Herpetic keratitis: Ophthalmic: Apply 1 drop in affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then apply 1 drop 3 times daily for 7 days.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
(For additional information see "Ganciclovir (ophthalmic): Pediatric drug information")
Herpetic keratitis: Children ≥2 years and Adolescents: Ophthalmic gel: Apply 1 drop in affected eye 5 times daily (approximately every 3 hours while awake) until corneal ulcer heals, then 1 drop 3 times daily for 7 days.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Gel, Ophthalmic:
Zirgan: 0.15% (5 g) [contains benzalkonium chloride]
No
For ophthalmic application only; avoid touching tip of applicator to eye or other surfaces.
Ophthalmic gel: Gel is intended for topical ophthalmic use only; avoid touching tip of applicator to eye or other surfaces.
Hazardous agent (NIOSH 2016 [group 2]).
Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends double gloving and a protective gown for administration (NIOSH 2016). Facilities may perform assessment of some (non-antineoplastic) hazardous drugs to determine if appropriate for alternative containment strategies and handling requirements; assess risk to determine appropriate containment strategy (USP-NF 2017).
Herpetic keratitis: Treatment of acute herpetic keratitis (dendritic ulcers)
Ganciclovir may be confused with acyclovir, valGANciclovir
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Ophthalmic: Blurred vision (60%), eye irritation (20%)
1% to 10%: Ophthalmic: Punctate keratitis (5%), conjunctival hyperemia (5%)
There are no contraindications listed in the manufacturer’s labeling.
Concerns related to adverse effects:
• Ocular adverse events: Blurred vision commonly occurs; may also cause eye irritation.
Special populations:
• Contact lens wearers: Contact lenses should not be worn during the course of therapy or in any patient with signs/symptoms of herpetic keratitis.
Other warnings/precautions:
• Appropriate use: For topical ophthalmic use only.
Use with caution in children; long-term safety has not been determined; the potential long-term carcinogenic and adverse reproductive effects of ganciclovir should be considered.
None known.
There are no known significant interactions.
Adverse events were observed in animal reproduction studies conducted with systemic ganciclovir. The amount of ganciclovir available systemically following topical application of the ophthalmic gel is significantly less in comparison to IV doses (0.1%).
The amount of ganciclovir available systemically following ophthalmic application is not known. The manufacturer recommends that caution be used with administration of the ophthalmic gel to breastfeeding females.
Ophthalmologic exams
Ganciclovir is phosphorylated to a substrate, which competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of DNA replication by herpes simplex viruses.
Absorption: Negligible systemic absorption (0.1% in comparison to IV doses and 0.04 % in comparison to oral valganciclovir)
Gel (Zirgan Ophthalmic)
0.15% (per gram): $100.41
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