Valganciclovir and ganciclovir

Valganciclovir is also known as Valcyte®. Ganciclovir is also known as Cytovene®.

What are valganciclovir and ganciclovir?

What valganciclovir looks like

Valganciclovir can come in a tablet or a liquid. Here is a photo of one brand of valganciclovir.

Note: This photo is a close-up of the medication; it is not to scale.

What ganciclovir looks like

Ganciclovir is a liquid that is prepared by the hospital pharmacy in a syringe. It will be prepared in an intravenous (IV) bag when you are at home.

How to take valganciclovir

• Wash your hands before and after handling valganciclovir.
• Take it once a day, at the same time, to prevent CMV and EBV infection.
• Take it twice a day (12 hours apart) to treat CMV and EBV infection.
• Take it with plenty of fluids.
• Take it with food to make sure as much as possible passes from your stomach into your blood. It is a good idea to take it with your largest meal of the day.

Taking valganciclovir tablets

• Swallow the tablet whole. Do not cut or crush it.

Taking valganciclovir solution (liquid)

• Shake the bottle well before measuring each dose.
• Measure your dose in the special syringe provided.
• Rinse the syringe with warm soapy water, then with plain warm water.
• Let the syringe air dry.
• Wash away any liquid left on your hands right after you take your dose.

The pharmacy team adds water to valganciclovir powder to make the liquid. If you finish your bottle, call the pharmacy to get another bottle made. Never add water to valganciclovir powder at home.

How to take ganciclovir

A nurse will give you ganciclovir through a vein in your arm each day. It will be given every 12 hours for the first two weeks after your transplant. It will then be given once a day for another 10 weeks to have the best chance of preventing CMV or EBV.

If you later have an infection with either CMV or EBV, the ganciclovir will be re-started.

What to do if you miss a dose of valganciclovir

• Take the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Take the next dose at the regular time.
• Never take two doses to make up for the missed dose.
• Call your transplant team if you have missed more than one dose of valganciclovir or if you have trouble remembering to take it.

What to do if you miss a dose of ganciclovir

• The home care nurse arranges your dose of ganciclovir. The nurse will contact you or your family if there are any delays in giving it. Call your transplant team if you have missed more than one dose.

What to do if you vomit a dose of valganciclovir

When you take a dose of medicine, it usually passes from your stomach into your blood within an hour. The transplant pharmacist will talk with you about this after your transplant.

• If you throw up more than an hour after taking valganciclovir: there is no need to repeat the dose.
• If you throw up less than an hour after taking valganciclovir: ask your transplant team if you need to repeat a dose. We will decide based on what is going on with you at the time (for example if you are sick).
• If you repeat a valganciclovir dose, and you throw it up too, do not repeat it again.

Keep track of any vomited or repeated doses and talk to your transplant team or family doctor if you are vomiting a lot. Use this chart to help you decide when to call for advice.

You may not feel like eating or drinking when you are vomiting (even if it does not happen around your medicine times). But you could become dehydrated if you do not drink. If you do not eat, your body will not absorb as much valganciclovir as it should.

What to do if you vomit while taking ganciclovir

Ganciclovir is given into your vein, so it travels directly in the blood. It is not affected by vomiting.​

What to do if you have diarrhea (watery stools)

Diarrhea (watery stools) can reduce the amount of valganciclovir that passes from your stomach into your blood. Frequent diarrhea can also cause you to become dehydrated.

Diarrhea will not affect ganciclovir since it is given into your vein and travels directly to your blood.

This chart will help you decide if you need to contact your transplant team for help with managing diarrhea.

Possible side effects of valganciclovir and ganciclovir

• Nausea (upset stomach)
• Vomiting (throwing up)
• Diarrhea (watery stools)
• Mild headache
• Greater risk of infections – valganciclovir and ganciclovir lower your white blood cell count (white blood cells help fight infection)
• Tiredness or fatigue – valganciclovir and ganciclovir can lower your red blood cell (hemoglobin) count (hemoglobin provides energy to the body)
• Heavier or longer bleeding from any cuts – valganciclovir and ganciclovir can lower your platelet count (platelets help stop bleeding)
• Higher levels of creatinine (a substance eliminated by the kidneys) and possible kidney damage

Taking valganciclovir or ganciclovir with food and other medicines

Some medicines may change the way valganciclovir or ganciclovir works in your body. Always call your transplant team before using any new medicines, whether:

• your doctor prescribes them
• you buy them over-the-counter​ at a drug store
• they are herbal or natural medicines.

Remember, your body will not absorb valganciclovir well when there is no food in your stomach! This is why you should take it with your largest meal each day.

How to store valganciclovir

• Keep valganciclovir out of reach of any small children.
• Store it away from direct sunlight. See the instructions for tablets and liquid below.
• Never store valganciclovir in the bathroom or near heat sources in the kitchen.

Valganciclovir tablets

• Keep valganciclovir tablets at room temperature in a cool dry place.

Valganciclovir liquid

• Keep valganciclovir liquid in the refrigerator.
• It is stable for 49 days (seven weeks) once it is mixed with water. The pharmacist will put an expiry label on the bottle to help you remember when it is no longer safe to take it.

How to store ganciclovir

• The pharmacy that prepares and delivers your ganciclovir will give you instructions on how to store it. Follow these instructions. You will be told to store it:
• at room temperature in a cool, dry place away from sunlight
or
• in the refrigerator.

Taking valganciclovir or ganciclovir safely

Valganciclovir is converted to a substance called ganciclovir in your body. The ganciclovir comes out of your body in your urine (pee).

It is important for your family to be careful if they ever come in contact with your urine. Do the following to reduce the risk of contact.

• Clean any urine droplets off the seat right away.
• Close the toilet seat before flushing.
• If a toilet does not have a seat (for example in the hospital), ask the nurse for a blue cover and place it across the toilet before you flush it. This will stop any urine particles from splashing into the air.
• If you have soiled any clothes or bed sheets with your urine, make sure they are washed separately from your family’s laundry.

How the transplant team checks how well valganciclovir or ganciclovir is working

The transplant team does regular blood work to check for any signs of CMV, EBV or other infections.

Other important tips

• Keep a list of all of your medicines in your wallet or purse so that you can show it to doctors, nurses and pharmacists when needed.
• Make sure that your family doctor and dentist know that you are taking valganciclovir or ganciclovir before you have any treatments.

​​​If you are sexually active

• Be aware that valganciclovir or ganciclovir can cause birth defects if it is taken by either partner at the time of conception or during pregnancy.
• Always use a condom, not only to prevent pregnancy but also to prevent sexually transmitted infections.
• Use a condom or other birth control for 90 days (three months) after either partner stops taking valganciclovir or ganciclovir.

If there comes a time when you want to have a child, you can talk to your transplant team. Changes to your medications may be possible to ensure a safe pregnancy for you and your partner.

What to do if someone else takes your valganciclovir or ganciclovir

Call your local poison information centre.

If you live in Ontario, call the Ontario Poison Centre at one of these numbers. The calls are free.

• Call 416-813-5900 if you live in Toronto.
• Call 1-800-268-9017 if you live somewhere else in Ontario.