Foscarnet sodium


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Cytomegaloviral retinitis in AIDS patients Induction: 60 mg/kg via infusion over 1 hour, every 8 hours for 2-3 weeks. Maintenance: 60 mg/kg once daily, increase to 90-120 mg/kg once daily if tolerated. If progression occurs, re-treat patient with induction regimen. Aciclovir-resistant mucocutaneous herpes simplex virus infections in immunocompromised patients 40 mg/kg via infusion over 1 hour, every 8 hours for 2-3 weeks or until lesions heal.
Dosage Details
Intravenous
Cytomegaloviral retinitis in AIDS patients
Adult: Induction: 60 mg/kg given via infusion over 1 hour, every 8 hours for 2-3 weeks. Maintenance: 60 mg/kg once daily, increase to 90-120 mg/kg once daily if tolerated. If progression occurs, re-treat with induction regimen.

Intravenous
Aciclovir-resistant mucocutaneous herpes simplex virus infection
Adult: In immunocompromised patients: 40 mg/kg via infusion over 1 hour, every 8 hours for 2-3 weeks or until lesions heal.
Renal Impairment
Cytomegaloviral retinitis in AIDS patients
CrCl (mL/kg/min) Dosage
<0.4 Not recommended.
0.4-0.6 Induction: 21 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
0.6-0.8 Induction: 28 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
0.8-1.0 Induction: 35 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
1.0-1.2 Induction: 42 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
1.2-1.4 Induction: 49 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
1.4-1.6 Induction: 55 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.
>1.6 Induction: 60 mg/kg via infusion over 1 hour, every 8 hours. Maintenance: Same with induction dosage, to be given once daily.

Aciclovir-resistant mucocutaneous herpes simplex virus infections

CrCl (mL/kg/min) Dosage
0.4-0.6 14 mg/kg via infusion over 1 hour, every 8 hours.
0.6-0.8 19 mg/kg via infusion over 1 hour, every 8 hours.
0.8-1.0 24 mg/kg via infusion over 1 hour, every 8 hours.
1.0-1.2 28 mg/kg via infusion over 1 hour, every 8 hours.
1.2-1.4 33 mg/kg via infusion over 1 hour, every 8 hours.
1.4-1.6 37 mg/kg via infusion over 1 hour, every 8 hours.
>1.6 40 mg/kg via infusion over 1 hour, every 8 hours.
Reconstitution
Dilute with equal amount of dextrose in water 5% or NaCl 0.9% inj to provide a solution containing 12 mg/mL.
Contraindications
Lactation.
Special Precautions
Patient with electrolyte imbalance, neurologic or cardiac abnormalities, heart failure, history or risk of QT prolongation, risk factors for seizures. Renal impairment. Pregnancy.
Adverse Reactions
Significant: Electrolyte imbalance (e.g. hypokalaemia, hypocalcaemia, hypomagnesaemia, hyper/hypophosphataemia), anaemia, granulocytopaenia, QT prolongation, seizures, serious hypersensitivity reactions (e.g. anaphylactic shock, angioedema).
Blood and lymphatic system disorders: Thrombocytopenia, neutropenia, leucopenia, bone marrow suppression.
Eye disorders: Visual disturbance.
Gastrointestinal disorders: Diarrhoea, nausea, vomiting, abdominal pain.
General disorders and administration site conditions: Fever, weakness, asthenia, chills, malaise, fatigue.
Injury, poisoning and procedural complications: Injection site reactions.
Investigations: Blood creatinine increased, haemoglobin decreased, electrocardiogram abnormal, decreased creatinine clearance.
Metabolism and nutrition disorders: Decreased appetite.
Musculoskeletal and connective tissue disorders: Muscle spasm.
Nervous system disorders: Headache, dizziness, paraesthesia, hypoaesthesia, peripheral neuropathy, rigors/tremor.
Psychiatric disorders: Anxiety, depression, aggression, agitation.
Renal and urinary disorders: Nephrotoxicity.
Respiratory, thoracic and mediastinal disorders: Cough, dyspnoea.
Skin and subcutaneous tissue disorders: Rash, diaphoresis, pruritus.
Potentially Fatal: Renal impairment.
IV/Parenteral: C
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor ECG, 24-hour creatinine clearance, electrolytes at baseline and periodically thereafter. Monitor complete blood count, electrolytes (e.g. Mg, Ca, K, phosphorus) twice weekly during induction stage and once weekly during maintenance therapy. Check hydration status before administration.
Overdosage
Symptoms: Seizures, renal impairment, paraesthesias, electrolyte disturbances. Management: Haemodialysis and hydration may be of benefit.
Drug Interactions
May enhance nephrotoxic effect with aminoglycosides, amphotericin B, ciclosporin, aciclovir, methotrexate and tacrolimus. Increased risk of QT prolongation with antiarrhythmic agents (e.g. quinidine, amiodarone, sotalol).
Action
Description: Foscarnet sodium is a non-nucleoside pyrophoshate analogue which acts as a noncompetitive inihibitor of many viral RNA and DNA polymerases as well as HIV reverse transcriptase.
Pharmacokinetics:
Distribution: Volume of distribution: Approx 0.5 L/kg. Plasma protein binding: Approx 14% to 17%.
Excretion: Via urine (≤28% as unchanged drug). Elimination half-life: Approx 3 to 4 hours.
Chemical Structure

Chemical Structure Image
Foscarnet sodium

Source: National Center for Biotechnology Information. PubChem Database. Foscarnet sodium, CID=44561, https://pubchem.ncbi.nlm.nih.gov/compound/Foscarnet-sodium (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C. Do not refrigerate.
MIMS Class
ATC Classification
J05AD01 - foscarnet ; Belongs to the class of phosphonic acid derivative antivirals. Used in the systemic treatment of viral infections.
References
Anon. Foscarnet. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/05/2018.

Buckingham R (ed). Foscarnet Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/05/2018.

Foscavir Injection (Astrazeneca LP). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/05/2018.

Joint Formulary Committee. Foscarnet Sodium. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/05/2018.

Disclaimer: This information is independently developed by MIMS based on Foscarnet sodium from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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