Adverse Effects Contraindications and Drug Interactions

The most immediately serious adverse effect associated with cidofovir therapy is nephrotoxicity. Accumulation of the drug within the proximal tubule epithelial cells can lead to proteinuria, azotemia, glycosuria, elevated serum creatinine, and rarely, Fanconi's syndrome. Probenecid is administered along with cidofovir to block its uptake into the proximal tubule epithelial cells and thereby inhibit its tubular secretion as well as its toxicity. Probenecid carries its own adverse effects, including gastrointestinal upset, hypersensitivity reactions, and a decrease in the elimination of drugs that also undergo active tubular secretion (e.g. nonsteroidal antiinflammatory drugs [NSAIDs], penicillin, acyclovir, zidovudine).

Anterior uveitis and neutropenia are fairly common side effects of cidofovir therapy. Ocular hypotony and metabolic acidosis are rare. Exposure to therapeutic levels of cidofovir causes cancer in rats; therefore, this drug should be considered a potential human carcinogen. Animal studies have also shown cidofovir to produce embryotoxic and teratogenic effects and to impair fertility.

Because of its potential nephrotoxicity, cidofovir should not be used in individuals with renal impair-

ment. Nephrotoxic agents (e.g., aminoglycosides, NSAIDs, amphotericin B, foscarnet) should not be given within 7 days of cidofovir administration.

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