Ganciclovir (Blood)

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Auckland Te Toka Tumai

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Ganciclovir (Blood)

Testing Laboratory

Auckland Te Toka Tumai | Auckland Hospital

Department

Chemical Pathology

Delphic Registration Code (Alpha Code)

GCVT

Test Code (Numeric Code)

5187

Laboratory Handling

Transport

Transport at 4°C (if longer than 5 days to receipt, transport frozen at -20°C)

Laboratory

LabPLUS High Performance Liquid Chromatography

Sample Stability

Ambient: at least 2 week
Refrigerated: at least 2 months

Synonyms

Ganciclovir, valganciclovir

Turnaround Time

4 days

For urgent requests please contact the on-call Chemical Pathologist

Specimen Type

Serum

Specimen Requirements

Tube/Container Type:

Preferred

Plain (Red Top)

Acceptable

Lithium Heparin - Non-gel (Green Cap)

Preferred Sample Volume (ml)

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Plain(Microtainer)

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

Pre-testing Requirements

Trough specimens should be collected less than an hour before the next dose.

Time of previous dose (or "Trough") must be documented with request.

Additional Specimen Information

Tubes containing gel (SST and PST) are NOT acceptable

Diagnostic Use

Ganciclovir is an antiviral used in patients at high risk or proven viral infection (e.g. CMV in immunosuppressed individual). This can be administered intravenously or given orally as the prodrug, valganciclovir. The main adverse consequences are bone marrow suppression, neuropathy, liver dysfunction (abnormal LFT) and renal insufficiency. This drug binds minimally to plasma proteins, and is predominantly excreted in urine unaltered.

Use of (val)ganciclovir is complicated by toxicity, slow response to treatment and acquired resistance with breakthrough infections. Although highly variable trough levels can be obtained using standard weight and renal function-based dosing regimen (significant interindividual variability), studies have indicated mixed results for the routine use of therapeutic drug monitoring for ganciclovir. Since its action is intracellular, measurement of plasma levels is only an indirect assessment. Nevertheless, therapeutic drug monitoring is likely useful in patients with fluctuating renal function, very young or premature neonates, abnormal GI function for the oral prodrug (Valganciclovir), high clinical risk of treatment failure (e.g. resistance to ganciclovir) or to guide dosage reduction in patients with ganciclovir related adverse effects.

There are two methods for (val)ganciclovir TDM. For the majority of patients, a trough concentration at steady state (5-7 days after initiation or dose adjustments) should be taken ideally 30-60 minutes before the next dose is due. Some patients may benefit from Bayesian AUC24 monitoring instead. This requires a random ganciclovir concentration (2-6 hours post dose) to be taken instead of a trough – contact your Antimicrobial Pharmacist or Infectious Diseases team for advice.

The half-life of ganciclovir is approximately 2-4h and increases with age. In the setting of advanced renal failure, this can increase by more than 10-fold (half-life of 60 hours). As it may take 3-5 half-lives to reach a new steady state, repeat dose measurements after a dose adjustment should be taken after 7-10 days for an accurate trough level.

Interpretation

Very low levels (< 0.6 mg/L) are associated with a higher incidence of disease progress and treatment failure. Risk of neutropenia increases from a trough > 2.6 ug/mL. Treatment targets may vary depending of knowledge of ganciclovir resistance, (baseline) viral load, renal function (eGFR), state of immunosuppression or dose/duration of use. Higher targets may be required for life threatening infections. Please contact the infectious diseases pharmacist or another team member before dose adjustments.

Reference Intervals

Prophylaxis: 1 – 2 mg/L (aiming to achieve AUC24 of 40-60 mg/L*h)

Treatment: 2 – 4 mg/L (aiming to achieve an AUC24 of 80-120 mg/L*h)

Individual targets may vary depending on patient circumstances.

Test Method

High performance liquid chromatography with fluorescence detection

Uncertainty of Measurement

Last updated: 25/08/2026

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Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Test Code (Numeric Code)

Laboratory Handling

Transport

Laboratory

Sample Stability

Synonyms

Turnaround Time

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

Pre-testing Requirements

Additional Specimen Information

Aliquot Instructions

Sample Type

Transport to Lab

Additional Referral/Aliquot Information

Diagnostic Use

Interpretation

Reference Intervals

Test Method

Uncertainty of Measurement

Contact Information

Enquiry Form

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Ganciclovir (Blood)

Overview

Testing Laboratory

Department

Delphic Registration Code (Alpha Code)

Test Code (Numeric Code)

Laboratory Handling

Transport

Laboratory

Sample Stability

Synonyms

Turnaround Time

Specimen

Specimen Type

Specimen Requirements

Tube/Container Type:

Preferred

Acceptable

Preferred Sample Volume (ml)

Paediatric Specimen Requirements

Tube/Container Type:

Preferred

Preferred Sample Volume (ml)

Minimum Sample Volume (ml)

Pre-testing Requirements

Additional Specimen Information

Referral

Aliquot Instructions

Sample Type

Transport to Lab

Additional Referral/Aliquot Information

Clinical Information/Test Method

Diagnostic Use

Interpretation

Reference Intervals

Test Method

Uncertainty of Measurement

Additional Information

Contact Information

Contact Information

Enquiry Form

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