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Foscarnet is an antiviral agent used to treat cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zoster virus (VZV) infections, particularly in immunocompromised individuals. Foscarnet is typically reserved for viral strains for which first-line treatments may be less effective. This activity examines the drug's mechanism of action, contraindications, adverse effects, and the FDA's boxed warnings. Pharmacokinetic properties and drug interactions will also be reviewed, providing essential knowledge for adjusting dosages to minimize adverse effects. Foscarnet requires careful management due to its nephrotoxic potential and electrolyte imbalances, among other risks. Understanding the role of an interprofessional healthcare team in monitoring and managing these adverse effects is critical for ensuring patient safety. A strong focus on adherence to evidence-based treatment protocols enhances the antiviral effectiveness of foscarnet. This activity highlights the importance of optimizing treatment regimens to improve patient outcomes with complex viral infections. Objectives: Identify the indications for foscarnet therapy. Assess the most common adverse events associated with foscarnet administration. Determine the importance of monitoring patients on foscarnet therapy. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from foscarnet therapy. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose Clinical features of foscarnet toxicity include seizures, nephrotoxicity, paresthesias, and electrolyte imbalances. Severe overdose may result in coma and fatal respiratory or cardiac arrest. Management of Overdose To prevent irreversible damage, the patient should have frequent bloodwork and constant monitoring for renal impairment, electrolyte derangement, and seizures in overdose situations. The risk of nephrotoxicity can be mitigated by concurrent administration of 0.9% normal saline (about 0.5 to 1.0 L) or dextrose 5% water solution. While a history of chronic renal disease can increase the risk of foscarnet toxicity, it is also important to withhold the administration of other potentially nephrotoxic drugs such as ACE inhibitors, angiotensin II receptor blockers, amphotericin B, vancomycin, or aminoglycosides to reduce the risk of additional renal damage.[26][27] While there is no particular antidote for foscarnet overdose, it can be prevented through adequate prophylactic hydration or urgent hemodialysis to decrease drug plasma levels.

Managing the administration of foscarnet to immunocompromised individuals infected with HSV, CMV, or VZV viruses requires an interprofessional team effort by healthcare professionals comprised of physicians, nurses, lab technicians, infectious disease specialists, pharmacists, and social workers. Such a team would be able to enhance the optimal outcomes during the administration of this drug. Prompt action in the diagnosis of infection and administration of the drug is fundamental to the optimal efficacy of this therapy.[28] Additionally, since this drug is not available orally and is administered most commonly via intravenous routes, it is of utmost importance to have the team involved with consistently monitoring the drug’s effect on the patient’s condition, especially during dosing changes.[29] Potential obstacles to ineffective therapy with foscarnet include inefficient interprofessional communication between team members, inconsistency in surveillance of the patient’s progress with the treatment, or concurrent usage of drugs that may interfere with foscarnet therapy.[30] Compliance and overdose are aspects of the medication that require emphasis during patient education. The education should come from all team members, such as physicians, specialists, nurses, and pharmacists. Since appropriate dosing of this drug is very crucial, clinicians must always be on the same page with the individualized aspect of therapy: the patient’s past medical history, inpatient and outpatient medication list, and changes in dosages of the foscarnet therapy regimen should always be available and consistent between all of them. With renal dysfunction being a major concern associated with this drug, the interprofessional team needs to monitor renal function.[31][18] Consultation with nephrology is recommended in cases of foscarnet overdose or nephrotoxicity.

Compliance and overdose are aspects of the medication that require emphasis during patient education. The education should come from all team members, such as physicians, specialists, nurses, and pharmacists. Since appropriate dosing of this drug is very crucial, clinicians must always be on the same page with the individualized aspect of therapy: the patient’s past medical history, inpatient and outpatient medication list, and changes in dosages of the foscarnet therapy regimen should always be available and consistent between all of them. With renal dysfunction being a major concern associated with this drug, the interprofessional team needs to monitor renal function.[31][18] Consultation with nephrology is recommended in cases of foscarnet overdose or nephrotoxicity. Upon completion of therapy, the patient’s primary care physician or infectious disease physician must schedule follow-up visits to assess remission status versus recurrence; this is a crucial part of treatment as it catches any early recurrence of disease and prevents the need to reinitiate therapy (thereby exposing the patient to more adverse effects). An interprofessional team approach and communication among clinicians are crucial to decreasing potential adverse effects, improving disease course, and improving patient outcomes related to foscarnet therapy.