Pharmacokinetics of ganciclovir in haematopoietic stem cell transplantation recipients with or without renal impairment.

OBJECTIVES We investigated the pharmacokinetics of ganciclovir in 12 haematopoietic stem cell transplantation (HSCT) recipients to evaluate the validity of a 50% reduction in the ganciclovir dosage for mild renal impairment. PATIENTS AND METHODS Ganciclovir at 5 mg/kg/day was pre-emptively infused in patients with estimated CL(CR) > or = 70 mL/min (Group A), whereas the dose was reduced to 2.5 mg/kg/day in patients with CL(CR) between 50 and 70 mL/min (Group B). RESULTS The peak concentration was significantly higher in Group A (P < 0.01). However, the decrease in the plasma ganciclovir concentration was slower in Group B (P = 0.09), and the AUC of all patients in both groups was distributed within a narrow range (25.6 +/- 4.77 microg x h/mL), when two patients with exceptionally high AUC values were excluded. CONCLUSIONS A 50% reduction in ganciclovir appeared to be appropriate for patients with mild renal impairment. Measuring the ganciclovir concentration at 4 h after starting infusion may be adequate for evaluating AUC.