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DOSAGE
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Corneal Dendritic Ucler: 1 gtt 5/day (~ q3hr while awake) until the corneal ulcer heals, taper 1 gtt TID x 7 days
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GENERIC
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ganciclovir 0.15%
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SIZE
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5gm tube
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TREATMENT REGIMEN
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HERPES ZOSTER
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HERPES SIMPLEX
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Conjunctivitis: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Cool compresses BID (3) Erythromycin ung BID
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Conjunctivitis: (1) Topical Antiviral (Choose one): Viroptic 1% 5/day x 7 days or Zirgan 0.15% (gel) 5/day x 7 days
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SPK Cornea: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Preservative-free artificial tears q1-2hrs + ung qHS
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Cornea Epithelial Dendrites (1) Topical Antiviral (Choose one): Viroptic 1% 9x/day x 7 days or Zirgan 0.15% (gel) 5x/day x 7 days (2) Oral Antiviral (choose one): Acyclovir 400 mg PO 5x/day x 7-10 days, Valacyclovir 500mg PO TID x 7-10 days or Famciclovir 250mg PO TID x 7-10 days (3) Consider Cyclopentolate 1% TID if AC reaction or photophobia (4) DO NOT use topical steroids with epithelial
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Cornea Pseudodendrites: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Preservative-free artificial tears q1-2hrs + ung qHS (3) Topical antiviral: Zirgan 0.15% (gel) TID-QID x 7-10 days
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Cornea Stromal (Disciform Keratitis) (1) Cyclopentolate 1% TID (2) Antiviral prophylaxis Oral (choose one): Acyclovir 400 mg PO BID or Valacyclovir 500mg PO qDay to BID (3) Antiviral prophylaxis Drops (choose one): Viroptic 1% TID or Zirgan 0.15% (gel) 3-5x/day (4) If moderate/Severe with central vision loss: Add on Predforte 1% q2hr to QID
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Stromal Cornea Keratitis: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Predforte 1% 4-8/day, then taper, usually with weaker steroid with goal of q1week.
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INDICATIONS
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ZIRGAN (ganciclovir ophthalmic gel) 0.15% is indicated for the treatment of acute herpetic keratitis (dendritic ulcers)
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MECHANISM OF ACTION
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guanine analogue: Activated form inhibits viral DNA synthesis.
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MICROBIOLOGY
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ZIRGAN contains the active ingredient, ganciclovir, which is a guanosine derivative that, upon phosphorylation, inhibits DNA replication by herpes simplex viruses (HSV). Ganciclovir is transformed by viral and cellular thymidine kinases (TK) to ganciclovir triphosphate, which works as an antiviral agent by inhibiting the synthesis of viral DNA in 2 ways: competitive inhibition of viral DNA-polymerase and direct incorporation into viral primer strand DNA, resulting in DNA chain termination and prevention of replication
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CONTRAINDICATIONS & WARNINGS
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Hypersensitivity to Ganciclovir or any included ingredients.
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PEDIATRIC USE
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Safety and efficacy in pediatric patients below the age of 2 years have not been established.
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PREGNANCY
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Category C Teratogenic Effects Ganciclovir has been shown to be embryotoxic in rabbits and mice following intravenous administration and teratogenic in rabbits. Fetal resorptions were present in at least 85% of rabbits and mice administered 60 mg/kg/day and 108 mg/kg/day (approximately 10,000x and 17,000x the human ocular dose of 6.25 mcg/kg/day), respectively, assuming complete absorption. Effects observed in rabbits included: fetal growth retardation, embryolethality, teratogenicity, and/or maternal toxicity. There are no adequate and well-controlled studies in pregnant women. ZIRGAN should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
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NOTE
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0.0075% BAK preserved, ⅔ of early Acanthamoeba keratitis are misdiagnosed as HSV
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