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Acyclovir

Oral
Intravenous
Topical
Class
Antiviral agents
Subclass
Nucleoside analogs
Generic name
Acyclovir, aciclovir
Brand names
Zovirax®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Chickenpox
•
800 mg PO QID for 5 days
Genital herpes • Initial episode
•
200 mg PO 5× per day for 10 days
Alternative
•
400 mg PO TID for 7-10 days
Genital herpes • Recurrent episode
•
200 mg PO 5× per day for 5 days
Alternative
•
800 mg PO TID for 2 days
Alternative
•
400 mg PO TID for 5 days
Alternative
•
800 mg PO BID for 5 days
Herpes zoster
•
800 mg PO 5× per day for 7-10 days
Chickenpox in patients with HIV infection • Off-label
•
800 mg PO 5× per day for 5-7 days
Eczema herpeticum • Off-label
•
200-400 mg PO 5× per day for 5 days
Genital herpes in patients with HIV infection • Initial episode • Off-label
•
400 mg PO TID for 7-10 days
Genital herpes in patients with HIV infection • Recurrent episode • Off-label
•
400 mg PO TID for 5-10 days
Herpes simplex keratitis • Off-label
•
400 mg PO 5× per day
Herpes zoster in patients with HIV infection • Off-label
•
800 mg PO 5× per day for 7-10 days
Herpes zoster ophthalmicus • Off-label
•
800 mg PO 5× per day for 7 days
Orolabial herpes • Recurrent episode • Off-label
•
400 mg PO TID for 5 days
Alternative
•
200 mg PO 5× per day for 5 days
Orolabial herpes in patients with HIV infection • Off-label
•
400 mg PO TID for 5-10 days
Adjunctive treatment
Adjunctive treatment for Bell's palsy • Off-label
•
400 mg PO 5× per day for 10 days
Administered in combination with corticosteroids.
Prevention
B virus infection • Post-exposure prophylaxis • Off-label
•
800 mg PO 5× per day for 14 days
Chickenpox in patients with HIV infection • Hematopoietic cell transplantation recipients or post-exposure prophylaxis • Off-label
•
800 mg PO 5× per day for 5-7 days
Secondary prevention
Genital herpes
•
400 mg PO BID for up to 12 months
Genital herpes in patients with HIV infection • Off-label
•
400 mg PO BID
HSV infection in patients with HIV infection • Off-label
•
400 mg PO BID
Orolabial herpes • Off-label
•
400 mg PO BID
Other off-label uses
•
Treatment of HSV infection (complicated)
•
Treatment of HSV infection in patients with HIV infection (orolabial, recurrent)
Indications for use
Labeled indications
Adults
•
Treatment of chickenpox
•
Treatment of genital herpes (initial episode)
•
Treatment of genital herpes (recurrent episode)
•
Treatment of genital herpes in patients with HIV infection (initial episode)
•
Treatment of herpes zoster
•
Secondary prevention of genital herpes
Off-label indications
Adults
•
Treatment of chickenpox in patients with HIV infection
•
Treatment of eczema herpeticum
•
Treatment of genital herpes in patients with HIV infection (initial episode)
•
Treatment of genital herpes in patients with HIV infection (recurrent episode)
•
Treatment of herpes simplex keratitis
•
Treatment of HSV infection (complicated)
•
Treatment of HSV infection in patients with HIV infection (orolabial, recurrent)
•
Treatment of herpes zoster in patients with HIV infection
•
Treatment of herpes zoster ophthalmicus
•
Treatment of orolabial herpes (recurrent episode)
•
Treatment of orolabial herpes in patients with HIV infection
•
Adjunctive treatment for Bell's palsy
•
Prevention of B virus infection (post-exposure prophylaxis)
•
Prevention of chickenpox in patients with HIV infection (hematopoietic cell transplantation recipients or post-exposure prophylaxis)
•
Secondary prevention of genital herpes in patients with HIV infection
•
Secondary prevention of HSV infection in patients with HIV infection
•
Secondary prevention of orolabial herpes
Safety risks
Contraindications
Hypersensitivity to acyclovir or its components or valacyclovir
Warnings and precautions
Renal failure
•
Use caution in all patients.
TTP, HUS
•
Use caution in immunocompromised patients.
Specific populations
Renal impairment
CrCl > 25 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 10-25 mL/min
•
Maximal dose of 800 mg. Do not exceed frequency of TID.
CrCl < 10 mL/min
•
Maximal dose of 200 mg, except for regimens with 800 mg, for which decrease to 800 mg BID. Do not exceed frequency of BID.
Renal replacement therapy
Continuous renal replacement
•
Use with caution. Obtain therapeutic drug monitoring if possible.
Intermittent hemodialysis
•
Administer an additional dose after each session. Dose as in CrCl < 10 mL/min.
Peritoneal dialysis
•
Maximal dose of 600-800 mg/day.
Hepatic impairment
Child-Pugh A (mild)
•
No guidance available.
Child-Pugh B (moderate)
•
No guidance available.
Child-Pugh C (severe)
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Generally acceptable for use. No adequate or well-controlled studies have been conducted to evaluate the use of acyclovir during human pregnancy; however, published observational studies over decades of acyclovir use have not identified a drug-associated risk of major birth defects, miscarriages, or adverse maternal or fetal outcomes.
Breastfeeding
Acceptable for use during breastfeeding.
Very low levels in breastfed infants (< 5%).
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia, malaise
Common 1-10%
•
↓ blood neutrophil count, ↑ serum TBIL, ↑ serum transaminases, ↑ serum creatinine, ↑ BUN, diarrhea, fever, headache, itching, skin rash, urticaria, nausea, vomiting
Uncommon < 1%
•
Anaphylaxis, angioedema, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome
Unknown frequency
•
Dysarthria, encephalopathy, aggressive behavior, confusion, agitation, hallucinations, ataxia, dizziness, somnolence, paresthesia, seizure, tremor
Interactions
Drug(s)
Check Interactions
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