AEGiS-GMHC: IN BRIEF: Approval Recommended for Foscarnet

Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.

IN BRIEF: Approval Recommended for Foscarnet

Gay Men's Health Crisis Treatment Issues, Vol. 5, No. 5 - June 20, 1991
David Barr

On June 12, the Antiviral Drugs Advisory Committee of the FDA recommended that the agency grant marketing approval for foscarnet (brand name Foscavir). This drug has been in clinical trials as a treatment for cytomegalovirus (CMV) for a number of years. In addition, foscarnet has some limited effect against HIV, at least in the test tube. It has also shown some efficacy in treating herpes simplex virus that has developed resistance to acyclovir (Zovirax), a drug approved to treat the condition. If the FDA follows the committee's recommendation, foscarnet will join ganciclovir (DHPG) as a licensed treatment for CMV.

Foscarnet has its share of limitations. Unfortunately, like ganciclovir, foscarnet does not cure CMV. People with CMV who are immunosuppressed must continue to take maintenance doses of foscarnet indefinitely. Otherwise, the infection will rebound. Since the drug can only be administered intravenously, regular dosing requires the surgical implantation of a catheter, a device providing direct access to the bloodstream. Foscarnet is a toxic drug, causing kidney problems and anemia.

Recently, another serious toxicity has come to light -- foscarnet also causes severe calcium deficiencies. Foscarnet- associated calcium deficiencies are not detectable by ordinary lab tests which measure calcium levels. However, the symptoms are quite evident to anyone experiencing them. People taking foscarnet should report to their physician any numbness or tingling in their fingers, toes, or lips, as well as nausea and dizziness. There is an easy solution to this problem: calcium can be administered intravenously before foscarnet treatments. The tubing must be flushed with saline after the infusion of calcium and before the infusion of foscarnet.

Despite the shortcomings of foscarnet, it is a welcome addition to the arsenal of drugs available to treat HIV-related opportunistic infections. Foscarnet is compatible with AZT, unlike ganciclovir. In addition, the drug has been shown to be effective in people with CMV who have developed resistance to ganciclovir.

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