Foscarnet

Foscarnet
Clinical data
Trade names	Foscavir, Vocarvi, others
Other names	phosphonomethanoic acid, dihydroxyphosphinecarboxylic acid oxide
AHFS/Drugs.com	Monograph
MedlinePlus	a601144
License data	US DailyMed: Foscarnet;
Pregnancy; category	AU: B3;
Routes of; administration	Intravenous
ATC code	J05AD01 (WHO) ;
Legal status
Legal status	AU: S4 (Prescription only); CA: ℞-only; UK: POM (Prescription only); US: ℞-only;
Pharmacokinetic data
Bioavailability	NA
Protein binding	14–17%
Elimination half-life	3.3–6.8 hours
Identifiers
	IUPAC name phosphonoformic acid;
CAS Number	4428-95-9 (trisodium salt);
PubChem CID	3415;
IUPHAR/BPS	5497;
DrugBank	DB00529 ;
ChemSpider	3297 ;
UNII	364P9RVW4X;
KEGG	D00579 ; D02267 ;
ChEBI	CHEBI:127780 ;
ChEMBL	ChEMBL666 ;
CompTox Dashboard (EPA)	DTXSID0048478 ;
Chemical and physical data
Formula	CH3O5P
Molar mass	126.004 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O=C(O)P(=O)(O)O;
	InChI InChI=1S/CH3O5P/c2-1(3)7(4,5)6/h(H,2,3)(H2,4,5,6) ; Key:ZJAOAACCNHFJAH-UHFFFAOYSA-N ;
	(what is this?) (verify)

Foscarnet (phosphonomethanoic acid), known by its brand name Foscavir, is an antiviral medication which is primarily used to treat viral infections involving the Herpesviridae family. It is classified as a pyrophosphate analog DNA polymerase inhibitor. Foscarnet is the conjugate base of a chemical compound with the formula HO₂CPO₃H₂ (Trisodium phosphonoformate).

Foscarnet was approved for medical use in 1991. It is available as a generic medication.

Medical use

This phosphonic acid derivative (marketed by Clinigen as foscarnet sodium under the trade name Foscavir) is an antiviral medication used to treat herpes viruses, including drug-resistant cytomegalovirus (CMV) and herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2). It is particularly used to treat CMV retinitis. Foscarnet can be used to treat highly treatment-experienced patients with HIV as part of salvage therapy.

In cases of herpes simplex encephalitis where the HSV is resistant to acyclovir, the addition of foscarnet may be considered for off-label use.

Mechanism of action

Foscarnet is a structural mimic of the anion pyrophosphate that selectively inhibits the pyrophosphate binding site on viral DNA polymerases at concentrations that do not affect human DNA polymerases.

In individuals treated with the DNA polymerase inhibitors acyclovir or ganciclovir, HSV or CMV particles can develop mutant protein kinases (thymidine kinase or UL97 protein kinase, respectively) that make them resistant to these antiviral drugs. However, unlike acyclovir and ganciclovir, foscarnet is not activated by viral protein kinases, making it useful in acyclovir- or ganciclovir-resistant HSV and CMV infections.

However, acyclovir- or ganciclovir-resistant mutants with alterations in viral DNA polymerase may also be resistant to foscarnet.

Administration

Foscarnet is administered by intravenous infusion or intravitreous injection. The medication has low oral bioavailability.

Side effects

Nephrotoxicity — increase in serum creatinine levels and renal injury can occur in patients receiving foscarnet. Other nephrotoxic drugs should be avoided. Nephrotoxicity is usually reversible and can be reduced by dosage adjustment and adequate hydration.
Electrolyte disturbances — hypocalcemia and hypomagnesemia can occur and regular monitoring of electrolytes is necessary to avoid clinical toxicity.
Genital ulceration — a less common reported side effect which occurs more in men and usually during induction use of foscarnet. It is most likely a contact dermatitis due to high concentrations of foscarnet in urine. It usually resolves rapidly following discontinuation of the drug.
CNS — less common side effects of perioral paresthesia, irritability and altered mental states.

References

↑ "Regulatory Decision Summary - Vocarvi". Health Canada. 23 October 2014. Retrieved 4 June 2022.
↑ "Foscavir- foscarnet sodium injection, solution". DailyMed. 23 April 2020. Retrieved 6 November 2020.
↑ Wagstaff AJ, Bryson HM (August 1994). "Foscarnet. A reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with viral infections". Drugs. 48 (2): 199–226. doi:10.2165/00003495-199448020-00007. PMID 7527325. S2CID 260483894.
↑ Chrisp P, Clissold SP (January 1991). "Foscarnet. A review of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with cytomegalovirus retinitis". Drugs. 41 (1): 104–129. doi:10.2165/00003495-199141010-00009. PMID 1706982.
1 2 3 4 5 6 Garikapati S, Nguyen M (2022). "Foscarnet". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32310568. Retrieved 2022-04-04.
↑ "phosphonoformic acid (CHEBI:127780)". www.ebi.ac.uk. Retrieved 2022-04-04.
↑ Long SS, Pickering LK, Prober CG (2012). Principles and Practice of Pediatric Infectious Disease. Elsevier Health Sciences. p. 1502. ISBN 978-1-4377-2702-9.
↑ "Competitive Generic Therapy Approvals". U.S. Food and Drug Administration (FDA). 29 June 2023. Archived from the original on 29 June 2023. Retrieved 29 June 2023.
↑ Canestri A, Ghosn J, Wirden M, Marguet F, Ktorza N, Boubezari I, et al. (2006). "Foscarnet salvage therapy for patients with late-stage HIV disease and multiple drug resistance". Antiviral Therapy. 11 (5): 561–566. doi:10.1177/135965350601100501. PMID 16964823. S2CID 24905247.
↑ Mathiesen S, Dam E, Roge B, Joergensen LB, Laursen AL, Gerstoft J, Clavel F (2007). "Long-term foscarnet therapy remodels thymidine analogue mutations and alters resistance to zidovudine and lamivudine in HIV-1". Antiviral Therapy. 12 (3): 335–343. doi:10.1177/135965350701200310. PMID 17591023. S2CID 19856772.
1 2 Meyer PR, Rutvisuttinunt W, Matsuura SE, So AG, Scott WA (May 2007). "Stable complexes formed by HIV-1 reverse transcriptase at distinct positions on the primer-template controlled by binding deoxynucleoside triphosphates or foscarnet". Journal of Molecular Biology. 369 (1): 41–54. doi:10.1016/j.jmb.2007.03.006. PMC 1986715. PMID 17400246.
↑ Bloch KC, Glaser C, Gaston D, Venkatesan A (September 2023). "State of the Art: Acute Encephalitis". Clinical Infectious Diseases. 77 (5): e14–e33. doi:10.1093/cid/ciad306. PMID 37485952.
↑ Morita A (May 2026). "Herpes Simplex Encephalitis". Brain and Nerve (in Japanese). 78 (5): 487–494. doi:10.11477/mf.188160960780050487. PMID 42156033.
↑ Chou S (July 2008). "Cytomegalovirus UL97 mutations in the era of ganciclovir and maribavir". Reviews in Medical Virology. 18 (4): 233–246. doi:10.1002/rmv.574. PMID 18383425. S2CID 42775774.
↑ Frobert E, Ooka T, Cortay JC, Lina B, Thouvenot D, Morfin F (March 2005). "Herpes simplex virus thymidine kinase mutations associated with resistance to acyclovir: a site-directed mutagenesis study". Antimicrobial Agents and Chemotherapy. 49 (3): 1055–1059. doi:10.1128/aac.49.3.1055-1059.2005. PMC 549244. PMID 15728902.
↑ Bonnafous P, Naesens L, Petrella S, Gautheret-Dejean A, Boutolleau D, Sougakoff W, Agut H (2007). "Different mutations in the HHV-6 DNA polymerase gene accounting for resistance to foscarnet". Antiviral Therapy. 12 (6): 877–888. doi:10.1177/135965350701200608. PMID 17926642. S2CID 24584000.
↑ Tchesnokov EP, Gilbert C, Boivin G, Götte M (February 2006). "Role of helix P of the human cytomegalovirus DNA polymerase in resistance and hypersusceptibility to the antiviral drug foscarnet". Journal of Virology. 80 (3): 1440–1450. doi:10.1128/JVI.80.3.1440-1450.2006. PMC 1346920. PMID 16415021.
↑ Ota R, Hirata A, Noto K, Yokoyama S, Hosomi K, Takada M, Matsuoka H (May 2020). "Relationship between serum calcium and creatinine in hematopoietic stem cell transplantation patients treated with foscarnet". International Journal of Clinical Pharmacology and Therapeutics. 58 (5): 274–281. doi:10.5414/CP203650. PMID 32101522. S2CID 211537187.
1 2 Jacobson MA (1992-01-01). "Review of the toxicities of foscarnet". Journal of Acquired Immune Deficiency Syndromes. 5 (Suppl 1): S11–S17. PMID 1534839.
↑ Gearhart MO, Sorg TB (March 1993). "Foscarnet-induced severe hypomagnesemia and other electrolyte disorders". The Annals of Pharmacotherapy. 27 (3): 285–289. doi:10.1177/106002809302700304. PMID 8384030. S2CID 37250222.
1 2 Zareifopoulos N, Lagadinou M, Karela A, Kyriakopoulou O, Velissaris D (August 2020). "Neuropsychiatric Effects of Antiviral Drugs". Cureus. 12 (8) e9536. doi:10.7759/cureus.9536. PMC 7465925. PMID 32905132.
↑ Adalsteinsson JA, Pan M, Kaushik S, Ungar J (April 2018). "Foscarnet-induced genital lesions: An overview with a case report". Dermatology Reports. 10 (1): 7749. doi:10.4081/dr.2018.7749. PMC 6026811. PMID 29991980.

Sources

Dennis L. Kasper, Eugene Braunwald. "Harrison's Manual of Medicine", 16th Edition, Mcgraw-hill, (2005), p. 2244.

External links

"Foscarnet". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on August 27, 2018.
"Foscarnet sodium". Drug Information Portal. U.S. National Library of Medicine. Archived from the original on June 28, 2019.

[1] "Regulatory Decision Summary - Vocarvi". Health Canada. 23 October 2014. Retrieved 4 June 2022.

[Foscavir_FDA_label-2] "Foscavir- foscarnet sodium injection, solution". DailyMed. 23 April 2020. Retrieved 6 November 2020.

[3] Wagstaff AJ, Bryson HM (August 1994). "Foscarnet. A reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with viral infections". Drugs. 48 (2): 199–226. doi:10.2165/00003495-199448020-00007. PMID 7527325. S2CID 260483894.

[4] Chrisp P, Clissold SP (January 1991). "Foscarnet. A review of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with cytomegalovirus retinitis". Drugs. 41 (1): 104–129. doi:10.2165/00003495-199141010-00009. PMID 1706982.

[:0-5] 1 2 3 4 5 6 Garikapati S, Nguyen M (2022). "Foscarnet". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 32310568. Retrieved 2022-04-04.

[6] "phosphonoformic acid (CHEBI:127780)". www.ebi.ac.uk. Retrieved 2022-04-04.

[7] Long SS, Pickering LK, Prober CG (2012). Principles and Practice of Pediatric Infectious Disease. Elsevier Health Sciences. p. 1502. ISBN 978-1-4377-2702-9.

[8] "Competitive Generic Therapy Approvals". U.S. Food and Drug Administration (FDA). 29 June 2023. Archived from the original on 29 June 2023. Retrieved 29 June 2023.

[9] Canestri A, Ghosn J, Wirden M, Marguet F, Ktorza N, Boubezari I, et al. (2006). "Foscarnet salvage therapy for patients with late-stage HIV disease and multiple drug resistance". Antiviral Therapy. 11 (5): 561–566. doi:10.1177/135965350601100501. PMID 16964823. S2CID 24905247.

[10] Mathiesen S, Dam E, Roge B, Joergensen LB, Laursen AL, Gerstoft J, Clavel F (2007). "Long-term foscarnet therapy remodels thymidine analogue mutations and alters resistance to zidovudine and lamivudine in HIV-1". Antiviral Therapy. 12 (3): 335–343. doi:10.1177/135965350701200310. PMID 17591023. S2CID 19856772.

[pmid17400246-11] 1 2 Meyer PR, Rutvisuttinunt W, Matsuura SE, So AG, Scott WA (May 2007). "Stable complexes formed by HIV-1 reverse transcriptase at distinct positions on the primer-template controlled by binding deoxynucleoside triphosphates or foscarnet". Journal of Molecular Biology. 369 (1): 41–54. doi:10.1016/j.jmb.2007.03.006. PMC 1986715. PMID 17400246.

[pmid37485952-12] Bloch KC, Glaser C, Gaston D, Venkatesan A (September 2023). "State of the Art: Acute Encephalitis". Clinical Infectious Diseases. 77 (5): e14–e33. doi:10.1093/cid/ciad306. PMID 37485952.

[pmid42156033-13] Morita A (May 2026). "Herpes Simplex Encephalitis". Brain and Nerve (in Japanese). 78 (5): 487–494. doi:10.11477/mf.188160960780050487. PMID 42156033.

[14] Chou S (July 2008). "Cytomegalovirus UL97 mutations in the era of ganciclovir and maribavir". Reviews in Medical Virology. 18 (4): 233–246. doi:10.1002/rmv.574. PMID 18383425. S2CID 42775774.

[15] Frobert E, Ooka T, Cortay JC, Lina B, Thouvenot D, Morfin F (March 2005). "Herpes simplex virus thymidine kinase mutations associated with resistance to acyclovir: a site-directed mutagenesis study". Antimicrobial Agents and Chemotherapy. 49 (3): 1055–1059. doi:10.1128/aac.49.3.1055-1059.2005. PMC 549244. PMID 15728902.

[pmid17926642-16] Bonnafous P, Naesens L, Petrella S, Gautheret-Dejean A, Boutolleau D, Sougakoff W, Agut H (2007). "Different mutations in the HHV-6 DNA polymerase gene accounting for resistance to foscarnet". Antiviral Therapy. 12 (6): 877–888. doi:10.1177/135965350701200608. PMID 17926642. S2CID 24584000.

[pmid16415021-17] Tchesnokov EP, Gilbert C, Boivin G, Götte M (February 2006). "Role of helix P of the human cytomegalovirus DNA polymerase in resistance and hypersusceptibility to the antiviral drug foscarnet". Journal of Virology. 80 (3): 1440–1450. doi:10.1128/JVI.80.3.1440-1450.2006. PMC 1346920. PMID 16415021.

[18] Ota R, Hirata A, Noto K, Yokoyama S, Hosomi K, Takada M, Matsuoka H (May 2020). "Relationship between serum calcium and creatinine in hematopoietic stem cell transplantation patients treated with foscarnet". International Journal of Clinical Pharmacology and Therapeutics. 58 (5): 274–281. doi:10.5414/CP203650. PMID 32101522. S2CID 211537187.

[:1-19] 1 2 Jacobson MA (1992-01-01). "Review of the toxicities of foscarnet". Journal of Acquired Immune Deficiency Syndromes. 5 (Suppl 1): S11–S17. PMID 1534839.

[20] Gearhart MO, Sorg TB (March 1993). "Foscarnet-induced severe hypomagnesemia and other electrolyte disorders". The Annals of Pharmacotherapy. 27 (3): 285–289. doi:10.1177/106002809302700304. PMID 8384030. S2CID 37250222.

[:2-21] 1 2 Zareifopoulos N, Lagadinou M, Karela A, Kyriakopoulou O, Velissaris D (August 2020). "Neuropsychiatric Effects of Antiviral Drugs". Cureus. 12 (8) e9536. doi:10.7759/cureus.9536. PMC 7465925. PMID 32905132.

[22] Adalsteinsson JA, Pan M, Kaushik S, Ungar J (April 2018). "Foscarnet-induced genital lesions: An overview with a case report". Dermatology Reports. 10 (1): 7749. doi:10.4081/dr.2018.7749. PMC 6026811. PMID 29991980.