Cytovene® IV (Ganciclovir Injection) – Critical Antiviral for CMV Management

Cytovene IV (ganciclovir) is an intravenous antiviral used for treating cytomegalovirus (CMV) retinitis in immunocompromised individuals and for preventing CMV disease in transplant recipients. It inhibits viral DNA polymerase, halting CMV replication and preserving vision or graft health.

Brand Name: Cytovene® IV

Generic Name: Ganciclovir Sodium

Drug Class: Antiviral – CMV DNA polymerase inhibitor

Formulation: Lyophilized powder for IV infusion (500 mg/vial, reconstitute to 50 mg/mL)

Prescription Status: Rx only

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Active Ingredient & Popular Names
Ganciclovir (also spelled “gancyclovir” or DHPG) 

Known brands: Cytovene®, Cymevene™, Vitrasert (intravitreal implant) 

Ganciclovir, once phosphorylated into ganciclovir-TP in infected cells, competitively inhibits CMV DNA polymerase, leading to premature chain termination and suppression of viral replication. It selectively targets CMV-infected cells due to viral kinase-mediated activation 

CMV Retinitis in immunocompromised patients (e.g., HIV/AIDS) 
Glowm

Prevention of CMV disease in solid-organ and bone marrow transplant recipients 
Off-label uses: CMV pneumonitis, colitis in transplants/HIV, and congenital CMV infection in neonates 

1. CMV Retinitis (Adults, normal renal function):

Induction: 5 mg/kg IV over 1 hr every 12 hrs for 14–21 days 
HRES PDF

Maintenance: 5 mg/kg IV daily (7 days/week) or 6 mg/kg daily (5 days/week) 

2. CMV Prophylaxis (Transplants):

Induction: 5 mg/kg IV every 12 hrs for 7–14 days

Maintenance: Follow same schedule as retinitis, up to 100–120 days post-transplant 

3. Renal Dose Adjustment (CrCl‐based):

≥70 mL/min: standard dosing

50–69: half dosing with same intervals

25–49: half dose every 24 hr

10–24: quarter dose every 24 hr

<10: 1.25 mg/kg 3×/week post-dialysis induction, taper to maintenance 
GoodRx

Reconstitute with 10 mL sterile water; dilute per protocol
Infuse over at least 1 hour to reduce phlebitis
Use gloves during preparation and aseptic technique 

Confirm negative pregnancy test in women of childbearing potential before starting 
Drugs.com

Baseline labs: CBC with differential, renal function, electrolytes

During therapy: Monitor CBC (neutrophils/platelets) and renal function at least weekly; ophthalmologic exams for retinitis 
Avoid IV bolus or IM/SQ injections due to risk of tissue irritation and toxicity 
FDA Access Data
GlobalRPH

Common (≥20%): fever, diarrhea, leukopenia, nausea, anemia, thrombocytopenia, headache, asthenia, abdominal pain, phlebitis or catheter-related infection, hyperhidrosis, chills, peripheral neuropathy, dyspnea 
Serious:

Bone marrow suppression: neutropenia, anemia, thrombocytopenia, pancytopenia (monitor CBC) 
HRES PDF

Nephrotoxicity: elevated serum creatinine; dose adjustment essential 
FDA Access Data

Reproductive toxicity: spermatogenesis suppression; teratogenic/mutagenic potential 
clinicalinfo.hiv.gov

Carcinogenic potential based on animal data 

Avoid in severe neutropenia (ANC <500/µL), anemia (Hgb <8 g/dL), or thrombocytopenia (<25,000/µL) 
FDA Access Data

Use caution with other myelosuppressive or nephrotoxic agents

Regular renal function monitoring and dose adjustments mandatory 
FDA Access Data

Use gloves and aseptic technique; avoid fast infusion or incorrect routes 
FDA Access Data
GlobalRPH
Contraindicated in hypersensitivity to ganciclovir or valganciclovir 
UPMC Children's Hospital of Pittsburgh
Nephrotoxins (e.g., amphotericin B, cyclosporine): additive renal damage—monitor closely 
FDA Access Data

Myelosuppressives: additive cytopenia risk—monitor CBC

Valganciclovir: concurrent use not recommended—overexposure risk

Probenecid: may elevate ganciclovir levels—adjust dose accordingly 
NCBI
ATC Code: J05AB06 (Ganciclovir)

Therapeutic Class: Antiviral – CMV DNA polymerase inhibitor

Prescription: Rx only

Clinical Evidence
Phase III trials in ### HIV-associated CMV retinitis showed delayed disease progression and improved survival compared to alternative regimens 

Consistent viremia suppression with prophylaxis in transplant recipients, reducing CMV-related morbidity and hospitalizations 
FDA Access Data

FAQ (Q&A Format)
Q: What conditions is Cytovene IV approved for?
A: It treats CMV retinitis and prevents CMV disease post-transplant in immunocompromised patients 
Mayo Clinic

Q: What is the typical dosing schedule?
A: Induction is 5 mg/kg IV every 12 hrs for 2–3 weeks; maintenance 5–6 mg/kg daily with adjustments for kidney function 
GoodRx
Q: How is renal impairment managed?
A: Dose and interval are scaled based on creatinine clearance. Lowest dose for severe impairment or dialysis patients 
FDA Access Data

Q: What labs should be monitored?
A: CBC, renal function weekly during treatment; ophthalmologic exams for retinitis 

Q: What are the most significant side effects?
A: Bone marrow suppression (neutropenia/anemia), kidney toxicity, catheter-related infection, reproductive effects 
FDA Access Data

Q: Is Cytovene safe during pregnancy?
A: No—it's teratogenic and mutagenic in animals. Effective contraception required during and 30 days post-treatment 

Store lyophilized vials at 2–8 °C (refrigerated), protect from light 
clinicalinfo.hiv.gov

Use sterile technique during reconstitution; discard unused reconstituted solution promptly

Clearly label prepared syringes/IV bags as “Ganciclovir, IV use only”

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