Valganciclovir: Dosing Strategies for Effective Cytomegalovirus Prevention

Valganciclovir has widely become the agent of choice for the prevention of cytomegalovirus in recipients of organ transplants. Optimal dosing is needed to achieve efficacy and avoid toxicity. For subjects at high risk of cytomegalovirus, it is strongly suggested that full-dose (based on renal function) valganciclovir be used. While low-dose valganciclovir appears to be efficacious in some reports, the recommendations are based on inadequately designed trials and must be taken with caution. Unfortunately, because of the sample size needed, it is not likely that the efficacy of reduced-dose valganciclovir will be adequately tested in well-controlled trials. The duration of prophylaxis, particularly whether prophylaxis should be extended beyond three months, continues to be an important question and is the subject of a well-designed clinical trial of which we anxiously await the results. (Trends in Transplant 2007;1:35-43) Corresponding author: Mark D. Pescovitz, [email protected]