Recommended Topic Related To:

Valcyte

"Current prevention strategies have reduced the incidence of HIV worldwide, but that decline has slowed in recent years. We need new prevention strategies if we are to realize President Obama's goal of an AIDS-free generation. Targeting people who"...

Valcyte

Side Effects
Interactions

SIDE EFFECTS

The following serious adverse events are discussed in greater detail in other sections of the labeling:

The most common adverse events and laboratory abnormalities reported in at least one indication by ≥ 20% of adult patients treated with Valcyte tablets are diarrhea, pyrexia, nausea, tremor, neutropenia, anemia, graft rejection, thrombocytopenia, and vomiting. The most common reported adverse events and laboratory abnormalities reported in > 10% of pediatric solid organ transplant recipients treated with Valcyte for oral solution or tablets are diarrhea, pyrexia, hypertension, upper respiratory tract infection, vomiting, anemia, neutropenia, constipation, nausea, and cough.

Clinical Trial Experience in Adult Patients

Valganciclovir, a prodrug of ganciclovir, is rapidly converted to ganciclovir after oral administration. Adverse events known to be associated with ganciclovir usage can therefore be expected to occur with Valcyte.

Because clinical trials are conducted under widely varying conditions, adverse event rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect rates observed in practice.

Treatment of CMV Retinitis in AIDS Patients

In a clinical study for the treatment of CMV retinitis in HIV-infected patients, the adverse events reported by patients receiving Valcyte tablets (n=79) or intravenous ganciclovir (n=79) for 28 days of randomized therapy (21 days induction dose and 7 days maintenance dose), respectively, included diarrhea (16%, 10%), nausea (8%, 14%), headache (9%, 5%), and catheter-related infections (3%, 11%). The incidence of adverse events was similar between the group who received Valcyte tablets and the group who received intravenous ganciclovir, with the exception of catheter-related infections, which occurred with greater frequency in patients randomized to receive intravenous ganciclovir. The frequencies of neutropenia (ANC < 500/μL) were 11% for patients receiving Valcyte tablets compared with 13% for patients receiving intravenous ganciclovir. Anemia (Hgb < 8 g/dL) occurred in 8% of patients in each group. Other laboratory abnormalities occurred with similar frequencies in the two groups.

Adverse events and abnormal laboratory values data are available for 370 patients who received maintenance therapy with Valcyte tablets 900 mg once daily in two open-label clinical trials. Approximately 252 (68%) of these patients received Valcyte tablets for more than nine months (maximum duration was 36 months). Table 2 and Table 3 show the pooled adverse event data and abnormal laboratory values from these patients.

Table 2 : Pooled Selected Adverse Events Reported in ≥ 5% of Patients who Received Valcyte Tablets Maintenance Therapy for CMV Retinitis

Adverse Events According to Body System Patients with CMV Retinitis
Valcyte Tablets
(N=370)
%
Gastrointestinal system
  Diarrhea 41
  Nausea 30
  Vomiting 21
  Abdominal pain 15
Body as a whole
  Pyrexia 31
  Headache 22
Central and peripheral nervous system
  Insomnia 16
  Peripheral neuropathy 9
  Paresthesia 8
  Special senses Retinal detachment 15

Table 3 : Pooled Laboratory Abnormalities Reported in Patients Who Received Valcyte Tablets Maintenance Therapy for the Treatment of CMV Retinitis

Laboratory Abnormalities Patients with CMV Retinitis
Valcyte Tablets
(N=370)
%
Neutropenia: ANC/μL
   < 500 19
  500 - < 750 17
  750 - < 1000 17
Anemia: Hemoglobin g/dL
   < 6.5 7
  6.5 - < 8.0 13
  8.0 - < 9.5 16
Thrombocytopenia: Platelets/μL
   < 25000 4
  25000 - < 50000 6
  50000 - < 100000 22
Serum Creatinine: mg/dL
   > 2.5 3
   > 1.5 - 2.5 12

Prevention of CMV Disease in Selected Solid Organ Transplantation

Table 4 shows selected adverse events regardless of severity and drug relationship with an incidence of ≥ 5% from a clinical trial (up to 28 days after study treatment) where heart, kidney, kidney-pancreas and liver transplant patients received Valcyte tablets (N=244) or oral ganciclovir (N=126) until Day 100 post-transplant. The majority of the adverse events were of mild or moderate intensity.

Table 4 : Percentage of Selected Grades 1-4 Adverse Events Reported in ≥ 5% of Patients From a Study of Selected Solid Organ Transplant Patients

Adverse Event Valcyte Tablets
(N=244)
%
Oral Ganciclovir
(N=126)
%
Diarrhea 30 29
Tremors 28 25
Graft rejection 24 30
Nausea 23 23
Headache 22 27
Insomnia 20 16
Hypertension 18 15
Vomiting 16 14
Pyrexia 13 14

The overall safety profile of Valcyte did not change with the extension of prophylaxis until Day 200 post-transplant in high risk kidney transplant patients (see Table 5).

Table 5 : Percentage of Selected Grades 1-4 Adverse Events Reported in ≥ 5% of Patients from a Study of Kidney Transplant Patients

Adverse Event Valcyte Tablets Day 100 Post-transplant
(N=164)
%
Valcyte Tablets Day 200 Post-transplant
(N=156)
%
Diarrhea 26 31
Tremors 12 17
Hypertension 13 12
Nausea 11 11
Pyrexia 12 9
Transplant rejection 9 6
Headache 10 6
Insomnia 7 6
Vomiting 3 6

Adverse events not included in Table 4 and Table 5, which either occurred at a frequency of ≥ 5% in clinical studies with solid organ transplant patients, or were selected serious adverse events reported in studies with patients with CMV retinitis or in studies with solid organ transplant patients with a frequency of < 5% are listed below.

Allergic reactions: valganciclovir hypersensitivity

Bleeding complications: potentially life-threatening bleeding associated with thrombocytopenia

Central and peripheral nervous system: paresthesia, dizziness (excluding vertigo), convulsion

Gastrointestinal disorders: abdominal pain, constipation, dyspepsia, abdominal distention, ascites

General disorders and administration site disorders: fatigue, pain, edema, peripheral edema, weakness

Hemic system: anemia, neutropenia, thrombocytopenia, pancytopenia, bone marrow depression, aplastic anemia

Hepatobiliary disorders: abnormal hepatic function

Infections and infestations: pharyngitis/nasopharyngitis, upper respiratory tract infection, urinary tract infection, local and systemic infections and sepsis, postoperative wound infection

Injury, poisoning, and procedural complications: postoperative complications, postoperative pain, increased wound drainage, wound dehiscence

Metabolism and nutrition disorders: hyperkalemia, hypokalemia, hypomagnesemia, hyperglycemia, appetite decreased, dehydration, hypophosphatemia, hypocalcemia

Musculoskeletal and connective tissue disorders: back pain, arthralgia, muscle cramps, limb pain

Psychiatric disorders: depression, psychosis, hallucinations, confusion, agitation

Renal and urinary disorders: renal impairment, dysuria, decreased creatinine clearance

Respiratory, thoracic and mediastinal disorders: cough, dyspnea, rhinorrhea, pleural effusion

Skin and subcutaneous tissue disorders: dermatitis, pruritus, acne

Vascular disorders: hypotension

Laboratory abnormalities reported with Valcyte tablets in two studies in solid organ transplant patients are listed in Table 6 and Table 7.

Table 6 : Laboratory Abnormalities Reported in a Study of Selected Solid Organ Transplant Patients*

Laboratory Abnormalities Valcyte Tablets
(N=244)
%
Ganciclovir Capsules
(N=126)
%
Neutropenia: ANC/μL
   < 500 5 3
  500 - < 750 3 2
  750 - < 1000 5 2
Anemia: Hemoglobin g/dL
   < 6.5 1 2
  6.5 - < 8.0 5 7
  8.0 - < 9.5 31 25
Thrombocytopenia: Platelets/μL
   < 25000 0 2
  25000 - < 50000 1 3
  50000 - < 100000 18 21
Serum Creatinine: mg/dL
   > 2.5 14 21
   > 1.5 - 2.5 45 47
*Laboratory abnormalities are those reported by investigators.

Table 7 : Laboratory Abnormalities Reported in a Study of Kidney Transplant Patients*

Laboratory Abnormalities Valcyte Tablets Day 100 Post-transplant
(N=164)
%
Valcyte Tablets Day 200 Post-transplant
(N=156)
%
Neutropenia: ANC/μL
   < 500 9 10
  500 - < 750 6 6
  750 - < 1000 7 5
Anemia: Hemoglobin g/dL
   < 6.5 0 1
  6.5 - < 8.0 5 1
  8.0 - < 9.5 17 15
Thromb ocytop enia: Platelets/μL
   < 25000 0 0
  25000 - < 50000 1 0
  50000 - < 100000 7 3
Serum Creatinine: mg/dL
   > 2.5 17 14
   > 1.5 - 2.5 50 48
*Laboratory abnormalities are those reported by investigators.

Clinical Trial Experience in Pediatric Patients

Valcyte for oral solution and tablets have been studied in 109 pediatric solid organ transplant patients who were at risk for developing CMV disease (aged 4 months to 16 years) and in 24 neonates with symptomatic congenital CMV disease (aged 8 to 34 days), with duration of ganciclovir exposure ranging from 2 to 100 days. The overall safety profile was similar in pediatric patients as compared to adult patients. However, the rates of certain adverse events and laboratory abnormalities, such as upper respiratory tract infection, pyrexia, nasopharyngitis, anemia, and neutropenia, were reported more frequently in pediatric patients than in adults [see Use in Specific Populations, Clinical Studies].

Postmarketing Experience

In general, the adverse events reported during the postmarketing use of Valcyte were similar to those identified during the clinical trials and to those reported during the postmarketing use of ganciclovir. Please also refer to the intravenous ganciclovir product information and ganciclovir capsule product information for more information on postmarketing adverse events associated with ganciclovir.

Read the Valcyte (valganciclovir hcl) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

In vivo drug-drug interaction studies were not conducted with valganciclovir. However, because valganciclovir is rapidly and extensively converted to ganciclovir, drug-drug interactions associated with ganciclovir will be expected for Valcyte. Established and other potentially significant drug interactions conducted with ganciclovir are listed in Table 8.

Table 8 : Established and Other Potentially Significant Drug Interactions With Ganciclovir

Name of the Concomitant Drug Change in the Concentration of Ganciclovir or Concomitant Drug Clinical Comment
Zidovudine ↓ Ganciclovir
↑ Zidovudine
Zidovudine and Valcyte each have the potential to cause neutropenia and anemia
Probenecid ↑Ganciclovir Patients taking probenecid and Valcyte should be monitored for evidence of ganciclovir toxicity
Mycophenolate Mofetil (MMF) ↔ Ganciclovir (in patients with normal renal function)
↔ MMF (in patients with normal renal function)
Patients with renal impairment should be monitored carefully as levels of MMF metabolites and ganciclovir may increase
Didanosine ↓ Ganciclovir
↑Didanosine
Patients should be closely monitored for didanosine toxicity

Read the Valcyte Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 4/15/2013
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
Interactions
A A A

Valcyte - User Reviews

Valcyte User Reviews

Now you can gain knowledge and insight about a drug treatment with Patient Discussions.

Here is a collection of user reviews for the medication Valcyte sorted by most helpful. Patient Discussions FAQs

Report Problems to the Food and Drug Administration

 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


WebMD Daily

Get breaking medical news.