Foscarnet Sodium 24 mg/mL (250 mL) Injection: Uses, Dosage, Side Effects & More
Brand Name: Scarnet
Active Ingredient: Foscarnet Sodium
Strength: 24mg/mL (250mL)
Dosage Form: Injection
Drug Class: Antiviral (Pyrophosphate Analog DNA Polymerase Inhibitor)Therapeutic Indications:
Foscarnet sodium is an antiviral prescription medicinal product approved by the U.S. FDA to treat cytomegalovirus (CMV) retinitis in individuals with AIDS. The foscarnet 24mg/ml (250 ml) is also approved by FDA for the treatment of a certain type of herpes simplex virus (HSV) infection, named acyclovir-resistant mucocutaneous HSV infection, in those with weakened immune systems.
Cytomegalovirus diseases; such as those affecting the eye (retinitis); and herpes simplex virus diseases can be opportunistic infections (OIs) of Human Immune Virus. An opportunistic infection is an infection that usually appears more routinely or is more severe in those with weakened immune systems; such as those with HIV, than in those with healthy immune systems.
Mechanism of Action:
Foscarnet inhibits, through non-competitive blockage, of the pyrophosphate binding site of viral DNA polymerase, thus preventing the cleavage of pyrophosphate from deoxynucleoside triphosphate and elongation of the viral DNA chain. For activation, foscarnet sodium does not need viral thymidine kinase, and viral replication resumes after the use of foscarnet is discontinued.
In vitro studies demonstrate foscarnet to block the viral replication of all familiar herpes viruses. This medication can also non-competitively block HIV (human immunodeficiency virus) reverse transcriptase and hepatitis B virus DNA polymerase. Although, complete assessments of the use of this medicinal pharmaceutical product in clinical practice for several of these infections have not yet been conducted.
Foscarnet medicinal product also blocks competitively the sodium-phosphate cotransport by renal cortical brush border membrane vesicles. This medicine is specific for phosphate and dose-dependent, possibly reducing the tubular reabsorption and thus enhancing the excretion of renal phosphate.
Posology and Method of Administration:
The foscarnet injection should be administered by the intravenous route only, either by a central venous line or in a peripheral vein.
If peripheral veins are considered, the foscarnet solution of 24 mg/ml must be diluted. Individually dispensed doses need to be aseptically transferred and diluted with equal parts of 0.9 percent sodium chloride (9 mg/ml) or 5 percent dextrose (50 mg/mL) by the hospital pharmacy. The diluted solutions of foscarnet need to be used as promptly as possible after preparation but can be stored for up to 24 hours if kept refrigerated.
The foscarnet 24 mg/ml solution may be given without dilution via a central vein.
Induction Therapy for CMV Retinitis: Foscarnet Sodium is administered over 2 to 3 weeks on behalf of the clinical response, as intermittent infusions every 8 hours at a dose of 60 mg per kg in those with normal renal function. Dosage of Foscarnet injection must be individualized for the patient's renal function. Infusion time-span should not be less than 60 minutes.
Maintenance Therapy for CMV Retinitis: Following the induction therapy of CMV retinitis, Foscarnet Sodium is administered 7-days a week as long as treatment is required appropriately. In those with normal renal function, it is needed to initiate treatment at 60 mg/kg. Increase to a Foscarnet dose of 90 to 120 mg/kg may then be considered in those tolerating the initial dose level or those with progressive retinitis. This medicine can be given as 90 mg/kg over a two hour time-span as an initial dose for maintenance therapy. Dosage of Foscarnet must be scaled down in those with renal insufficiency.
All those who experience progression of retinitis while on maintenance therapy may be re-given induction regimen.
Induction Therapy for HSV Infections Unresponsive to Aciclovir: Foscarnet is administered for 2 to 3 weeks or until healing of lesions, as intermittent infusions at a dose of 40 mg per kg over 60 minutes every 8 hours in those with normal renal function. Dosage of Foscarnet must be individualized for patients' renal function. The infusion time-span should not be less than 60 minutes.
Efficacy of Foscarnet maintenance therapy following the use of induction therapy of acyclovir unresponsive herpes simplex virus (HSV) infections has not been established.
Caution: Do not administer Foscarnet 24mg/mL (250mL) by rapid intravenous injection.
Side Effects:
- The extensive dose-limiting adverse reaction is impairment of renal function.
- The most common sort of nephrotoxicity (kidney damage) is acute tubular necrosis.
- Nephrogenic diabetes insipidus (NDI) and foscarnet crystal creation in the glomerular capillary lumen have been noted.
- Patients treated with the medicine may have abnormal blood electrolyte levels or seizures.
Nephrotoxic effects have been alleviated with hydration using 0.5-1 liter of 0.9 percent sodium chloride per dose throughout the course of treatment with foscarnet.
Special Warnings and Precautions for Use:
Foscarnet (Scarnet 24mg/mL should be used with caution in those with reduced renal function. Since renal function impairment may appear at any stage of Foscarnet therapy, serum creatinine needs to be monitored every 2'nd day during induction therapy and once in a week during maintenance therapy and apt dose adjustments need to be performed as per the renal function.
Maintain adequate hydration in all the patients. Renal function of those with renal disease or receiving concomitant therapy with other nephrotoxic medicinal products should be precisely monitored.
Because of the sodium content in Foscarnet Sodium 24mg/mL (250mL), its use needs to be avoided when a saline load cannot be tolerated (e.g. in cardiomyopathy). This must also be taken into consideration by those on a controlled sodium diet.
Due to Foscarnet propensity to chelate bivalent metal ions, such as calcium, Foscarnet Sodium administration may be linked with an acute reduction of ionized serum calcium corresponding to the rate of infusion of Foscarnet, which may not be exhibited in total serum calcium levels. The electrolytes, mainly calcium and magnesium, should be evaluated before and throughout Foscarnet therapy and deficiencies corrected.
Foscarnet injection has been linked with scenarios of prolongation of QT interval and a bit rarely with scenarios of torsade de pointes. Those with known existing prolongation of cardiac conduction intervals, mainly QTc, those with electrolyte disturbances (hypomagnesaemia, hypokalaemia), bradycardia, as well as those with underlying cardiac diseases such as congestive heart failure or who are taking medicines known to prolong the QT interval must be precisely assessed due to increased probability of ventricular arrhythmia. Patients should promptly report any cardiac signs/symptoms.
Seizures, linked with alterations in plasma minerals and electrolytes, have been related to Foscarnet treatment. Cases of status epilepticus may occur. Therefore, patients should be precisely monitored for such alterations and their potential sequelae. Mineral, as well as electrolyte supplementation, may be needed.
Foscarnet injection is excreted in high concentrations in the urine and may be linked with genital irritation or ulceration. In order to prevent irritation and ulceration, precise attention to personal hygiene is required and cleaning of the genital area following each micturition is required.
Effects on Potential to Drive and Use Machines:
Foscarnet 24mg/mL (250 mL) has a moderate influence on the potential to drive and use machines. Because of the disease itself and possible undesirable effects of medicine Foscarnet, the potential to drive and use machines can be impaired. A health specialist is advised to discuss this issue with the respective patient and depending on the disease condition and the tolerance of medicine, give a recommendation in the individual case.
Incompatibilities:
Foscarnet injection is not compatible with dextrose 30% solution, acyclovir sodium, amphotericin B, ganciclovir, trimethoprim-sulfamethoxazole, pentamidine isethionate and vancomycin hydrochloride. Neither is foscarnet compatible with all those solutions that contain calcium. It is required that other medicines should not be infused concomitantly in the same line.
Storage: Foscavir is supplied in 250 and 500 mL bottles containing 24 mg foscarnet sodium/mL. This medicinal product should be stored at room temperature (15 to 30 degree C).
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