Acyclovir - Micromedex

10/19/2019 Drug summary - MICROMEDEX
Acyclovir
DrugPoint Summary
DOSING/ADMINISTRATION
Adult Dosing
Important Note
Orphan drug designation: Treatment of acute herpetic keratitis caused by Herpes Simplex Virus type 1 and 2
Bell's palsy
400 mg orally 5 times daily for 10 days plus predniSONE 1 mg/kg (minimum dose, 30 mg) orally twice daily for the first 5 days,
followed by a gradual taper down to 5 mg twice daily over the next 5 days (off-label dosage) [3]
Eczema herpeticum
200 mg orally 5 times daily for 5 days [4]
Genital herpes simplex
(Oral) Initial episode: 200 mg orally every 4 hours 5 times per day for 10 days (FDA dosage) [5][6]
(Oral) Initial episode: 400 mg orally 3 times per day for 7 to 10 days OR 200 mg orally 5 times daily for 7 to 10 days; may extend
duration of therapy if healing is not complete after 10 days (guideline dosage) [7]
(Oral) Episodic therapy: 200 mg orally every 4 hours, 5 times daily for 5 days; Initiate therapy at the earliest sign or symptom of
recurrence (FDA dosage) [5][6]
(Oral) Episodic therapy: 400 mg orally 3 times daily for 5 days OR 800 mg orally twice daily for 5 days OR 800 mg orally 3 times
daily for 2 days; initiate treatment preferably within 1 day of lesion onset or during preceding prodrome (guideline dosage) [7].
(Oral) Suppressive therapy: 400 mg orally twice daily for up to 12 months [5][6][7]
(Topical) Initial therapy: Apply ointment topically every 3 hours (6 times per day) for 7 days in sufficient quantities to adequately
cover lesion [8]
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Genital herpes simplex - HIV infection
(Initial or recurrent) 400 mg orally 3 times daily for 5 to 14 days (guideline dosage) [9]
(Chronic suppressive therapy) 400 mg orally twice daily (guideline dosage) [9]
Herpes labialis - HIV infection
400 mg orally 3 times daily for 5 to 10 days (guideline dosage) [9]

(Chronic suppressive therapy) 400 mg orally twice daily (guideline dosage) [9]
Herpes simplex, Non-Life Threatening Mucocutaneous Infections - Patient immunocompromised
Apply ointment topically (using a finger cot or glove) every 3 hours (6 times per day) for 7 days in sufficient quantities to adequately
cover lesions (manufacturer dosing) [8]. The CDC discourages the use of topical therapy [7].
Herpes simplex keratitis
(3% ophthalmic ointment) Apply 1 cm ribbon in lower cul-de-sac of affected eye 5 times per day (every 3 hours while awake) until
corneal ulcer heals, then 3 times per day for 7 days (FDA dosage) [10]
(Oral) 400 mg orally 5 times daily (off-label dosage) [11][12]
Herpes zoster, Shingles
800 mg orally every 4 hours (5 times a day) for 7 to 10 days [5][6]
Herpes zoster, Shingles - HIV infection
(Acute localized dermatomal) 800 mg orally 5 times daily for 7 to 10 days (guideline dosage) [9]
HIV infection - Varicella
Uncomplicated cases, 20 mg/kg (MAX, 800 mg per dose) orally 5 times daily for 5 to 7 days (guideline dosage) [9]
Recurrent herpes simplex labialis
(Buccal tablet) Place one 50-mg tablet buccally in upper gum above incisor tooth (canine fossa) and hold with slight pressure for 30
seconds [13]
(Cream) Apply cream topically 5 times per day for 4 days [14]
Varicella
800 mg orally 4 times a day for 5 days [5][6]
Varicella-zoster virus infection; Prophylaxis
(Infection as a result of vaccination and post-exposure prophylaxis) 800 mg orally 5 times a day for 5 to 7 days; for post-exposure
prophylaxis, begin treatment 7 to 10 days after exposure (guideline dosage) [9].
Pediatric Dosing
Important Note
Orphan drug designation: Treatment of acute herpetic keratitis caused by Herpes Simplex Virus type 1 and 2
Eczema herpeticum
25 to 30 mg/kg/day orally in 5 divided doses (study dose) [15][16].
(Less than 45 kg) 20 mg/kg orally 3 times daily for 5 to 14 days; MAX 400 mg/dose (guideline dose) [17]
(Adolescents) 400 mg orally twice daily for 5 to 14 days (guideline dose) [17]
Mild symptomatic gingivostomatitis: 20 mg/kg orally 3 times daily for 5 to 10 days; MAX 400 mg/dose (guideline dosage) [17]
(2 years or older, 3% ophthalmic ointment) Apply 1 cm ribbon in lower cul-de-sac of affected eye 5 times per day (every 3 hours
while awake) until corneal ulcer heals, then 3 times per day for 7 days [10]
Mild disease with no or moderate immune suppression, CDC immunologic categories 1 and 2: 20 mg/kg (MAX, 800 mg per dose)
orally 4 times daily for 7 to 10 days or until no new lesions appear for 48 hours (guideline dose) [17]
(12 years or older) Apply cream topically 5 times per day for 4 days [14]
Varicella
(2 years or older, 40 kg or less) 20 mg/kg orally 4 times a day for 5 days [5][6]
(2 years or older, more than 40 kg) 800 mg orally 4 times a day for 5 days [5][6]
FDA Uses
Genital herpes simplex

Herpes simplex, Non-Life Threatening Mucocutaneous Infections - Patient immunocompromised
Herpes zoster, Shingles
Varicella
Non-FDA Uses
Acute retinal necrosis

Bell's palsy
Chickenpox pneumonia
Eczema herpeticum
Herpes zoster, Shingles - HIV infection
Herpes zoster; Prophylaxis - Patient immunocompromised
Herpes zoster auricularis
Varicella-zoster virus infection; Prophylaxis
Dose Adjustments
Renal impairment (CrCl greater than 25 mL/min/1.73 m(2) and dose regimen of 800 mg orally every 4 hours, 5 times daily): No
adjustment required [5][18]
Renal impairment (CrCl 10 to 25 mL/min/1.73 m(2) and dose regimen of 800 mg orally every 4 hours, 5 times daily): Reduce to 800
mg orally every 8 hours [5][18]
Renal impairment (CrCl less than 10 mL/min/1.73 m(2) and dose regimen of 800 mg orally every 4 hours, 5 times daily): Reduce to
800 mg orally every 12 hours [5][18]
Renal impairment (CrCl greater than 10 mL/min/1.73 m(2) and dose regimen of 400 mg orally every 12 hours): No adjustment
required [5][18]
Renal impairment (CrCl 10 mL/min/1.73 m(2) or less and dose regimen of 400 mg orally every 12 hours): Reduce to 200 mg orally
every 12 hours [5][18]
Renal impairment (CrCl greater than 10 mL/min/1.73 m(2) and dose regimen 200 mg orally every 4 hours, 5 times daily): No
adjustment required [5][18]
Renal impairment (CrCl 10 mL/min/1.73 m(2) or less and dose regimen of 200 mg orally every 4 hours, 5 times daily): Reduce to
200 mg orally every 12 hours [5][18]
Renal impairment (CrCl less than 10 mL/min and HIV infection and chronic kidney disease or ESRD): 200 mg orally every 12 hours
[19]
Hepatic impairment: No specific recommendations are available [5][18].
Geriatric (reduced renal function): Adjustment may be necessary [5][18]
Hemodialysis: Administer renally adjusted dosage regimen; adjust dosing schedule so that an additional dose is administered after
each dialysis session [5][18]
Peritoneal dialysis: Administer renally adjusted dosage regimen; a supplemental dose after dialysis is not necessary [5][18]
Continuous ambulatory peritoneal dialysis, herpes zoster or varicella infection: 600 mg or 800 mg orally once daily [20]
Administration
Buccal
do not crush, chew, suck, or swallow buccal tablet [13]
apply within 1 hour after onset of prodromal symptoms and before signs of lesions appear [13]
place with dry finger immediately after removing from blister; place on upper gum just above incisor tooth (canine fossa) on the
same side of mouth as symptoms; face rounded side of tablet towards gum for comfort, but either side of tablet can be applied; hold
with slight pressure for 30 seconds for adhesion [13]
if tablet does not adhere or falls off within first 6 hours, reapply the same tablet immediately; if repositioning fails, place a new
tablet [13]
if tablet is swallowed within first 6 hours, drink a glass of water and apply a new tablet; if tablet falls off or is swallowed after the
first 6 hours, reapplication is not needed [13]
Ophthalmic
Pull down lower lid of affected eye to form a pocket; apply ointment in the pocket, then close eye for 1 to 2 minutes; may wipe
away any excess ointment [10]
Oral
take with or without food [5][6]

(suspension) shake well before measuring each dose [6]
Topical
(ointment) apply sufficient quantity with finger cot or rubber glove to adequately cover lesions; dose size per application should
approximate a one-half inch ribbon per 4 square inches of surface area [8]
Comparative Efficacy
No results available
Place In Therapy
MEDICATION SAFETY
Contraindications
Hypersensitivity to acyclovir, milk protein concentrate, or any other component of the product with the buccal tablet [13]
Hypersensitivity to acyclovir or valacyclovir with oral capsule, tablet, suspension, or ophthalmic ointment [10][5][6], or any
component of the product with the topical cream [14]
Hypersensitivity to any component of the product with the topical ointment [8]
Precautions
Dermatologic: Contact sensitization or irritation has been reported with topical cream [14]
Dermatologic: Cutaneous use only; avoid contact with eyes when using topical ointment or cream [8], the inside of the mouth, or
nose with topical cream [14]
Hematologic: Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), resulting in fatalities, has been
reported in immunocompromised patients with oral capsule, tablet, and suspension [5][6]
Renal: Renal failure, with some fatal cases, has been reported with oral capsule, tablet, and suspension [5][6]
Renal: Renal impairment; dose adjustment recommended, and maintain adequate hydration when using oral capsule, tablet, or
suspension [5][6]
Adverse Effects
Common
Dermatologic: Contact dermatitis (topical cream, 2% )

Gastrointestinal: Diarrhea (2.4% to 3.2% ), Nausea (2.7% to 4.8% ), Vomiting
Neurologic: Headache (2.2% )
Ophthalmic: Follicular conjunctivitis (Ophthalmic ointment, 2% to 10% ), Pain in eye, or stinging (Ophthalmic ointment, 2% to
10% )
Other: Malaise (11.5% )
Serious
Hematologic: Thrombotic thrombocytopenic purpura, Hemolytic Uremia Syndrome

Ophthalmic: Punctate keratitis (Ophthalmic ointment, 2% to 10% )
Renal: Renal failure
Black Box Warning
REMS
Drug Interactions (single)
Drug-Drug Interactions (6)

Drugs: Severity: Documentation: Summary:
TOLVAPTAN -- OAT3 Fair Concurrent use of TOLVAPTAN
Major
SUBSTRATES and OAT3 SUBSTRATES may
result in increased plasma
concentrations of OAT3
substrates.
FOSCARNET -- NEPHROTOXIC Fair Concurrent use of FOSCARNET
Major
AGENTS and NEPHROTOXIC AGENTS
may result in nephrotoxicity.
ACYCLOVIR -- PHENYTOIN Good Concurrent use of ACYCLOVIR
Moderate
and PHENYTOIN may result in
interact(s) with: decreased phenytoin plasma
Interacting substances
concentrations and potential

increased seizure activity.
ACYCLOVIR -- VALPROIC ACID Good Concurrent use of ACYCLOVIR
Moderate
and VALPROIC ACID may result
in decreased valproic acid
plasma concentrations and
potential increased seizure
activity.
ACYCLOVIR -- MEPERIDINE Fair Concurrent use of ACYCLOVIR
Moderate
and MEPERIDINE may result in
an increased risk of CNS
stimulation and excitation.
ACYCLOVIR -- ZIDOVUDINE Good Concurrent use of ACYCLOVIR
Minor
and ZIDOVUDINE may result in
increased lethargy and fatigue.
Drug-ALLERGY Interactions (None found)
Drug-FOOD Interactions (None found)
Drug-ETHANOL Interactions (None found)
Drug-LAB Interactions (None found)
Drug-TOBACCO Interactions (None found)
Drug-PREGNANCY Interactions (1)

PREGNANCY -- ACYCLOVIR [All Unknown Acyclovir is rated as US FDA

Moderate
Routes] Category B. Animal studies have
revealed no evidence of harm to
the fetus, however, there are no
adequate and well-controlled
studies in pregnant women.
(OR) Animal studies have shown
an adverse effect, but adequate
and well-controlled studies in
pregnant women have failed to
demonstrate a risk to the fetus.
Drug-LACTATION Interactions (1)

LACTATION -- ACYCLOVIR [All Unknown According to the American
Minor
Routes] Academy of Pediatrics, Acyclovir
is compatible with breast-
feeding.
Definitions
Severity:
The drugs are contraindicated for concurrent use.

Contraindicated
Major The interaction may be life-threatening and/or require medical intervention

to minimize or prevent serious adverse effects.
Moderate The interaction may result in exacerbation of the patient's condition

and/or require an alteration in therapy.
Minor The interaction would have limited clinical effects. Manifestations may include
an increase in the frequency or severity of the side effects but generally
would not require a Major alteration in therapy.
Unknown.
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Unknown
Documentation:
Excellent Controlled studies have clearly established the existence of the interaction.
Good Documentation strongly suggests the interaction exists,
but well-controlled studies are lacking.
Fair Available documentation is poor, but pharmacologic considerations lead
clinicians to suspect the interaction exists; or, documentation is good for a
pharmacologically similar drug.
Unknown Unknown.
IV Compatibility (single)
Pregnancy Category
B[13] (FDA)
B3[32] (AUS)
Breast Feeding
AAP: Maternal medication usually compatible with breastfeeding.[33]

Micromedex: Infant risk is minimal.
Monitoring
genital herpes: reduction in the duration of acute genital herpes infection, lesion healing, pain, and viral shedding is indicative of
efficacy; long-term therapy effectiveness is measured by the prevention or reduction in the frequency or severity of genital herpes
recurrence
genital herpes: need for continued treatment; after one year of therapy [5][6]
herpes labialis (cold sores): reduction in mean duration of recurrent episode and prevention of cold sore lesion progression are
indicative of efficacy
herpes zoster (shingles): reduced duration of viral shedding and new lesion formation, shortened time to complete cessation of pain,
lesion scabbing and healing, and decreased incidence of shingles-related neurologic symptoms (ie, paresthesia, dysesthesia,
hyperesthesia) are indicative of efficacy
varicella (chickenpox): shortened time to rash healing, reduction in number of lesions, vesicles, and residual lesions, and alleviation
of fever, anorexia, and lethargy are indicative of efficacy
Do Not Confuse
Zovirax - Doribax[1]
Zovirax - Zostrix[2]
Zovirax - Zyvox[2]
MECHANISM OF ACTION
Mechanism of Action
Acyclovir is a synthetic purine nucleoside analog with inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and
varicella-zoster virus (VZV). Acyclovir triphosphate, a converted form of acyclovir, stops replication of herpes viral DNA by competitive
inhibition of viral DNA polymerase, incorporation into and termination of the growing viral DNA chain, and inactivation of the viral
DNA polymerase [13][8][5][14][6].
PHARMACOKINETICS
Pharmacokinetics
Absorption
Tmax, Oral: 1.7 hours [21].

Bioavailability, Oral: 10% to 20%, decreases with increasing dose [5][6]

Tmax, Buccal: 8 hours (salivary) [13]
Bioavailability, Buccal: minimal [13]
Bioavailability, Topical: minimal [8][14]
Effect of food: no effect on absorption [5][6]
Distribution
Protein binding: 9% to 33% [5][6]

Vd: (adults), 48 L/m(2) (range, 37 to 57 L/m(2)) [22][23]
Vd: (children and adolescents), 45 L/m(2) [22]
Vd: (neonates), 28 L/m(2) (range, 24 to 30 L/m(2)) [22][24][25]
Metabolism
Metabolite: 9-(carboxymethoxy)methylguanine (inactive) [13][5][6]

Metabolite: 8-hydroxy-acyclovir (inactive) [13]
Excretion
Fecal: (Oral), 2% [26][22]

Renal: (Oral), extensive [13]
Renal: (Topical, cream), 0.04% of daily-applied dose [14]
Renal: (Topical, ointment), less than 0.02% to 9.4% of daily applied dose [8]
Dialyzable: Yes (hemodialysis), 60% decrease in plasma concentrations following 6-hour dialysis period [27]; No (peritoneal
dialysis), less than 10% is removed [28]
Other extracorporeal: No (plasmapheresis) (Chavanet al, 1990a); No (exchange transfusion) [29]; No (hemofiltration) [30]
Elimination Half Life
2.5 to 3.3 hours [5][6]

(neonates 0 to 3 months) 4 hours [31]
PATIENT EDUCATION
Medication Counseling
Advise patient to maintain adequate hydration with oral therapy to prevent renal toxicity [5][6].
Counsel patient that drug does not prevent reinfection or disease transmission of genital herpes [5][8][6].
Instruct patient to abstain from sex during acute outbreaks of genital herpes and to always use condoms, as the disease can also be
transmitted in the absence of symptoms [5][6].
Ophthalmic side effects may include eye pain (stinging), punctate keratitis and follicular conjunctivitis [10].
Oral side effects may include diarrhea, nausea, vomiting, malaise, or renal failure [5][6].
Buccal side effects may include headache and application site pain [13].
Topical side effects may include local application reactions such as a burning sensation, dryness (cream), pruritus, or stinging [8]
[14].
Teach patient proper technique and placement of product being used [10][13].
Instruct patient to avoid use of topical ointment or cream in the eye or inside the mouth or nose [8][14].
Advise patient to apply ointment with a finger cot or rubber glove to prevent transmission of virus [8].
Patient Handouts
Acyclovir (Oral route, Capsule, Tablet, Liquid, Suspension)

Acyclovir Ointment (Topical route, Ointment)
Acyclovir (Intravenous route, Solution, Powder for Solution)
Acyclovir Cream (Topical route, Cream)
Acyclovir (Buccal mucosa route, Tablet)
Acyclovir (Ophthalmic route, Ointment)
TOXICOLOGY
Clinical Effects
ACYCLOVIR AND RELATED AGENTS
USES: Substances include acyclovir, famciclovir, and penciclovir. Famciclovir is a prodrug of penciclovir. Ganciclovir, valganciclovir,
and valacyclovir are covered in separate managements. Acyclovir and related medications are used for prophylaxis and treatment of
herpes virus infections, including varicella infection. PHARMACOLOGY: These drugs are acyclic analogues of the natural nucleoside
guanosine. They are activated via monophosphorylation by virus-induced thymidine kinase and then will undergo 2 additional
phosphorylations. The triphosphate forms inhibit herpes viral DNA synthesis but do not inhibit DNA synthesis in uninfected cells
because the initial phosphorylation only occurs in herpes-infected cells. TOXICOLOGY: At high concentrations, acyclovir precipitates
as crystals in the urine, causing nephropathy. The mechanism for neurologic toxicity is not understood. EPIDEMIOLOGY: Overdose is
uncommon; most reported toxicity is from high therapeutic doses. Severe toxicity is very rare, and there are no reported deaths from
overdose. MILD TO MODERATE TOXICITY: Most patients who ingest these agents in overdose experience only mild or moderate
effects. The primary manifestations are nausea, vomiting, and headache. Renal injury has been reported. SEVERE TOXICITY: Most
toxicity from these agents is from therapeutic or high therapeutic doses (particularly in patients with renal insufficiency) rather than
inadvertent or intentional oral overdose. Neurotoxicity predominates and may include lethargy, confusion, ataxia, nystagmus,
dysarthria, hallucinations, myoclonus, agitation, and in severe cases, seizures or coma. Renal failure can also develop and is usually
transient. ADVERSE EFFECTS: ORAL: Nausea, vomiting, and headaches are common. IV: Adverse effects include neurotoxicity which
resembles an extension of viral infection into the central nervous system. Most commonly, mental status changes and involuntary
movements occur. Lethargy, fatigue, irritability, depression, agitation, occasional myoclonus with muscle fasciculations, hyperactive
tendon reflexes, tremor, stupor and coma have been reported following intravenous acyclovir, particularly rapid infusions. Psychosis
and neuropsychiatric symptoms have also been described with IV acyclovir administration. Neurotoxicity is generally reversible. Local
inflammation at injection site or phlebitis, renal injury and acute renal failure, agitation, coma, seizures, and lethargy may occur with
acute or repeated administration to patients with renal insufficiency. Obstructive nephropathy as a result of acyclovir crystalluria may
develop following high-dose therapy. Leukopenia has occasionally been reported as an adverse effect following therapeutic doses.
TOPICAL: Mild pain, burning, stinging, and itching. OCULAR: Mild irritation.
Range of Toxicity
TOXICITY: A toxic dose has not been established for these agents. ACYCLOVIR: ADULT: Overdose ingestions up to 20 grams have
been reported, associated with the development of lethargy, agitation, seizures, and coma. PEDIATRIC: A 2-year-old received 800 mg
acyclovir IV and developed transient neurotoxicity, but recovered. Two neonates, who received 65 mg/kg and 100 mg/kg acyclovir IV
had no evidence of toxicity. Transient nephrotoxicity developed in a neonate who received acyclovir 100 mg/kg IV three times daily
for 4 days, and another who received 750 mg/kg IV. THERAPEUTIC DOSE: Varies with indication. ACYCLOVIR: ADULT: Oral dose is
200 to 800 mg 4 to 5 times daily. The IV dose is 5 to 10 mg/kg every 8 hours. PEDIATRIC: ORAL: 2 yrs and older, less than 40 kg:
20 mg/kg 4 times daily; greater than 40 kg: 800 mg 4 times daily. IV (birth to 12 yrs of age): 10 to 20 mg/kg every 8 hours.
FAMCICLOVIR: ADULT: 500 mg to 2 g daily divided in 2 or 3 doses. PENCICLOVIR: ADULT: Apply topically every 2 hours while
awake.
Treatment
Support: MANAGEMENT OF MILD TO MODERATE TOXICITY: Patients generally do well with supportive care. Nausea and vomiting
should be treated with antiemetics. Rashes should be treated with supportive care, discontinuation of the offending agent, and
consideration of antihistamines and corticosteroids. With massive overdose, hydrate patients and monitor renal function.
MANAGEMENT OF SEVERE TOXICITY: Supportive care remains the mainstay of care in severe toxicity. Seizures should be treated
with benzodiazepines as first line therapy, followed by barbiturates or propofol, if seizures persist. Hydrate patients and monitor urine
output and renal function. Airway protection should be employed as need for patients with coma.
Decontamination: PREHOSPITAL: No pre-hospital decontamination is indicated. HOSPITAL: Activated charcoal should be considered
in patients with recent, large overdose if they are awake, alert, and willing to drink the charcoal. Gastric lavage has no role, as
toxicity is not life threatening.
Airway management: Central respiratory failure is not expected with oral overdose of acyclovir. Patients with profound CNS
depression or recurrent seizures require airway management, but this is exceedingly rare.
Antidote: None
Monitoring of patient: Monitor renal function and urine output in patients receiving IV acyclovir with suspected toxicity or after
massive oral overdose.
Enhanced elimination procedure: Acyclovir and famciclovir have low protein binding and volumes of distribution, and can be removed
by hemodialysis. Hemodialysis has been used to reduce serum acyclovir concentrations in patients with toxicity, but is rarely indicated
as patients do well with supportive care.
Patient disposition: HOME CRITERIA: Asymptomatic patients with inadvertent ingestion of these products may be observed at home.
OBSERVATION CRITERIA: Patients with deliberate overdose and symptomatic patients should be sent to a healthcare facility for
evaluation and treatment. Patients should be observed for 6 hours, primarily monitoring signs of co-ingestant toxicity or development
of significant CNS depression. Follow-up renal function tests should be obtained in patients with massive overdose. ADMISSION
CRITERIA: Admit patients with severe toxicity characterized by CNS effects or renal injury. CONSULT CRITERIA: Consider consultation
with nephrology for patients with renal injury.
ABOUT
How Supplied
Generic
Oral Capsule: 200 MG

Oral Suspension: 200 MG/5 ML
Oral Tablet: 400 MG, 800 MG
Topical Cream: 5 %
Topical Ointment: 5 %
Sitavig
Buccal Tablet: 50 MG
Zovirax
Oral Capsule: 200 MG

Oral Suspension: 200 MG/5 ML
Oral Tablet: 400 MG, 800 MG
Topical Cream: 5 %
Topical Ointment: 5 %
Drug Properties
Storage & Stability
Trade Names
Zovirax
Sitavig
Avaclyr
All Trade Names
Regulatory Status
RX
References
1. Institute for Safe Medication Practices: ISMP's List of Confused Drug Names. Institute for Safe Medication Practices. Horsham, PA. 2011.
Available from URL: http://www.ismp.org/tools/confuseddrugnames.pdf. As accessed 2011-10-27.
2. Institute for Safe Medication Practices: ISMP's list of confused drug names. Institute for Safe Medication Practices. Huntingdon Valley, PA.
2005. Available from URL: http://ismp.org/Tools/confuseddrugnames.pdf.
3. Adour KK, Ruboyianes JM, Von Doersten PG, et al: Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a
double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol 1996; 105(5):371-378.
PubMed Abstract: http://www.ncbi.nlm.nih.gov/...
PubMed Article: http://www.ncbi.nlm.nih.gov/...
4. Niimura M & Nishikawa T: Treatment of eczema herpeticum with oral acyclovir. Am J Med 1988; 85(suppl 2A):49-52.
5. Product Information: acyclovir oral capsules, oral tablets, acyclovir oral capsules, oral tablets. Mylan Pharmaceuticals Inc. (per DailyMed),
Morgantown, WV, 2012.
6. Product Information: acyclovir oral suspension, acyclovir oral suspension. Actavis Mid Atlantic LLC (per DailyMed), Lincolnton, NC, 2010.
7. Centers for Disease Control and Prevention (CDC): Sexually transmitted diseases (STDs): prevention. Centers for Disease Control and
Prevention (CDC). Atlanta, GA. 2015. Available from URL: http://www.cdc.gov/std/prevention/default.htm. As accessed 2015-07-29.
8. Product Information: acyclovir 5% topical ointment, acyclovir 5% topical ointment. Mylan Pharmaceuticals Inc. (per DailyMed),
Morgantown, WV, 2012.
9. AIDSinfo: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations
from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious
Diseases Society of America. AIDSinfo. Rockville, MD. 2017. Available from URL:
https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. As accessed 2018-04-16.
10. Product Information: AVACLYR(TM) ophthalmic ointment, acyclovir ophthalmic ointment. Fera Pharmaceuticals LLC (per FDA), Locust
Valley, NY, 2018.
11. Dawson CR, Beck R, Wilhelmus KR, et al: Herpetic eye disease study: you can help. Arch Ophthalmol 1996; 114:89-90.
12. Collum LMT, McGettrick P, Akhtar J, et al: Oral acyclovir (Zovirax(R)) in herpes simplex dendritic corneal ulceration. Br J Ophthalmol
1986; 70:435-438.
13. Product Information: SITAVIG buccal tablets, acyclovir buccal tablets. Farméa (per FDA), Angers, France, 2013.
14. Product Information: ZOVIRAX(R) topical cream, acyclovir 5% topical cream. Valeant Pharmaceuticals North America LLC (per DailyMed),
Bridgewater, NJ, 2011.
15. Woolfson H: Oral acyclovir in eczema herpeticum. Br Med J 1984; 288:531-532.
16. Muelleman PJ, Doyle JA, & House RF Jr: Eczema herpeticum treated with oral acyclovir. J Am Acad Dermatol 1986; 15:716-717.
17. Centers for Disease Control and Prevention, National Institutes of Health, HIV Medicine Association of the Infectious Diseases Society of
America, et al: Guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children.
Recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America,
the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep 2009; 58(RR11):1-166.
18. Product Information: Acyclovir oral suspension, acyclovir oral suspension. Actavis Pharma Inc (per DailyMed), Parsippany, NJ, 2016.
19. Gupta SK, Eustace JA, Winston JA, et al: Guidelines for the management of chronic kidney disease in HIV-infected patients:
recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005; 40(11):1559-1585.
20. Stathoulopoulou F, Almond MK, Dhillon S, et al: Clinical pharmacokinetics of oral acyclovir patients on continuous ambulatory peritoneal
dialysis. Nephron 1996; 74:337-341.
21. Meyer LJ, Miranda P, Sheth N, et al: Acyclovir in human breast milk.. Am J Obstet Gynecol 1988; 158:586-8.
22. Laskin OL: Clinical pharmacokinetics of acyclovir.. Clin Pharmacokinet 1983; 8:187-201.
23. Blum MR, Liao SHT, & Miranda P: Overview of acyclovir pharmacokinetic disposition in adults and children.. Am J Med 1982; 73 Suppl
1A:186-92.
24. Hintz M: Neonatal acyclovir pharmacokinetics in patients with herpes virus infections.. Am J Med 1982; 73 Suppl 1A:210-4.
25. Reviewer comments, 10/10/2001.
26. Wagstaff AJ, Faulds D, & Goa KL: Aciclovir: a reappraisal of its antiviral activity, pharmacokinetic properties, and therapeutic efficacy..
Drugs 1994; 47(1):153-205.
27. Krasny HC, Liao SH, De Miranda P, et al: Influence of hemodialysis on acyclovir pharmacokinetics in patients with chronic renal failure.
Am J Med 1982; 73:202-204.
28. Seth SK, Visconti JA, Hebert LA, et al: Acyclovir pharmacokinetics in a patient on continuous ambulatory peritoneal dialysis. Clin Pharm
1985; 4:320-322.
29. Englund JA, Fletcher CV, Johnson D, et al: Effect of blood exchange on acyclovir clearance in an infant with neonatal herpes. J Pediatr
1987; 110:151-153.
30. Wagstaff AJ, Faulds D, & Goa KL: Aciclovir: a reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy.
Drugs 1994; 47:153-205.
31. Laskin OL: Clinical pharmacokinetics of acyclovir. Clin Pharmacokinet 1983; 8:187-201.
32. Australian Government Department of Health and Ageing Therapeutic Goods Administration: Prescribing medicines in pregnancy
database. Australian Government Department of Health and Ageing Therapeutic Goods Administration. Woden, Australia. 2012. Available
from URL: http://www.tga.gov.au/hp/medicines-pregnancy.htm. As accessed 2012-05-31.
33. Anon: American academy of pediatrics committee on drugs: transfer of drugs and other chemicals into human milk. Pediatrics 2001;
108(3):776-789.
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10/19/2019 Drug summary - MICROMEDEX

200 mg orally 5 times daily for 5 days [4]

Genital herpes simplex

Genital herpes simplex - HIV infection

Herpes labialis - HIV infection

400 mg orally 3 times daily for 5 to 10 days (guideline dosage) [9]

Herpes simplex, Non-Life Threatening Mucocutaneous Infections - Patient immunocompromised

Herpes simplex keratitis

Herpes zoster, Shingles

800 mg orally every 4 hours (5 times a day) for 7 to 10 days [5][6]

Herpes zoster, Shingles - HIV infection

HIV infection - Varicella

Recurrent herpes simplex labialis

800 mg orally 4 times a day for 5 days [5][6]

Varicella-zoster virus infection; Prophylaxis

25 to 30 mg/kg/day orally in 5 divided doses (study dose) [15][16].

Genital herpes simplex - HIV infection

Herpes labialis - HIV infection

Herpes simplex keratitis

HIV infection - Varicella

Recurrent herpes simplex labialis

Genital herpes simplex

Acute retinal necrosis

do not crush, chew, suck, or swallow buccal tablet [13]

take with or without food [5][6]

Dermatologic: Contact dermatitis (topical cream, 2% )

Hematologic: Thrombotic thrombocytopenic purpura, Hemolytic Uremia Syndrome

Black Box Warning

Drug Interactions (single)

Drug-Drug Interactions (6)

concentrations and potential

Drug-ALLERGY Interactions (None found)

Drug-FOOD Interactions (None found)

Drug-ETHANOL Interactions (None found)

Drug-LAB Interactions (None found)

Drug-TOBACCO Interactions (None found)

Drug-PREGNANCY Interactions (1)

PREGNANCY -- ACYCLOVIR [All Unknown Acyclovir is rated as US FDA

Drug-LACTATION Interactions (1)

The drugs are contraindicated for concurrent use.

Major The interaction may be life-threatening and/or require medical intervention

Moderate The interaction may result in exacerbation of the patient's condition

AAP: Maternal medication usually compatible with breastfeeding.[33]

Tmax, Oral: 1.7 hours [21].

Bioavailability, Oral: 10% to 20%, decreases with increasing dose [5][6]

Protein binding: 9% to 33% [5][6]

Metabolite: 9-(carboxymethoxy)methylguanine (inactive) [13][5][6]

Fecal: (Oral), 2% [26][22]

Elimination Half Life

2.5 to 3.3 hours [5][6]

Acyclovir (Oral route, Capsule, Tablet, Liquid, Suspension)

ACYCLOVIR AND RELATED AGENTS

ACYCLOVIR AND RELATED AGENTS

ACYCLOVIR AND RELATED AGENTS

Oral Capsule: 200 MG

Oral Capsule: 200 MG

Storage & Stability

All Trade Names

15. Woolfson H: Oral acyclovir in eczema herpeticum. Br Med J 1984; 288:531-532.

25. Reviewer comments, 10/10/2001.

from URL: http://www.tga.gov.au/hp/medicines-pregnancy.htm. As accessed 2012-05-31.

Last Modified: October 08, 2019

© Copyright IBM Corporation 2019

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