Foscarnet

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.^[3][4] Foscarnet is the conjugate base of a chemical compound with the formula HO₂CPO₃H₂ (Trisodium phosphonoformate).^[5][6]

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[1] UK: POM (Prescription only) US: ℞-only[2]
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 N (trisodium salt)
PubChem CID	3415
IUPHAR/BPS	5497
DrugBank	DB00529 Y
ChemSpider	3297 Y
UNII	364P9RVW4X
KEGG	D00579 Y D02267 Y
ChEBI	CHEBI:127780 Y
ChEMBL	ChEMBL666 Y
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) Y Key:ZJAOAACCNHFJAH-UHFFFAOYSA-N Y
NY (what is this?)  (verify)

Foscarnet was approved for medical use in 1991.^[7] It is available as a generic medication.^[8]

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.^[9][10][11]

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.^[11]

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.^[12][13] 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.^[5]

However, acyclovir- or ganciclovir-resistant mutants with alterations in viral DNA polymerase may also be resistant to foscarnet.^[14][15]

Administration

Foscarnet is administered by intravenous infusion or intravitreous injection.^{[citation needed]}

Side effects

• Nephrotoxicity — increase in serum creatinine levels and renal injury can occur in patients receiving foscarnet.^[5][16] Other nephrotoxic drugs should be avoided. Nephrotoxicity is usually reversible and can be reduced by dosage adjustment and adequate hydration.^[17]
• Electrolyte disturbances — hypocalcemia and hypomagnesemia can occur^[17][18] and regular monitoring of electrolytes is necessary to avoid clinical toxicity.^[5][19]
• Genital ulceration — a less common reported side effect which occurs more in men and usually during induction use of foscarnet.^[5] It is most likely a contact dermatitis due to high concentrations of foscarnet in urine. It usually resolves rapidly following discontinuation of the drug.^[20]
• CNS — less common side effects of perioral paresthesia, irritability and altered mental states.^[19]