Introduction

Antiviral; purine nucleoside analog of guanine.

Uses for Ganciclovir

Herpetic Keratitis

Topical treatment of acute herpetic keratitis in patients with dendritic ulcers; designated an orphan drug by FDA for treatment of acute herpetic keratitis (dendritic and geographic^{† [off-label]} ulcers).

Herpetic keratitis usually caused by herpes simplex virus (HSV) type 1 (HSV-1), but can be caused by HSV type 2 (HSV-2).

Ganciclovir Dosage and Administration

Administration

Ophthalmic Administration

Apply 0.15% ophthalmic gel topically to the eye.

To avoid contaminating the ophthalmic gel, do not allow tip of dispensing dropper to touch any surface.

Dosage

Pediatric Patients

Herpetic Keratitis

Ophthalmic

Children ≥2 years of age with dendritic ulcers: Instill 1 drop of 0.15% ophthalmic gel into affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals. Then, instill 1 drop 3 times daily for 7 additional days.

Children ≥2 years of age with geographic ulcers^{† [off-label]}: Some experts state use same dosage recommended for dendritic ulcers.

Adults

Herpetic Keratitis

Ophthalmic

Dendritic ulcers: Instill 1 drop of 0.15% ophthalmic gel into affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals. Then, instill 1 drop 3 times daily for 7 additional days.

Geographic ulcers^{† [off-label]}: Some experts state use same dosage recommended for dendritic ulcers.

Special Populations

No special population dosage recommendations.

Contraindications

• Manufacturer states none.

Warnings/Precautions

Administration Precautions

For topical ophthalmic use only.

Do not wear contact lenses during topical treatment with ganciclovir gel or if any signs or symptoms of herpetic keratitis are present.

Specific Populations

Pregnancy

Category C.

Use only if potential benefits to the woman justify risks to the fetus.

No adequate, well-controlled studies in pregnant women; IV ganciclovir associated with embryotoxicity, teratogenicity, and/or maternal toxicity in animal studies.

Lactation

Not known whether distributed into milk after topical application to the eye.

Use with caution in nursing women.

Pediatric Use

Safety and efficacy not established in children <2 years of age.

Geriatric Use

No overall differences in safety or efficacy observed between geriatric and younger patients.

Common Adverse Effects

Blurred vision, eye irritation, punctate keratitis, conjunctival hyperemia.

Administration

Ophthalmic Administration

Apply 0.15% ophthalmic gel topically to the eye.

To avoid contaminating the ophthalmic gel, do not allow tip of dispensing dropper to touch any surface.

Dosage

Pediatric Patients

Herpetic Keratitis

Ophthalmic

Children ≥2 years of age with dendritic ulcers: Instill 1 drop of 0.15% ophthalmic gel into affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals. Then, instill 1 drop 3 times daily for 7 additional days.

Children ≥2 years of age with geographic ulcers^{† [off-label]}: Some experts state use same dosage recommended for dendritic ulcers.

Adults

Herpetic Keratitis

Ophthalmic

Dendritic ulcers: Instill 1 drop of 0.15% ophthalmic gel into affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals. Then, instill 1 drop 3 times daily for 7 additional days.

Geographic ulcers^{† [off-label]}: Some experts state use same dosage recommended for dendritic ulcers.

Special Populations

No special population dosage recommendations.