Table 4 Anti-CMV medications and common associated side effects

Ganciclovir

Competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of viral DNA synthesis

Thrombocytopenia, leukopenia, increased creatinine, fever, vomiting, diarrhea

Valganciclovir

Converted to ganciclovir in the body, much higher bioavailability of ganciclovir compared to oral ganciclovir

As ganciclovir

Foscarnet

Non-competitive inhibitor of many viral RNA and DNA polymerases

Electrolyte abnormalities, fever, vomiting, diarrhea, anemia, granulocytopenia, renal insufficiency, cardiotoxicity, central nervous system toxicity, hepatic toxicity

Cidofovir

Suppresses CMV replication by selective inhibition of viral DNA synthesis

Fever, alopecia, rash, ocular, renal, and gastrointestinal toxicity, cough, dyspnea