) that make them resistant to these antiviral drugs. However, unlike aciclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in aciclovir- or ganciclovir-resistant HSV and CMV infections.
However, aciclovir- or ganciclovir-resistant mutants with alterations in viral DNA polymerase may also be resistant to foscarnet.
Nephrotoxicity - Increase in serum creatinine levels occurs on average in 45% of patients receiving foscarnet. Other nephrotoxic drugs should be avoided. Nephrotoxicity is usually reversible and can be reduced by dosage adjustment and adequate hydration.
Electrolyte disturbances - Changes in calcium, magnesium (Harisson 16th ed page2244) potassium and phosphate levels occurs commonly and regular monitoring of electrolytes is necessary to avoid clinical toxicity.
Genital ulceration - Occurs more commonly in men and usually occurs during induction use of foscarnet. It is most likely a contact dermatitis due to high concentrations of foscarnet in urine. It usually resolves rapidly following discontinuation of the drug.
CNS - Paraesthesias,irritability and hallucinations
^Canestri A, Ghosn J, Wirden M et al. (2006). "Foscarnet salvage therapy for patients with late-stage HIV disease and multiple drug resistance". Antivir. Ther. (Lond.)11 (5): 561–6. PMID16964823.CS1 maint: Explicit use of et al. (link)
^Mathiesen S, Dam E, Roge B et al. (2007). "Long-term foscarnet therapy remodels thymidine analogue mutations and alters resistance to zidovudine and lamivudine in HIV-1". Antivir. Ther. (Lond.)12 (3): 335–43. PMID17591023.CS1 maint: Explicit use of et al. (link)
^Bonnafous P, Naesens L, Petrella S et al. (2007). "Different mutations in the HHV-6 DNA polymerase gene accounting for resistance to foscarnet". Antivir. Ther. (Lond.)12 (6): 877–88. PMID17926642.CS1 maint: Explicit use of et al. (link)