Author: Anoma Ranaweera B.V. Sc; PhD (Clinical Biochemistry, University of Liverpool, UK). Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015.

Cidofovir (Gilead Sciences; California, USA) is a potent antiviral drug that has been approved for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome (AIDS) due to infection with human immunodeficiency virus (HIV).

Several small studies and case reports describe the successful use of cidofovir applied either topically or by intralesional injection in virally-induced skin diseases.

Cidofovir is not marketed in New Zealand.

Off-label indications of cidofovir in dermatology

Non-approved reported uses of cidifovir in dermatology include:

Human papillomavirus infections

Anogenital warts

Viral warts in anogenital skin are caused by human papilloma virus (HPV) Types 6 and 8, and at times, Types 16 and 18.

Laryngeal papillomatosis

Recurrent respiratory papillomatosis is a condition characterised by viral warts in the upper airway.

Common warts

Common warts (also known as verrucae) are also due to infection with subtypes of HPV. The plantar area (the sole of the foot) is one of most frequent locations.

Herpes virus infections

HIV- associated Kaposi sarcoma

Kaposi sarcoma is associated with infection with Kaposi sarcoma herpes virus (KSHV) also called human herpes virus type 8.

Herpes simplex infections

Herpes simplex presents with localised blistering. Type 1 herpes simplex virus is mainly associated with facial infections (cold sores or fever blisters) while type 2 causes genital herpes.

Pox virus infections

Molluscum contagiosum

Molluscum contagiosum is a common viral skin infection of infants and young children. Adolescents and adults are less often infected.

Mechanism of action of cidofovir

Cidofovir suppresses cytomegalovirus (CMV) replication by selective inhibition of viral DNA synthesis.

Drug interactions with cidofovir

Concomitant use of other nephrotoxic drugs (e.g. aminoglycosides, amphotericin B, foscarnet, IV pentamidine, vancomycin, nonsteroidal anti-inflammatory agents) is contraindicated since it may result in increased risk of nephrotoxicity

There is no evidence of pharmacokinetic interactions of cidofovir with probenecid.

Adverse effects with cidofovir

In humans, systemic adverse reactions after topical or intralesional administration of cidofovir have been reported in a single patient with laryngeal papillomatosis who experienced chest pain after treatment with intralesional cidofovir.

Other potentially serious adverse effects with parenteral cidofovir include:

Use of cidofovir in special populations

Pregnancy and lactation

Paediatric use

Geriatric use

The safety and efficacy of cidofovir has not been evaluated in adults >60 years of age.

Precautions when using cidofovir

Precautions include:

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