Medical Editor: John P. Cunha, DO, FACOEP
Vistide (cidofovir) is an antiviral medication used to treat an eye infection called cytomegalovirus retinitis (CMV) in people who are infected with HIV (human immunodeficiency virus). Common side effects of Vistide include nausea, vomiting, diarrhea, loss of appetite, white patches or sores inside your mouth or on your lips, headache, skin rash, hair loss, or cough. When Vistide is used with probenecid side effects include:
- nausea, and
Dosing of Vistide is determined by a physician and the medication is administered under a physician's supervision. Vistide may interact with acetaminophen, acyclovir, zidovudine, bumetanide, clofibrate, famotidine, furosemide, methotrexate, theophylline, aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs), ACE inhibitors, barbiturates, diazepam or similar medicines. Tell your doctor all medications you use. During pregnancy, Vistide should be used only when prescribed. It may harm a fetus. The manufacturer recommends avoiding pregnancy. Men should use effective barrier protections (such as latex or polyurethane condoms) during all sexual activity during treatment and for at least 90 days after stopping the medication. Women should use at least 2 forms of birth control (such as birth control pills and condoms) during treatment and for at least 1 month after stopping the medication. It is unknown if this medication passes into breast milk. Because of the possible risks to the infant and because breast milk can transmit HIV, do not breast-feed.
Our Vistide (cidofovir) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any of these serious side effects:
- urinating less than usual or not at all;
- fever, chills, body aches, flu symptoms;
- any change in your vision; or
- increased thirst and urination, loss of appetite, weakness, constipation.
Less serious side effects are more likely to occur, such as:
- nausea, vomiting, diarrhea, loss of appetite;
- white patches or sores inside your mouth or on your lips;
- mild skin rash;
- hair loss; or
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Vistide (Cidofovir)
- Nephrotoxicity: Renal toxicity, as manifested by = 2+ proteinuria, serum creatinine elevations of = 0.4 mg/dL, or decreased creatinine clearance = 55 mL/min, occurred in 79 of 135 (59%) patients receiving VISTIDE at a maintenance dose of 5 mg/kg every other week. Maintenance dose reductions from 5 mg/kg to 3 mg/kg due to proteinuria or serum creatinine elevations were made in 12 of 41 (29%) patients who had not received prior therapy for CMV retinitis (Study 106) and in 19 of 74 (26%) patients who had received prior therapy for CMV retinitis (Study 107). Prior foscarnet use has been associated with an increased risk of nephrotoxicity; therefore, such patients must be monitored closely (see CONTRAINDICATIONS, WARNINGS, DOSAGE AND ADMINISTRATION).
- Neutropenia: In clinical trials, at the 5 mg/kg maintenance dose, a decrease in absolute neutrophil count to = 500 cells/mm3 occurred in 24% of patients. Granulocyte colony stimulating factor (GCSF) was used in 39% of patients.
- Decreased Intraocular Pressure/Ocular Hypotony: Among the subset of patients monitored for intraocular pressure changes, a = 50% decrease from baseline intraocular pressure was reported in 17 of 70 (24%) patients at the 5 mg/kg maintenance dose. Severe hypotony (intraocular pressure of 0-1 mm Hg) has been reported in 3 patients. Risk of ocular hypotony may be increased in patients with preexisting diabetes mellitus.
- Anterior Uveitis/Iritis: Uveitis or iritis has been reported in clinical trials and during postmarketing in patients receiving VISTIDE therapy. Uveitis or iritis was reported in 15 of 135 (11%) patients receiving 5 mg/kg maintenance dosing. Treatment with topical corticosteroids with or without topical cycloplegic agents may be considered. Patients should be monitored for signs and symptoms of uveitis/iritis during VISTIDE therapy.
- Metabolic Acidosis: A diagnosis of Fanconi's syndrome, as manifested by multiple abnormalities of proximal renal tubular function, was reported in 1% of patients. Decreases in serum bicarbonate to = 16 mEq/L occurred in 16% of cidofovir-treated patients. Cases of metabolic acidosis in association with liver dysfunction and pancreatitis resulting in death have been reported in patients receiving VISTIDE.
In clinical trials, VISTIDE was withdrawn due to adverse events in 39% of patients treated with 5 mg/kg every other week as maintenance therapy.
The incidence of adverse reactions reported as serious in three controlled clinical studies in patients with CMV retinitis, regardless of presumed relationship to drug, is listed in Table 4.
Table 4. Serious Clinical Adverse Events or Laboratory Abnormalities
Occurring in > 5% of Patients
|N = 135*
# patients (%)
|Proteinuria (≥ 100 mg/dL)||68||(50)|
|Neutropenia (≤ 500 cells/mm3)||33||(24)|
|Decreased Intraocular Pressure†||17||(24)|
|Decreased Serum Bicarbonate (≤ 16 mEq/L)||21||(16)|
|Creatinine Elevation (≥ 2.0 mg/dL)||16||(12)|
|Nausea with Vomiting||10||(7)|
|*Patients receiving 5 mg/kg maintenance regimen in Studies 105, 106 and 107.
†Defined as decreased intraocular pressure (IOP) to ≤ 50% that at baseline. Based on 70 patients receiving 5 mg/kg maintenance dosing (Studies 105, 106 and 107), for whom baseline and follow-up IOP determinations were recorded.
The most frequently reported adverse events regardless of relationship to study drugs (cidofovir or probenecid) or severity are shown in Table 5.
The following additional list of adverse events/intercurrent illnesses have been observed in clinical studies of VISTIDE and are listed below regardless of causal relationship to VISTIDE. Evaluation of these reports was difficult because of the diverse manifestations of the underlying disease and because most patients received numerous concomitant medicines.
Body As A Whole
abdominal pain, accidental injury, AIDS, allergic reaction, back pain, catheter blocked, cellulitis, chest pain, chills and fever, cryptococcosis, cyst, death, face edema, flu-like syndrome, hypothermia, injection site reaction, malaise, mucous membrane disorder, neck pain, overdose, photosensitivity reaction, sarcoma, sepsis
cardiomyopathy, cardiovascular disorder, congestive heart failure, hypertension, hypotension, migraine, pallor, peripheral vascular disorder, phlebitis, postural hypotension, shock, syncope, tachycardia, vascular disorder, edema
cholangitis, colitis, constipation, esophagitis, dyspepsia, dysphagia, fecal incontinence, flatulence, gastritis, gastrointestinal hemorrhage, gingivitis, hepatitis, hepatomegaly, hepatosplenomegaly, jaundice, abnormal liver function, liver damage, liver necrosis, melena, pancreatitis, proctitis, rectal disorder, stomatitis, aphthous stomatitis, tongue discoloration, mouth ulceration, tooth caries
adrenal cortex insufficiency
Hemic & Lymphatic System
Metabolic & Nutritional System
cachexia, dehydration, edema, hypercalcemia, hyperglycemia, hyperkalemia, hyperlipemia, hypocalcemia, hypoglycemia, hypoglycemic reaction, hypokalemia, hypomagnesemia, hyponatremia, hypophosphatemia, hypoproteinemia, increased alkaline phosphatase, increased BUN, increased lactic dehydrogenase, increased SGOT, increased SGPT, peripheral edema, respiratory alkalosis, thirst, weight loss, weight gain
abnormal dreams, abnormal gait, acute brain syndrome, agitation, amnesia, anxiety, ataxia, cerebrovascular disorder, confusion, convulsion, delirium, dementia, depression, dizziness, drug dependence, dry mouth, encephalopathy, facial paralysis, hallucinations, hemiplegia, hyperesthesia, hypertonia, hypotony, incoordination, increased libido, insomnia, myoclonus, nervousness, neuropathy, paresthesia, personality disorder, somnolence, speech disorder, tremor, twitching, vasodilatation, vertigo
Skin & Appendages
acne, angioedema, dry skin, eczema, exfoliative dermatitis, furunculosis, herpes simplex, nail disorder, pruritus, rash, seborrhea, skin discoloration, skin disorder, skin hypertrophy, skin ulcer, sweating, urticaria
abnormal vision, amblyopia, blindness, cataract, conjunctivitis, corneal lesion, corneal opacity, diplopia, dry eyes, ear disorder, ear pain, eye disorder, eye pain, hyperacusis, iritis, keratitis, miosis, otitis externa, otitis media, refraction disorder, retinal detachment, retinal disorder, taste perversion, tinnitus, uveitis, visual field defect, hearing loss
decreased creatinine clearance, dysuria, glycosuria, hematuria, kidney stone, mastitis, metorrhagia, nocturia, polyuria, prostatic disorder, toxic nephrophathy, urethritis, urinary casts, urinary incontinence, urinary retention, urinary tract infection
Table 5. All Clinical Adverse Events, Laboratory Abnormalities or
Intercurrent Illnesses Regardless of Severity Occurring in > 15% of Patients
|N = 115*
# patients (%)
|Any Adverse Event||115||(100)|
|Proteinuria (≥ 30 mg/dL)||101||(88)|
|Nausea +/- Vomiting||79||(69)|
|Neutropenia (< 750 cells/mm3)||50||(43)|
|Creatinine Elevation (> 1.5 mg/dL)||28||(24)|
|*Patients receiving 5 mg/kg maintenance regimen in Studies 106 and 107.|
Reporting Of Adverse Reactions
Malignancies or serious adverse reactions that occur in patients who have received VISTIDE should be reported to Gilead in writing to the Director of Clinical Research, Gilead Sciences, Inc., 333 Lakeside Drive, Foster City, CA 94404 or by calling 1-800-GILEAD-5 (445-3235), or to FDA MedWatch 1- 800-FDA-1088/fax 1-800-FDA-0178.
Read the entire FDA prescribing information for Vistide (Cidofovir)
© Vistide Patient Information is supplied by Cerner Multum, Inc. and Vistide Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.