Generic name: Foscavir or Foscavir Injection (foscarnet sodium)
Other commonly used names: PFA, phosphonoformic acid, trisodium phosphonoformate
Manufacturer: Astra USA
Foscarnet is indicated in the treatment of:
Foscarnet is not active against bacteria or mycoplasma.
Mechanism of action
Foscarnet blocks, through non-competitive inhibition, of the pyrophosphate binding site of viral DNA polymerase, thereby preventing the cleavage of pyrophosphate from deoxynucleoside triphosphate and elongation of the viral DNA chain. Foscarnet does not require viral thymidine kinase for activation, and viral replication resumes after foscarnet is discontinued.
In vitro studies reveal foscarnet to inhibit the viral replication of all known herpes viruses. It can also non-competitively inhibit human immunodeficiency virus (HIV) reverse transcriptase and hepapitis B virus DNA polymerase. However, full evaluations of the use of this drug in clinical practice for many of these infections have not yet been conducted.
Foscarnet also inhibits competitively the sodium-phosphate cotransport by renal cortical brush border membrane vesicles. This drug is dose-dependent and specific for phosphate, possibly decreasing tubular reabsorption and thus increasing phosphate-renal excretion.
Oral administration of foscarnet is poorly absorbed, and bioavailability ranges from 12 to 22%.
About 80-87% of the drug was excreted unchanged in urine. Tubular reabsorption could possibly occur, and apparent extrarenal clearance could indicate the uptake of foscarnet into bone matrix.
Nephrotoxic effects have been alleviated with hydration using 0.5 to 1 liter of 0.9% sodium chloride per dose throughout the course of foscarnet treatment.
Foscavir is available in 250 and 500 mL bottles containing 24 mg foscarnet sodium/mL. It should be storeed at room temperature (15 to 30 degree C).
Patients with acyclovir-resistant mucocutaneous HSV infections who lack insurance coverage can participate in the Foscavir Assistance and Information on Reimbursement program by calling 1-800-488-3247 (FDA Reports 1995; p T&G1-2.)