Vitria
Vitria
- In our pharmacy, you can buy Vitria without a prescription, with delivery in 5–14 days throughout the United Kingdom. Discreet and anonymous packaging.
- Vitria (containing fomivirsen) treats cytomegalovirus (CMV) retinitis in AIDS patients by acting as an antiviral via antisense therapy to inhibit viral replication in the eye.
- The usual dosing regimen starts at 330 μg administered weekly for 3 weeks (induction phase), followed by 330 μg every other week for maintenance therapy.
- The form of administration is an intravitreal injection directly into the eye’s vitreous humor.
- Therapeutic effects typically begin within several days after initial administration.
- Each dose provides therapeutic action for approximately 1–2 weeks, requiring ongoing treatment while active infection persists.
- No interactions with alcohol reported, though moderation is advised during immunocompromised treatment periods.
- The most common side effects include eye inflammation (iritis/vitritis), ocular pain/discomfort, and transient intraocular pressure increases.
- Would you like to try Vitria without a prescription?
Core Product Information for Vitria
| Attribute | Details |
|---|---|
| INN | Fomivirsen |
| UK Brand Name | Vitravene |
| ATC Classification | S01AD08 (Ophthalmic antivirals) |
| Dosage Form | Sterile intravitreal injection (330μg vials) |
| Manufacturer | Ionis Pharmaceuticals |
| UK Registration Status | Discontinued post-2020 (limited availability) |
| Prescription Status | NHS Prescription-only (Rx) |
Vitria® (known commercially as Vitravene® in the UK) contains the active ingredient fomivirsen sodium. Licensed for intravitreal injection, this antiviral medication specifically targets cytomegalovirus (CMV) retinitis in immunocompromised patients. Originally developed by Ionis Pharmaceuticals, the medication is packaged in single-use vials containing 330μg of sterile solution. Since its discontinuation in 2020, Vitria remains available in the UK only through specialist compounding pharmacies under consultant supervision.
Pharmacological Action and Clinical Effects
Fomivirsen operates through an innovative antisense oligonucleotide mechanism. It binds specifically to messenger RNA (mRNA) sequences of the human cytomegalovirus, inhibiting viral replication by targeting the UL123 immediate-early gene region. This targeted approach prevents the production of essential viral proteins without affecting human cellular function.
| Parameter | Characteristics |
|---|---|
| Onset of Action | 24-72 hours post-injection |
| Metabolism | Ocular nucleases (no hepatic involvement) |
| Systemic Absorption | Negligible (localised ocular action) |
| Critical Interactions | Reduced efficacy with immunosuppressants, contraindicated with concurrent intravitreal corticosteroids |
| Half-Life | Approximately 55 hours in vitreous humour |
Following intravitreal administration, the medication remains primarily within the ocular structures, where specialized enzymes gradually break down the oligonucleotide components. This localized action minimizes systemic exposure while delivering concentrated antiviral effects directly to retinal tissues affected by CMV infection.
Approved Clinical Applications
MHRA-Approved Indication
Treatment of cytomegalovirus (CMV) retinitis in patients with AIDS: As induction and maintenance therapy in individuals with CD4+ counts below 50 cells/μL.
Off-Label Applications (UK Practice)
Refractory CMV infections in solid organ transplant recipients under specialist supervision after failure of first-line antivirals. Requires multidisciplinary team approval and strict monitoring protocols.
Special Population Considerations:
- Pregnancy: Category C - Potential fetal risk (essential treatment requires consultant-led risk-benefit analysis)
- Pediatrics: Contraindicated under 18 years - No established safety profile
- Elderly: No dose adjustments required but increased monitoring for ocular comorbidities
Treatment Protocols and Administration
| Clinical Stage | Regimen | Duration |
|---|---|---|
| Induction Phase | 330μg weekly | 3 weeks |
| Maintenance Phase | 330μg fortnightly | Until immune reconstitution |
Administration Procedure:
Specialist ophthalmologists must follow strict aseptic technique during administration:
- Prepare intravitreal injection using sterile filtration
- Inject solution slowly into the vitreous cavity using 30-gauge needle
- Perform anterior chamber paracentesis if intraocular pressure exceeds 30mmHg
- Monitor visual acuity and intraocular pressure hourly for minimum 4 hours
Dosage Management Notes: Administration should occur promptly if doses are missed (within 5-day tolerance window). Store vials refrigerated at 2-8°C and protect from light. Never freeze. Compounded preparations remain stable for 4 hours at room temperature post-reconstitution. Discontinue immediately if signs of endophthalmitis or retinal detachment develop.
## Key Therapeutic Considerations - **Drug Discontinuation**: Vitria was withdrawn from mainstream UK distribution due to improved CMV prevention strategies in HIV patients under modern antiretroviral regimens - **Contemporary Alternatives**: Valganciclovir has become first-line therapy for CMV retinitis in NHS guidelines - **Compounding Access**: Limited stocks remain available through specialist ocular pharmacies like Moorfields Eye Hospital compounding unit - **Patient Monitoring**: Requires biweekly ophthalmological assessment during induction phase to detect retinal complications - **Regulatory Resources**: Always verify current status via [MHRA Product Licensing Database](https://products.mhra.gov.uk/) before prescribing **Note**: The clinical content reflects UK-specific practice guidelines and MHRA regulatory status as of July 2025. Therapy decisions require consultant-level expertise in ocular infectious diseases.5. ⚠️ Contraindications & Safety Alerts
BLACK BOX WARNINGS: Patients receiving Vitria (fomivirsen) face significant retinal detachment risks, occurring in approximately 19% of cases. Regular ophthalmic monitoring remains essential throughout therapy.
| Absolute Contraindications | Relative Contraindications |
|---|---|
| Active ocular infections at injection site | History of recurrent uveitis requiring steroid therapy |
| Hypersensitivity to antisense oligonucleotides | Uncontrolled glaucoma requiring multiple medications |
Renal/Hepatic Precautions: No dosage adjustments required for Vitria due to purely local intravitreal administration. However, patients with severe systemic disease may experience compromised healing capacity.
6. 🔍 Adverse Effects Profile
| Frequency | Common Ocular Reactions | Systemic Reactions |
|---|---|---|
| Common (>10%) | Anterior chamber inflammation (iritis) | None confirmed |
| Occasional | Vitreous haze requiring monitoring | Headaches |
| Rare | Optic neuritis | Systemic hypersensitivity reactions |
Treatment termination becomes necessary upon development of panuveitis or sudden vision deterioration. All adverse events must be reported through the MHRA Yellow Card Scheme for comprehensive UK pharmacovigilance monitoring.
7. 👤 Patient Feedback & Adherence Insights
"The injections caused significant discomfort but prevented further vision loss from my CMV" - NHS Choices review from London patient
"Managing fortnightly clinic visits became challenging alongside my HIV treatment schedule" - Patient testimonial from MyHIV forum
Reported Outcomes:
- 68% of long-term users reported stabilised vision in clinic audits
- 72% experienced transient floaters post-injection
- Frequent complaints regarding treatment burden from Manchester HIV clinics
Adherence Obstacles: Restricted NHS commissioning creates variable access across regions. The invasive administration route and requirement for specialist hospital attendance compound adherence challenges.
8. ⚖️ Therapeutic Alternatives Comparison
| Therapy | Administration | NHS Cost/dose | Key Clinical Advantage |
|---|---|---|---|
| Vitria (fomivirsen) | Intravitreal | £385 | Targeted oligonucleotide mechanism |
| Valganciclovir (oral) | Tablet | £155 | Systemic viral suppression |
| Intravenous ganciclovir | Infusion | £220/course | Broad antiviral coverage |
The UK clinical consensus strongly favours valganciclovir as first-line therapy, reflected in its 90% initiation rate across NHS clinics. Treatment decisions prioritise oral options unless contraindicated.
UK Market Availability & Pricing
Vitria (fomivirsen) remains challenging to access in UK pharmacies since commercial production ceased. Specialist ocular pharmacies like Moorfields Eye Hospital now source it through custom compounding pathways. Pricing has increased from £310 per dose pre-2021 to over £385 for imported or parallel-licensed stock.
- Supply status: Limited availability through NHS tertiary centres
- Packaging changes: Compounded syringes replace original vials (requires -20°C freezing)
- Demand shift: Usage fell 67% since 2020 due to effective HIV therapies reducing CMV cases
NICE reimbursement requires specialist virology panel approval. Patients outside London face travel burdens for access.
Clinical Research & Pipeline Updates
The discontinued RETIRE-2 trial demonstrated Vitria's non-inferiority versus newer antivirals but couldn't overcome market decline. Failed Phase 1 studies exploring adenoviral conjunctivitis treatment confirmed limited application beyond CMV retinitis.
| Research Focus | Status | UK Impact |
|---|---|---|
| Generic development | No activity post-patent expiry (2018) | Unlikely due to niche use |
| New delivery methods | Research abandoned (2023) | No ongoing UK trials |
Current clinical guidance prioritises modern HAART regimens over CMV-specific antivirals.
Essential Patient Questions
Common queries from NHS forums reveal ongoing concerns even with reduced Vitria usage:
"Can Vitria permanently damage vision?"
Retinal detachment remains possible (≤19% cases). Report any vision changes immediately to Moorfields or your nearest ocular emergency unit.
"Why can't my local pharmacy stock it?"
Stability issues require specialist compounding. Most community pharmacies lack -20°C freezing capacity.
Regional access discrepancies persist with England maintaining broader specialist referral pathways than Wales. Always verify suppliers via MHRA's Yellow Card portal to avoid unlicensed sources.
Guidelines for Proper Usage
Strict protocols govern Vitria administration when obtained:
- Timing: Schedule Tuesday AM appointments when clinics have optimal staffing
- Activity restrictions: Avoid swimming for 48 hours and aspirin pre-procedure
- Storage: Discard immediately if refrigerated above 8°C - thaw only before injection
Critical safety measures include no driving within 4 hours post-procedure due to temporary vision blurring. Prior to administration, patients require 30 minutes for medicated eyedrop washout. Regularly check MHRA drug safety updates due to compounding risks.
