| ACYCLOVIR, ACYCLOVIR SODIUM
Classifications: antiviral; Therapeutic: antiviral
Pregnancy Category: B
200 mg capsules; 400 mg, 800 mg tablets; 200 mg/5 mL suspension; 50 mg/mL injection; 5% ointment, cream
Acyclovir is a synthetic nucleoside analog of guanine. Acyclovir preferentially interferes with DNA synthesis of herpes
simplex virus types 1 and 2 (HSV-1 and HSV-2) and varicella-zoster virus, thereby inhibiting viral replication.
Acyclovir reduces viral shedding and formation of new lesions and speeds healing time. It demonstrates antiviral activity
against herpes virus simiae (B virus), Epstein-Barr (infectious mononucleosis), varicella-zoster and cytomegalovirus, but
does not eradicate the latent herpes virus.
Parenterally for treatment of initial and recurrent mucosal and cutaneous herpes simplex virus (HSV-1 and HSV-2) infections
in immunocompromised adults and children and for severe initial episodes of herpes genitalis in immunocompetent (normal
immune system) patients. Treatment of herpes encephalitis or neonatal herpes infection. Used orally for treatment of initial
episodes of genital herpes, for management of selected patients with severe recurrent episodes, and for prophylaxis to reduce
frequency and severity of recurrent infections. Used topically for herpes labialis (cold sores), initial episodes of herpes
genitalis and in non-life-threatening mucocutaneous herpes simplex virus infections in immunocompromised patients.
Treatment of eczema herpeticum caused by HSV localized and disseminated herpes zoster. Prevention of CMV in transplant patients.
Prevention of HSV in immunosuppressed HSV-seropositive patients.
Hypersensitivity to acyclovir and valacyclovir.
Renal insufficiency, dehydration, seizure disorders, or neurologic disease; pregnancy (category B).
Route & Dosage
Adult/Adolescents (≥12 y): Topical Apply 5 times/d for 4 d
Genital Herpes Simplex
Adult: PO 400 mg t.i.d. for 710 d cycle IV 5 mg/kg q8h x 7 d Topical Apply q3h 6 times/d for 7 d
Child (<12 y): IV 250 mg/m2 q8h, 80 mg/kg/d in 25 doses
Herpes Simplex Immunocompromised Patient
Adult: IV 5 mg/kg q8h x 7 d
Child: IV 10 mg/kg q8h x 7 d
Prophylaxis for Genital Herpes Simplex
Adult: PO 200 mg 25 times/d, 400 mg t.i.d., 800 mg b.i.d.
Child: PO 80 mg/kg/d in 25 divided doses
Severe Genital Herpes
Adult/Adolescent: IV 5 mg/kg q8h x 5 d
Adult: PO 800 mg q4h 5 times/d
Child: PO 80 mg/kg/d in 5 divided doses
Herpes Simplex Encephalitis
Adult: IV 10 mg/kg q8h x 10 d
Child (3 mo12 y): IV 20 mg/kg q8h x 10 d
Neonate (<3 mo): IV 10 mg/kg q8h x 10 d
Child/Adolescent: PO 20 mg/kg (max: 800 mg) q.i.d. for 5 d cycle initiated within 24 h of onset of rash
Adult: IV 10 mg/kg q8h x 7 d
Child: IV 20 mg/kg q8h x 7 d
Patient dose should be calculated using IBW.
Clcr 2550 mL/min: standard dose q12h; 1025 mL/min: standard dose q24h; <10 mL/min give half normal dose q24h
Hemodialysis: Administer dose after dialysis
- Shake suspension well prior to use.
- Store capsules in tight, light-resistant containers at 15°30° C (59°86° F) unless otherwise
- Wash hands thoroughly before and after treatment of lesions and after handling and disposition of secretions.
- Apply approximately ? inch of cream or ointment ribbon for each 4 square inches of surface area. Use sufficient ointment
or cream to completely cover lesions.
- Apply topical preparation with finger cot or surgical glove.
- Store at 15°25° C (59°78° F) unless otherwise directed.
PREPARE: Intermittent: ??Reconstitute by adding 10 mL sterile water for injection to 500-mg vial to yield 50 mg/mL. Note: Do not use bacteriostatic
water for injection containing benzyl alcohol. Shake well.??Use reconstituted solution within 12 h.??Further dilute to ≤7 mg/mL to reduce risk of renal injury and phlebitis. Example:
Add 1 mL of reconstituted solution to 9 mL of diluent to yield 5 mg/mL.??Use standard electrolyte and glucose solutions (e.g., NS, RL, D5W) for dilution. Diluted solution should be used within
ADMINISTER: Intermittent: ??Administer over at least 1 h to prevent renal tubular damage. Rapid or bolus IV administration must be avoided.??Monitor IV flow rate carefully; infusion pump or microdrip infusion set preferred.
INCOMPATIBILITIES Solution/additive: Bacteriostatic water for injection, dobutamine, dopamine, pantoprazole. Y-site: Amifostine, amsacrine, aztreonam, cefepime, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondanseteron, piperacillin/tazobactam, sargramostim, TPN, vinorelbine.
- Refrigerated reconstituted solution may precipitate; however, crystals will redissolve at room temperature.
- Store acyclovir powder and reconstituted solutions at controlled room temperature preferably at 15°30° C
(59°86° F) unless otherwise directed by manufacturer.
Adverse Effects (≥1%) Body as a Whole:
Generally minimal and infrequent. CNS: Headache,
light-headedness, lethargy, fatigue
, tremors, confusion, seizures, dizziness. GI: Nausea, vomiting, diarrhea. Urogenital:
Glomerulonephritis, renal tubular damage, acute renal failure. Skin:
Rash, urticaria, pruritus, burning, stinging sensation, irritation, sensitization. Other:
Inflammation or phlebitis at IV injection site, sloughing (with extravasation), thrombocytopenic purpura/hemolytic uremic syndrome.
may cause increased drowsiness and lethargy.
Oral dose is 1530% absorbed. Peak:
1.52 h after oral dose. Distribution:
Into most tissues with lower levels in the CNS; crosses placenta. Metabolism:
Drug is primarily excreted unchanged. Elimination:
Renally eliminated; also excreted in breast milk. Half-Life:
Assessment & Drug Effects
- Observe infusion site during infusion and for a few days following infusion for signs of tissue damage.
- Monitor I&O and hydration status. Keep patient adequately hydrated during first 2 h after infusion to maintain sufficient
urinary flow and thus prevent precipitation of drug in renal tubules. Consult physician about amount and length of time
oral fluids need to be pushed after IV drug treatment.
- Monitor for S&S of: reinfection in pregnant patients; acyclovir-induced neurologic symptoms in patients with history of
neurologic problems; drug resistance in immunocompromised patients receiving prolonged or repeated therapy; acute renal failure
with concomitant use with other nephrotoxic drugs or preexisting renal disease.
- Lab tests: Monitor baseline and periodic renal function studies, particularly with IV administration. Elevations of BUN
and serum creatinine and decreases in creatinine clearance indicate need for dosage adjustment, discontinuation of drug,
or correction of fluid and electrolyte balance.
- Monitor for adverse effects and viral resistance with long-term prophylactic use of the oral drug.
Patient & Family Education
- Start therapy as soon as possible after onset of S&S for best results.
- Do not exceed recommended dosage, frequency of drug administration, or specified duration of therapy. Contact physician if
relief is not obtained or adverse effects appear.
- Cleanse affected areas with soap and water 34 times daily prior to topical application; dry well before application.
With application to genitals, wear loose-fitting clothes over affected areas.
- Note: Even after HSV infection is controlled, latent virus can be activated by stress, trauma, fever, exposure to sunlight, sexual
intercourse, menstruation, treatment with immunosuppressive drugs.
- Refrain from sexual intercourse if either partner has S&S of herpes infection; neither topical nor systemic drug prevents
transmission to other individuals.
- Avoid topical drug contact in or around eyes. Report unexplained eye symptoms to physician immediately (e.g., redness, pain);
untreated infection can lead to corneal keratitis and blindness.