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G. MARK BAILLIE, PHARM.D., MHA, is Clinical Coordinator, Surgery and Critical Care Pharmacy Services, and Clinical Associate Professor of Pharmacy, Medical University of South Carolina, 150 Ashley Avenue, Charleston, SC 29425 (bailliem{at}musc.edu).

Purpose. The mechanism of action, pharmacokinetics, and other advantages and disadvantages of ganciclovir and valganciclovir are discussed. Summary. Shortcomings of oral ganciclovir include low bioavailability, large pill burden, patient nonadherence, and the emergence of resistance. Valganciclovir, an oral prodrug of ganciclovir, has a nearly tenfold greater absolute bioavailability than ganciclovir. Dosage adjustment is required for both drugs in patients with renal impairment. Conclusion. The pharmacokinetic profile of valganciclovir offers significant advantages for its use in cytomegalovirus (CMV) prophylaxis. Index terms: Antivirals; Compliance; Cytomegalovirus infections; Dosage; Drug administration routes; Drugs, availability; Drugs; Economics; Ganciclovir; Kidney failure; Mechanism of action; Patients; Pharmacokinetics; Resistance; Transplantation; Valganciclovir