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Downloaded from https://aidsinfo.nih.gov/guidelines on 5/22/2018
Guidelines for the Prevention and Treatment of OpportunisticInfections Among HIV-Exposed and HIV-Infected Children
Downloaded from https://aidsinfo.nih.gov/guidelines on 5/22/2018
Visit the AIDSinfo website to access the most up-to-date guideline.
Register for e-mail notification of guideline updates at https://aidsinfo.nih.gov/e-news.
Downloaded from https://aidsinfo.nih.gov/guidelines on 5/22/2018
Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-1
Table 4. Common Drugs Used for Treatment of Opportunistic Infections inHIV-Infected Children: Preparations and Major Toxicities (Last updatedNovember 6, 2013; last reviewed November 6, 2013) (page 1 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need for MedicalAttention
Indicating Need forMedical Attention if
Persistent or Bothersome
Acyclovir(Zovirax)
OralSuspension: • 40 mg/mL
Capsules: • 200 mg
Tablets: • 400 mg• 800 mg
IV
More Frequent: • Phlebitis (at injection sitewhen given IV)
Less Frequent:• Acute renal failure (parenteraluse, more common with rapidinfusion)
RareParenteral Form Only:• Encephalopathy• Hematologic toxicity(leukopenia, neutropenia,thrombocytopenia, anemia,hemolysis)
Requires dose adjustment inpatients with renalimpairment.
Avoid other nephrotoxicdrugs.
Administer IV preparation byslow IV infusion over at least1 hour at a final concentrationnot to exceed 7 mg/mL. Thisis to avoid renal tubulardamage related to crystalluria;must be accompanied byadequate hydration.
Albendazole(Albenza)
Tablets:• 200 mg
More Frequent:• Abnormal liver function tests(LFTs)
Less Frequent:• Hypersensitivity (rash,pruritus)
• Neutropenia (with high doses)
Rare: • Pancytopenia
Less frequent:• CNS effects (dizziness,headache)
• GI disturbances (abdominalpain, diarrhea, nausea,vomiting)
Rare:• Alopecia
Should be given with food.
May crush or chew tabletsand give with water.
Monitor CBC and LFTs prior toeach cycle.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-2
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 2 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Amikacin IV More Frequent: • Nephrotoxicity• Neurotoxicity (includingmuscle twitching, seizures)
• Ototoxicity, both auditoryand vestibular
Less Frequent:• Hypersensitivity (skin rash,redness, or swelling)
Rare:• Neuromuscular blockade
N/A Must be infused over 30 to 60minutes to avoidneuromuscular blockade.
Requires dose adjustment inpatients with impaired renalfunction.
Should monitor renal functionand hearing periodically (e.g.,monthly) in children onprolonged therapy.
Therapeutic drug monitoring(TDM). indicated
Amphotericin BDeoxycholate(Fungizone)
IV More Frequent: • Infusion-related reactions(fever/chills;nausea/vomiting;hypotension; anaphylaxis)
• Anemia • Hypokalemia• Renal function impairment• Thrombophlebitis (atinjection site)
Less Frequent or Rare:• Blurred or double vision• Cardiac arrhythmias, usuallywith rapid infusions
• GI disturbance (nausea,vomiting, diarrhea,abdominal pain)
• Headache
Monitor BUN, Cr, CBC,electrolytes, LFTs.
Infuse over 1 to 2 hours; inpatients with azotemia,hyperkalemia, or gettingdoses >1 mg/kg, infuse over 3to 6 hours.
Requires dose reduction inpatients with impaired renalfunction.
Avoid other nephrotoxicdrugs, when possible,becausenephrotoxicity is exacerbatedwith concomitant use of othernephrotoxic drugs; permanentnephrotoxicity is related tocumulative dose.
Nephrotoxicity may beameliorated by hydration with0.9% saline IV over 30minutes prior to theamphotericin B infusion.
Infusion-related reactions lessfrequent in children thanadults; the onset is usually 1to 3 hours after infusion,duration <1 hour; frequencydecreases over time.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-3
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 3 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Amphotericin BLipid Complex(Abelcet)
IV More Frequent: • Infusion-related reactions(fever/chills, nausea/vomiting; headache, nauseaand vomiting)
Less Frequent:• Anemia • Leukopenia• Respiratory distress• Thrombocytopenia• Renal function impairment
• GI disturbance (loss ofappetite, nausea, vomiting,diarrhea, abdominal pain)
Monitor BUN, Cr, CBC,electrolytes, and LFTs.
Infuse diluted solution at rateof 2.5 mg/kg/hour.
In-line filters should not beused.
Use with caution with otherdrugs that are bone marrowsuppressants or that arenephrotoxic; renal toxicity isdose-dependent, but lessrenal toxicity than seen withconventional amphotericin B.
Consider dose reduction inpatients with impaired renalfunction.
Amphotericin BLiposome(AmBisome)
IV More Frequent: • Fever, chills• Hypokalemia
Less Frequent:• Back pain• Chest pain• Dark urine• Dyspnea• Infusion-related reaction(fever/chills, headache)
• Jaundice• Renal function impairment
Rare:• Anaphylactic reaction
• GI disturbance (nausea,vomiting, diarrhea,abdominal pain)
• Headache• Skin rash
Monitor BUN, Cr, CBC,electrolytes, and LFTs.
Infuse over 2 hours.
Consider dose reduction inpatients with impaired renalfunction.
Artesunate IV:• Only availablefrom CDCMalaria Hotline;telephone:(770) 488-7788
IV infusion over 1 hour innormal saline (do not usediluents containing dextrose)
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-5
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 5 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need for MedicalAttention
Indicating Need for MedicalAttention if Persistent or
Bothersome
ChloroquinePhosphate(Aralen)
Tablets:• 500 mg• 250 mg
More Frequent: • Pruritus: Common inindividuals of black race(25%–33%)
Less Frequent, but MoreSevere:• Auditory toxicity• Ocular toxicity• Neuropsychiatric disorders• QT prolongation• Hepatitis• Bone marrow suppression• Peripheral neuropathy
• Psoriasis exacerbations• GI disturbances (nausea,vomiting, diarrhea)
• Visual disturbancesincluding photosensitivity
• Tinnitus• Muscle weakness
Store in child-proof containersand protect from light.
Can be toxic in overdose.
Bitter tasting, so consideradministering with foods thatcan mask the taste.
Solution available worldwide, butnot in United States.
Caution in patients with G6PDdeficiency or seizure disorder.
Monitor CBC; periodic neurologicand ophthalmologic exams inpatients on prolonged therapy.
Cidofovir(Vistide)
IV More Frequent:• Nephrotoxicity• Neutropenia
Less Frequent:• Fever and allergic reactions
Rare:• Vision changes due toocular hypotony
• Metabolic acidosis
• GI disturbances (anorexia,diarrhea, nausea, vomiting)
• Headache• Asthenia• Proteinuria
Infuse over 1 hour.
Should not be used in patientswith severe renal impairment.
Nephrotoxicity risk is decreasedwith pre-hydration with IV normalsaline and probenecid with eachinfusion. Probenecid isadministered prior to each doseand repeated for two additionaldoses after infusion. Additionalhydration after infusion isrecommended if tolerated.
Concurrent use of other nephro-toxic drugs should be avoided.
Monitor renal function, urinalysis,electrolytes, and CBC and performophthalmologic exams.
Administer oral formulations atleast 2 hours before, or 6 hoursafter, sucralfate or antacids orother products containingcalcium, zinc, or iron (includingdaily products or calcium-fortified juices). Take with fullglass of water to avoidcrystalluria.
Possible phototoxicity reactionswith sun exposure.
IV infusions should be over 1hour.
Do not split, crush, or chewextended-release tablets.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-6
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 6 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
ErythromycinEthyl SuccinateSuspension:• 200 mg• 400 mg/5 mL
Oral Drops: • 100 mg/2.5 mL
ChewableTablet:• 200 mg
Tablet:• 400 mg
ErythromycinEstolateSuspension: • 125 mg• 250 mg/5 mL
ErythromycinStearateTablet: • 250 mg• 500 mg
ErythromycinGluceptate:• IV
ErythromycinLactobionate:• IV
Less Frequent:• Estolate may causecholestatic jaundice,although hepatotoxicity isuncommon (2% of reportedcases).
Rare:• QT prolongation• Hypersensitivity reactions(rash, exfoliative skindisorders including SJS)
• GI disturbances (nausea,vomiting, abdominalcramps)
• Rash, urticaria• Increased LFTs
Use with caution in liverdisease.
Oral therapy should replace IVtherapy as soon as possible.
Give oral doses after meals.
Parenteral administrationshould consist of acontinuous drip or slowinfusion over 1 hour or longer.
Adjust dose in renal failure.
Erythromycin should be usedwith caution in neonates;hypertrophic pyloric stenosisand life-threatening episodesof ventricular tachycardiaassociated with prolongedQTc interval have beenreported.
High potential for interactionwith many ARVs and otherdrugs.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-9
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 9 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Ethambutol(Myambutol)
Tablets:• 100 mg• 400 mg
Less Frequent:• Acute gouty arthritis(secondary tohyperuricemia)
Monitor serum concentrationsand adjust dose to maintaintherapeutic levels andminimize risk of bone marrowsuppression.
Requires dose adjustment inpatients with impaired renalfunction; use with extremecaution.
Fatal aplastic anemia andagranulocytosis have beenrarely reported.
Oral preparations should beadministered with food over a15-minute period to minimizeGI side effects
Monitor CBC, LFTs, renalfunction, and electrolytes.
Foscarnet(Foscavir)
IV More Frequent:• Nephrotoxicity• Serum electrolyteabnormalities(hypocalcaemia,hypophosphatemia,hypomagnesemia,hypokalemia)
Less Frequent:• Hematologic toxicity(anemia, granulocytopenia)
• Neurotoxicity (muscletwitching, tremor, seizures,tingling around mouth)
• Cardiac abnormalitiessecondary to electrolytechanges
• Phlebitis (at site ofinjection)
Rare:• Sores or ulcers mouth orthroat
Frequent:
• GI disturbances (abdominalpain, anorexia, nausea,vomiting)
• Anxiety, confusion,dizziness, headache
• Fever
Requires dose adjustment inpatients with impaired renalfunction.
Use adequate hydration todecrease nephrotoxicity. Avoidconcomitant use of otherdrugs with nephrotoxicity.
Monitor serum electrolytes,renal function, and CBC.
Consider monitoring serumconcentrations (TDM)
IV solution of 24 mg/mL canbe administered via centralline but must be diluted to afinal concentration not toexceed 12 mg/mL if given viaperipheral line.
Must be administered at aconstant rate by infusionpump over ≥2 hours (or nofaster than 1 mg/kg/minute).
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-11
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 11 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Ganciclovir(Cytovene)
Capsules: • 250 mg• 500 mg
IV
More Frequent:• Granulocytopenia• Thrombocytopenia
Less Frequent:• Anemia• CNS effects (confusion,headache)
• Hypersensitivity (fever,rash)
• Elevated transaminaseenzymes
• Increase in creatinine, BUN• Phlebitis (at injection sites)
Less Frequent:• Cardiovascular effects(chest pain, hypertension,arrhythmias, hypotension)
• Hypoesthesia/paresthesia
Rare: • Abnormality or loss ofvision
• Allergic reaction (rash,hives)
• Hypothyroidism• Development of antinuclearantibodies
More Frequent:• Flu-like syndrome (myalgia,arthralgia, fever, chills,headache, back pain,malaise, fatigue)
• GI disturbances (abdominalpain, anorexia, nausea,vomiting, diarrhea,dyspepsia)
• Pharyngitis, dry mouth
Less Frequent:• Alopecia• Epistaxis• Elevated serumtransaminases, serumcreatinine and BUN,glucose, triglycerides
Severe adverse effects lesscommon in children thanadults.
Toxicity dose-related, withsignificant reduction over thefirst 4 months of therapy.
For non-life-threateningreactions, reduce dose ortemporarily discontinue drugand restart at low doses withstepwise increases.
If patients have visualcomplaints, an ophthalmologicexam should be performed todetect possible retinalhemorrhage or retinal artery orvein obstruction.
Should not be used in childrenwith decompensated hepaticdisease, significant cytopenia,autoimmune disease, orsignificant pre-existing renalor cardiac disease.
If symptoms of hepaticdecompensation occur
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-12
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 12 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Interferon-alfa-2B(IFN-α-2B;Intron),continued
(ascites, coagulopathy,jaundice), IFN-α-2B should bediscontinued.
Adverse GI effects occur lessoften when administered withfood.
Drugs that decrease gastricacidity or sucralfate should beadministered ≥2 hours afterketoconazole.
Disulfiram-like reactions haveoccurred in patients ingestingalcohol.
Hepatotoxicity is anidiosyncratic reaction, usuallyreversible when stopping thedrug, but rare fatalities canoccur any time duringtherapy; more common infemales and adults >40 years,but cases reported in children.
Less Frequent:• Cardiovascular effects(chest pain, hypertension,arrhythmias, hypotension)
• Hypoesthesia/paresthesia
Rare: • Vision abnormalities or lossof vision
• Allergic reaction (rash,hives)
• Hypothyroidism• Development of antinuclearantibodies
More Frequent:• Flu-like syndrome (myalgia,arthralgia, fever, chills,headache, back pain,malaise, fatigue)
• GI disturbances (abdominalpain, anorexia, nausea,vomiting, diarrhea,dyspepsia)
• Pharyngitis, dry mouth
Less Frequent:• Alopecia• Epistaxis• Elevated serumtransaminases, serumcreatinine and BUN,glucose, triglycerides
Toxicity dose-related. Dosemodifications based on typeand degree of toxicity.
For non-life threateningreactions, reduce dose ortemporarily discontinue drugand restart at low doses withstepwise increases.
If patients have visualcomplaints, anophthalmologic exam shouldbe performed to detectpossible retinal hemorrhageor retinal artery or veinobstruction.
Should not be used in childrenwith decompensated hepaticdisease, significant cytopenia,autoimmune disease, orsignificant pre-existing renalor cardiac disease.
If symptoms of hepaticdecompensation occur(ascites, coagulopathy,jaundice),Peg- IFN-α-2Ashould be discontinued.
Less Frequent:• Cardiovascular effects(chest pain, hypertension,arrhythmias, hypotension)
• Hypoesthesia/paresthesia
More Frequent:• Flu-like syndrome (myalgia,arthralgia, fever, chills,headache, back pain,malaise, fatigue)
• GI disturbances (abdominalpain, anorexia, nausea,vomiting, diarrhea,dyspepsia)
• Pharyngitis, dry mouth
Less Frequent:• Alopecia• Epistaxis• Elevated serum
Toxicity dose-related. Dosemodifications based on typeand degree of toxicity.
For non-life threateningreactions, reduce dose ortemporarily discontinue drugand restart at low doses withstepwise increases.
If patients have visualcomplaints, anophthalmologic exam shouldbe performed to detectpossible retinal hemorrhageor retinal artery or veinobstruction.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-16
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 16 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
PegylatedInterferon Alfa-2B(Pegintron),continued
Rare: • Abnormality or loss ofvision
• Allergic reaction (rash,hives)
• Hypothyroidism• Development of antinuclearantibodies
transaminases, serumcreatinine and BUN,glucose, triglycerides
Should not be used in childrenwith decompensated hepaticdisease, significant cytopenia,autoimmune disease, orsignificant pre-existing renalor cardiac disease.
If symptoms of hepaticdecompensation occur(ascites, coagulopathy,jaundice),Peg- IFN-α-2Ashould be discontinued.
IVMore Frequent:• GI disturbances (anorexia,nausea, vomiting, diarrhea)
Less Frequent:• Unpleasant metallic taste
AresolMore Frequent:• Bronchospasm
Rapid infusion may result inprecipitous hypotension; IVinfusion should beadministered over ≥1 hour(preferably 2 hours).
Cytolytic effect on pancreaticbeta islet cells, leading toinsulin release, can result inprolonged severehypoglycemia (usually occursafter 5–7 days of therapy, butcan also occur after the drugis discontinued); riskincreased with higher dose,longer duration of therapy,and re-treatment within 3months of prior treatment.
Hyperglycemia and diabetesmellitus can occur up toseveral months after drugdiscontinued.
Inhalation: • A special nebulizer isrequired for aerosoladministration. Medicalpersonnel should be trainedin the proper administrationof aerosolized pentamidine.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-17
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 17 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Posaconazole(Noxafil)
Oral Solution:• 40 mg/mL
Less frequent:• Hypersensitivity (fever,chills, skin rash)
• Anaphylactoid reaction withIV infusion
Rare:• Hepatotoxicity (includinghepatic failure)
• Exfoliative skin disorders(including SJS)
• Renal dysfunction• Cardiac arrhythmias (QTinterval prolongation,torsades de pointes,hypertension)
• Rash• Discoloration of body fluids• Elevated serumtransaminases
• Visual changes
Preferably take on emptystomach, but can beadministered with food inpatients with GI intolerance;take with full glass of water.
Suspension formulation stablefor 30 days. Shake well prior todosing.
May cause reddish to brown-orange color urine, feces, saliva,sweat, skin, or tears (candiscolor soft contact lenses).
Multiple potential druginteractions
Use with caution in patientswith hepatic impairment.
Administer IV by slow infusion.Extravasation may cause localirritation and inflammation.
Monitor CBC and LFTs.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-20
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 20 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Streptomycin IM More Frequent: • Nephrotoxicity• Neurotoxicity (includingmuscle twitching, seizures)
• Peripheral neuritis• Ototoxicity, both auditoryand vestibular
Less Frequent:• Hypersensitivity (skin rash,redness, or swelling)
• Optic neuritis• Bone marrow suppression
Rare:• Neuromuscular blockade
• CNS effects (headache,ataxia, dizziness )
Usual route of administration is deepIM injection into large muscle mass.
For patients who cannot tolerate IMinjections, dilute to 12–15 mg in 100mL of 0.9% sodium chloride; mustbe infused over 30 to 60 minutes toavoid neuromuscular blockade.
Requires dose adjustment inpatients with impaired renalfunction.
Monitor renal function and hearingperiodically (e.g., monthly) inchildren on prolonged therapy.
Monitor serum concentrations(TDM).
Sulfadiazine Tablet:• 500 mg
Oral Suspension:• Extempo-raneouspreparation
Rare: • Crystalluria, renal failure• Bone marrow suppression/blood dyscrasias
• Severe hypersensitivitysyndrome
• Hemolytic anemia (withG6PD deficiency)
• GI disturbances (abdominalpain, diarrhea, nausea)
• GI disturbances (anorexia,nausea, vomiting, diarrhea)
• Photosensitivity• Rash
Requires dose adjustment inpatients with impaired renalfunction.
Maintain adequate fluid intake toprevent crystalluria and stoneformation (take with full glass ofwater).
Potential for photosensitivity skinreaction with sun exposure.
IV infusion over 60 to 90 minutes
Monitor CBC, renal function.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-21
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 21 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Valacyclovir(Valtrex)
Tablets: • 500 mg• 1 g
Note: An oralsuspensionformulation 50 mg/mL canbe prepared inOra-Sweet orSyrpalta syrups)
Rare:• Renal failure• Bone marrow suppression• Thromboticmicroangiopathy/hemolyticuremic syndrome
• CNS (psychosis, seizures,delirium)
More Frequent:• Headache, nausea
Less Frequent:• Arthralagia• Dizziness, fatigue• GI disturbances (diarrheaor constipation, anorexia,abdominal pain, vomiting)
• Dysmenorrhea
Thrombotic thrombocytopeniapurpura/hemolytic uremicsyndrome has been reportedin HIV-infected adults withadvanced disease receivinghigh (i.e., 8 g/day) but not lowdoses.
Monitor CBC and renalfunction.
Valganciclovir(Valcyte)
Tablets:• 450 mg
Oral Solution:• 50 mg/mL
More Frequent:• Granulocytopenia• Thrombocytopenia
Less Frequent:• Anemia• CNS effects (seizures,psychosis, hallucinations
• Hypersensitivity (fever,rash)
• Elevated transaminaseenzymes
• Increase in creatinine, BUN• Retinal detachment
• GI disturbances (abdominalpain, anorexia, nausea,vomiting)
• CNS effects (headache,insomnia)
Requires dose adjustment inpatients with renalimpairment.
Avoid other nephrotoxicdrugs.
Tablets should not be brokenor crushed.
Monitor CBC and renalfunction.
Potentially teratogenic andcarcinogenic.
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Guidelines for the Prevention and Treatment of Opportunistic Infections In HIV-Exposed and HIV-Infected Children HH-22
Table 4. Common Drugs Used for Treatment of Opportunistic Infections in HIV-Infected Children:
Preparations and Major Toxicities (page 22 of 22)
Drug Preparations Major Toxicitiesa Special Instructions
Indicating Need forMedical Attention
Indicating Need forMedical Attention if
Persistent or Bothersome
Voriconazole(VFEND)
Tablet:• 50 mg• 200 mg
Oral Suspension:• 40 mg/mL
IV
Less Frequent:• Hypersensitivity (fever,chills, skin rash)
More Frequent:• Visual changes, dose-related (photophobia,blurry vision)
• CNS effects (dizziness,drowsiness, headache)
• GI disturbances (abdominalpain, constipation,diarrhea, anorexia, nausea,vomiting)
• Photosensitivity
Rare:• Gynecomastia• Elevated serumtransaminases
Oral tablets should be taken 1hour before or after a meal.
Shake oral suspension wellprior to dosing.
Maximum IV infusion rate 3 mg/kg/hour over 1 to 2hours.
Oral administration to patientswith impaired renal function ifpossible (accumulation of IVvehicle occurs in patients withrenal insufficiency)
Dose adjustment needed ifhepatic insufficiency.
Visual disturbances common(>30%) but transient andreversible when drug isdiscontinued.
Multiple potential druginteractions
Monitor renal function,electrolytes, and LFTs
Consider monitoring serumconcentrations (TDM).
a The toxicities listed in the table have been selected based on their potential clinical significance and are not inclusive of all side effectsreported for a particular drug.
Key to Acronyms: ARV = antiretroviral; BP = blood pressure; BUN = blood urea nitrogen; CBC = complete blood count; CDC = Centers forDisease Control and Prevention; CNS = central nervous system; Cr = creatinine; CrCl = creatinine clearance; EKG = electrocardiogram;G6PD = Glucose-6-phosphate dehydrogenase; GI = gastrointestinal; IFN-� = interferon alfa; IM = intramuscular; IND = investigational newdrug; IV = intravenous; LFT = liver function test; SJS = Stevens-Johnson Syndrome; SMX = sulfamethoxazole; SQ = subcutaneous; TDM = therapeutic drug monitoring; TMP = trimethoprim