Valganciclovir

Cytomegalovirus (CMV) continues to be a substantial problem for transplant patients. Although several agents are available with activity against CMV, the primary drug used over the past 15 years is ganciclovir. Because of poor absorption of oral ganciclovir, which results in the need for frequent and large oral doses, the valine ester of ganciclovir, valganciclovir, was developed. Valganciclovir provides 10-fold higher bioavailability allowing smaller doses given once a day. With the high ganciclovir blood levels achieved, the ability to treat CMV with an oral medication is being explored. This review provides an update on valganciclovir, highlighting areas of ongoing study including appropriate drug dose, length of prophylaxis, pediatric use, and use for preemptive treatment and treatment of established disease.