Valgan
Valgan (Valganciclovir 450 mg) — Cipla ganciclovir prodrug for CMV retinitis in HIV/AIDS and CMV prevention/treatment in solid-organ and bone-marrow transplant recipients.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
Quick Answer
Valgan — valganciclovir 450 mg (Cipla). Ganciclovir prodrug — used for cytomegalovirus (CMV) retinitis in HIV/AIDS, CMV prophylaxis and treatment in solid-organ and bone-marrow transplant recipients, and congenital CMV. Better oral bioavailability than ganciclovir.
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Valganciclovir carries multiple black-box warnings: bone marrow suppression (granulocytopenia, anaemia, thrombocytopenia), animal carcinogenicity and teratogenicity, and male/female fertility impairment. Use only when clearly indicated. Pregnant or potentially pregnant women must use effective contraception during treatment AND for at least 1 month after.
Weekly FBC during induction therapy and the first month of maintenance, then every 2-4 weeks. Stop if neutrophils <500/μL, platelets <25,000/μL, or haemoglobin drops sharply. Monitor renal function (CrCl-based dose adjustment). Monitor visual function during CMV retinitis treatment.
Dosing
| Indication | Dose |
|---|---|
| CMV retinitis induction (HIV) | 900 mg BID × 21 days with food |
| CMV retinitis maintenance | 900 mg once daily with food |
| CMV prevention (transplant) | 900 mg once daily × 100-200 days post-transplant |
| Congenital CMV (paediatric) | 16 mg/kg BID × 6 months — specialist supervised |
Take with food. Renal-dose adjustment for CrCl <60 mL/min. Tablets must be swallowed whole — handling broken tablets is a teratogenic exposure risk.
Frequently Asked Questions
When is valganciclovir indicated?
CMV retinitis in HIV/AIDS (mostly historical with modern ART), CMV prevention and treatment in solid-organ and bone-marrow transplant, congenital CMV in symptomatic neonates. Discuss with infectious disease or transplant specialist.
How does it work?
Prodrug of ganciclovir, converted to active form intracellularly by viral kinases (preferentially in CMV-infected cells). Active form is incorporated into viral DNA as a chain terminator.
Why is monitoring required?
Bone marrow suppression is the dose-limiting toxicity. Up to 25-40% of patients develop significant neutropenia or anaemia. Weekly FBC during induction is mandatory. G-CSF (filgrastim) is sometimes used to manage neutropenia without stopping therapy.
Pregnancy?
Strongly contraindicated due to teratogenicity. Effective contraception during treatment and for at least 1 month after for women, 90 days after for men. Pregnancy testing before starting if reproductive potential.
Drug interactions?
Major: zidovudine (additive marrow suppression), trimethoprim-sulfa, mycophenolate (transplant context), didanosine (raised levels). Probenecid reduces clearance. Always disclose all medications including transplant immunosuppression.
Renal function?
Renally cleared — adjust dose by creatinine clearance. CrCl <10 mL/min: avoid; haemodialysis patients require post-dialysis dosing schedule.
Side effects?
Bone marrow suppression (commonest), GI (nausea, vomiting, diarrhoea), headache, insomnia, fever, retinal detachment in CMV retinitis (disease-related, not drug).
Storage?
Below 30°C in original container. Crushed/broken tablets are teratogenic — handle with gloves; pregnant household members should not handle.
What if I miss a dose?
Take when you remember unless nearly time for the next dose. Do not double up. Discuss adherence challenges with your transplant or HIV team — alternative anti-CMV agents (foscarnet, cidofovir) exist if oral therapy fails.
Resistance?
CMV resistance can develop with prolonged exposure — UL97 and UL54 mutations confer ganciclovir resistance. Maraviroc/foscarnet/cidofovir are options for resistant disease, all with their own toxicities.
Other Antiviral Medications
- Zimivir — valacyclovir for HSV
- Natclovir — valacyclovir — Natco brand
- Centrex — valacyclovir 500/1000 mg
- X-Vir — entecavir for HBV
- Lamivir HBV — lamivudine for HBV
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| Strength | 450 mg |
|---|---|
| Quantity | 4 Tablet/s, 16 Tablet/s, 32 Tablet/s |
| Pharma Form | Tablet/s |
| Manufacturer | Cipla Inc |
| Treatment | Eye infections by Herpes simplex virus |
| Generic Brand | Valganciclovir |
Valgan
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