# A transplant recipient is starting maribavir for post-transplant cytomegalovirus infection. Classify each finding by the medication-safety decision it supports.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522598&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A transplant recipient is starting maribavir for post-transplant cytomegalovirus infection. Classify each finding by the medication-safety decision it supports.

|  | Avoid because antiviral activity or maribavir efficacy may fall | Monitor or adjust an interacting medication | Intensify CMV virologic follow-up |
| --- | --- | --- | --- |
| Valganciclovir remains scheduled with maribavir |  |  |  |
| Rifampin is newly prescribed |  |  |  |
| The client takes digoxin |  |  |  |
| The client takes cyclosporine |  |  |  |
| CMV DNA rises during treatment |  |  |  |
| CMV symptoms recur 5 weeks after treatment ends |  |  |  |

## Explanation

Valganciclovir or ganciclovir can be antagonized by maribavir; rifampin or St. John wort can reduce maribavir efficacy; digoxin and calcineurin-inhibitor exposure may increase; CMV DNA must be followed for failure or relapse.

## In-depth explanation

Quick answer
Separate antiviral antagonism, pharmacokinetic interaction, and virologic surveillance.

Why this is correct
Maribavir has clinically important bidirectional interactions and resistance-related failure can occur during or after therapy. Medication reconciliation and CMV DNA monitoring are both essential.

Easy analogy or mental picture
Use a closed medication-safety loop: identify the immune or cytotoxic exposure, connect the new findings, interrupt further harm, stabilize the client, and verify the response over time.

Memory hook
Exposure, immune effect, organ toxicity, infection risk, immediate action, and serial reassessment.

NCLEX decision rule
Choose the action that reduces the most immediate medication-related risk while preserving diagnostic evaluation and authorized treatment.

Why the other choices are wrong
Options that continue the exposure, treat only one symptom, or delay reassessment leave the toxic or infectious process active.References
1DailyMed: LIVTENCITY (maribavir)Antagonism with ganciclovir or valganciclovir, CYP3A inducer effects, monitored interactions, and CMV DNA follow-up

## Clinical scenario

Oncology, transplant, and biologic safety review
Verify the indication, immune status, infection screen, interacting medicines, current organ findings, authorized action, and measurable follow-up.

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