ANTIVIRAL AGENTS

I. HERPES SIMPLEX VIRUS (HSV)/ VARICELLA-ZOSTER VIRUS (VZV)

MECHANISM OF ACTION REMARKS ADRs

ACYCLOVIR All are DNA POLYMERASE Potency for HSV > VZV n,v,d,h
VALACYCLOVIR INHIBITORS Valyl ester of acyclovir NEPHROTOX
FAMCICLOVIR PRODRUG; converted to NEUROTOX
ACYCLOVIR and penciclovir Animal studies showed the potential of these
PENCICLOVIR VALACYCLOVIR – DNA Available for topical administration agents to cause testicular toxicity
polymerase inhibition leads
to DNA chain termination.

II. CYTOMEGALOVIRUS (CMV)

MECHANISM OF KINETICS ADRs REMARKS

ACTION
VALGANCYCLOVIR DNA Better PO MYELOSUPPRESSION; ALL ANTIVIRAL AGENTS ARE DNA
POLYMERASE absorption n,v,d,f,r,h; POLYMERASE INHIBITORS.
GANCYCLOVIR INHIBITION PO/IV; poor insomnia; peripheral neuropathy; FOSCARNET ALSO INHIBITS RNA
CSF animals: mutagenic, carcinogenic, POLYMERASE AND REVERSE
penetration aspermatogenesis TRANSCRIPTASE.
CIDOFOVIR IV; poor CSF NEPHROTOXICITY;
penetration OCULAR TOXICITY; “Valgancyclovir and gancyclovir are VERY
Neutropenia; GOOD FOR MYELOSUPPRESSION.”
Animals: mutagenic, carcinogenic;
gonadotoxic “GUYS WOULD NOT WANT TO TAKE DRUGS
FOSCARNET DNA and RNA IV; Good CSF NEPHROTOXICITY; FOR CMV:
POLYMERASE penetration HYPO/HYPERCALCEMIA Valgancyclovir/ gancyclovir –
INHIBITION; HYPO/HYPERMAGNESEMIA aspermatogenesis
REVERSE PENILE ULCERATION Cidofovir – gonadotoxic
TRANSCRIPTASE n,v,d,f Foscarnet – penile ulceration”
INHIBITION Hepatotox; CNS toxicity
III. HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Nucleotide/ Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

MECHANISM OF ACTION REMARKS PARTICULAR ADRs

ABACAVIR HIV Reverse transcriptase All may be ABACAVIR Cough; risk of myocardial infarction
DIDANOSINE inhibition given PO. DIDANOSINE Pancreatitis
EMTRICITABINE ↓ EMTRICITABINE Darkening of palms and soles
LAMIVUDINE Viral DNA chain All can LAMIVUDINE Pancreatitis
STAVUDINE termination cross the STAVUDINE Pancreatitis; peripheral neuropathy
TENOFOVIR BBB. TENOFOVIR Nephrotoxicity  altered Ca and Mg
metabolism  osteoporosis
ZALCITABINE ZALCITABINE Peripheral neuropathy; Oral and
esophageal toxicity
ZIDOVUDINE ZIDOVUDINE Myelosuppression; Myopathy;
Thrombocytopenia

NON-Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

MECHANISM OF REMARKS PARTICULAR ADRs

ACTION
DELAVIRDINE Allosteric Common Teratogenic CYP INHIBITOR
EFAVIRENZ inhibition of adverse effects CNS – dizziness,
reverse for ALL: drowsiness, insomnia, MIXED CYP EFFECT
transcriptase GI headache, mania
↓ RASH Teratogenic
Viral DNA chain SJS hepatotox
ETRAVIRINE termination HEPATOTOXICITY
NEVIRAPINE CYP INDUCER
Protease Inhibitors (PI)

MECHANISM OF REMARKS PARTICULAR ADRs

ACTION
ATAZANAVIR Protease enzyme ALL are excreted via Hyperbilirubinemia ALL PROTEASE INHIBITORS ARE CYP INHIBITORS.
DARUNAVIR mediates the the fecal route. SJS
FOSAMPRENAVIR conversion of SJS ; perioral paresthesia RITONAVIR is often used to BOOST the levels of
INDINAVIR Gag-Pol ALL are associated Hyperbilirubinemia; other PIs when concomitantly administered
polyproteins to with the following Nephrolithiasis; (EXCEPT FOSAMPRENAVIR)
functional ADRs: Thrombocytopenia;
proteins. n,v,d,abd pain Insulin resistance LOPI- and NELFINAVIR may be used ideally for the
LOPINAVIR INHIBITION OF Hepatotox treatment of pregnant women.
NELFINAVIR PROTEASE  NO Lipid abnormality
RITONAVIR FUNCTIONAL Circumoral paresthesia
SAQUINAVIR PROTEINS FOR Rhinitis
TIPRANAVIR VIRAL PARTICLE Intracranial hemorrhage
PRODUCTION

Others

MECHANISM OF ACTION REMARKS ADRs

RALTEGRAVIR Integrase inhibition PO N,v,d,h; myopathy
ENFUVIRTIDE Viral entry inhibition SC Local irritation; allergy
MARAVIROC PO Cough; myalgia; arthralgia;
diarrhea; hepatotox
IV. HEPATITIS B (HBV)/ HEPATITIS C (HCV)

MECHANISM OF REMARKS PARTICULAR ADRs

ACTION
ADEFOVIR DNA All may be NEPHROTOX
ENTECAVIR POLYMERASE administered
LAMIVUDINE INHIBITION PO RISK OF PANCREATITIS
TELBIVUDINE PERIPHERAL NEUROPATHY
All are
associated with
the ff ADRs:
n,v,d,abd pain
lactic acidosis
steatosis

Hepatitis C: RIBAVIRINE: MOA (?); ADR: Hemolytic anemia, depression, fatigue

V. INFLUENZA VIRUS

MECHANISM OF ACTION REMARKS ADRs

AMANTADINE Inhibits UNCOATING of viral PO GI: nausea, anorexia
RIMANTADINE RNA PO CNS: nervousness,
10x more potent than insomnia,
amantadine lightheadedness
OLSETAMIVIR Inhibits NEURAMINIDASE  PO n,v,h,d,abd pain
ZANAMIVIR inhibition of release INH Cough, throat
irritation,
bronchospasm