Valganciclovir

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Valganciclovir
Valganciclovir structure.svg
Valganciclovir ball-and-stick.png
Systematic (IUPAC) name
2-[(2-amino-6-oxo-6,9-dihydro-3H-purin-9-yl)methoxy]-3-hydroxypropyl-(2S)-2-amino-3-methylbutanoate
Clinical data
Trade names Valcyte
AHFS/Drugs.com monograph
MedlinePlus a605021
Pregnancy cat.
Legal status
Routes Oral
Pharmacokinetic data
Bioavailability 60%
Protein binding 1–2%
Metabolism Hydrolysed to ganciclovir
Half-life 4 hours
Excretion Renal
Identifiers
CAS number 175865-59-5 N
ATC code J05AB14
PubChem CID 64147
DrugBank DB01610
ChemSpider 57721 YesY
UNII GCU97FKN3R YesY
ChEMBL CHEMBL1201314 N
NIAID ChemDB 032967
Chemical data
Formula C14H22N6O5 
Mol. mass 354.362 g/mol
 N (what is this?)  (verify)

Valganciclovir (Valcyte, manufactured by Hoffmann–La Roche, and also known as Cymeval, Valcyt, Valixa, Darilin, Rovalcyte, Patheon, and Syntex[1]) is an antiviral medication used to treat cytomegalovirus infections. As the L-valyl ester of ganciclovir, it is actually a prodrug for ganciclovir.[2] After oral administration, it is rapidly converted to ganciclovir by intestinal and hepatic esterases.

Administration[edit]

Orally, available in 450 mg tablets. For patients who have received a transplant, the recommended dose is 900 mg once daily, starting within 10 days of transplantation and continuing for 6 months post transplantation. HIV patients might initially need to take the dose 900 mg twice daily for the first 3 weeks.[3]

Pharmacokinetics[edit]

  1. Oral bioavailability is approximately 60%. Fatty foods significantly increase the bioavailability and the peak level in the serum.
  2. It takes about 2 hours to reach maximum concentrations in the serum.
  3. Valganciclovir is eliminated as ganciclovir in the urine, with a half-life of about 4 hours in people with normal kidney function.
  4. The mechanism of this drug is activation via a viral protein kinase HCMV UL97 and subsequent phosphorylation by cellular kinases. The phosphotransferase enzyme can likewise activate valganciclovir.

Side effects[edit]

Alternative uses[edit]

It has been proposed that valganciclovir could be used in the treatment of chronic fatigue syndrome. In an initial, open-label trial, 12 patients with elevated antibody titers to human herpesvirus 6 (HHV-6) and Epstein-Barr virus (EBV) and who had suffered with neurocognitive symptoms and debilitating fatigue consistent with chronic fatigue syndrome were administered valganciclovir for six months. "Nine out of 12 (75%) patients experienced near resolution of their symptoms, allowing them all to return to the workforce or full time activites," accompanied in the same patients by falls in antibody titers to both viruses.[4] The results of a follow-up double-blind, placebo-controlled study of 30 patients[5] were ambiguous: overall scores on the Multidimensional Fatigue Inventory (MFS-20) were nominally higher in valganciclovir-treated patients vs. placebo, but the difference was not statistically significant; moreover, there were no differences in antibody titers between the two groups. However, in a secondary analysis, differences in several specific subscales of the score were significantly different between valganciclovir treatment and placebo.[5]

Continuous treatment of cytomegalovirus infections with valganciclovir in patients with glioblastoma multiforme has shown to increase 2-year survival to 90% in a trial of 25 patients.[6]

Price and patent status[edit]

Roche's Valcyte is protected by patent. However a generic version manufactured by Japanese-owned Indian company Daiichi-Ranbaxy was found by the District Court of New Jersey, USA not to infringe Roche's patent.[7]

The price of a four-month course of valganciclovir from Roche is about US$8,500 in high-income countries, $6,000 in India. However, the valganciclovir patent was rejected by the Indian Patent Office[8] in 2010, although Roche may appeal the rejection.

References[edit]

  1. ^ Drugs.about list of names for valganciclovir
  2. ^ Sugawara M, Huang W, Fei YJ, et al. Transport of valganciclovir, a ganciclovir prodrug, via peptide transporters PEPT1 and PEPT2. J Pharm Sci. 2000;89(6):781-9.
  3. ^ electronic Medicines Compendium
  4. ^ Kogelnik AM; Loomis K; Hoegh-Petersen M; Rosso F; Hischier C; Montoya JG (Dec 2006). "Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue.". J Clin Virol 37 (Suppl 1): S33–8. doi:10.1016/S1386-6532(06)70009-9. PMID 17276366. 
  5. ^ a b Montoya JG; Kogelnik AM; Bhangoo M; Lunn MR; Flamand L; Merrihew LE; Watt T; Kubo JT; Paik J; Desai M (Dec 2013). "Randomized clinical trial to evaluate the efficacy and safety of valganciclovir in a subset of patients with chronic fatigue syndrome". J Med Virol 85 (12): 2101–9. doi:10.1002/jmv.23713. PMID 23959519. 
  6. ^ Survival in Patients with Glioblastoma Receiving Valganciclovir
  7. ^ US Court rules Ranbaxy's generic valganciclovir does not infringe Roche's Valcyte patent
  8. ^ Valganciclovir rejected by the Indian Patent Office
  • Kogelnik AM et al. Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue. J Clin Virol. 2006;37(S1):S33-S38.
  • Paltiel AD et al. Preevaluation of clinical trial data: the case of preemptive cytomegalovirus therapy in patients with human immunodeficiency virus. Clin Infect Dis. 2001;32(5):783-93.
  • Pescovitz MD et al. Valganciclovir results in improved oral absorption of ganciclovir in liver transplant recipients. Antimicrob Agents Chemother. 2000;44(10):2811-5.
  • Reusser P. Antiviral therapy: current options and challenges. Schweiz Med Wochenschr. 2000;130(4):101-12.