II. Indications
- Primary or Recurrent Herpes Simplex Virus Infection
- HSV Encephalitis
- HSV Keratitis
- Herpes Neonatorum
- Herpes Zoster
- Genital Herpes
- Varicella Zoster Virus
- Herpes Zoster Ophthalmicus
- Herpes Labialis
III. Contraindications
- Milk Protein concentrate allergy
IV. Mechanism
- Prodrug metabolized by multiple enzymes (e.g. thymidine kinase) to active triphosphate agent
- Inhibits viral DNA Polymerase
V. Medications
- Tablets: 200, 400, 800 mg
- Suspension: 200 mg/5 ml
- Buccal tablet (Sitavig)
- Must stay in place in buccal space until dissolves (6 hours)
- Replace if buccal tablet falls off before 6 hours
- Do not chew gum while tablet is in place
VI. Dosing: Orolabial Herpes (Cold Sores)
-
Primary Herpetic Gingivostomatitis
- Adult: 200 mg orally every 4 hours while awake (5x/day)
- Ped: 15 mg/kg/day (750 mg/m2/day) divided five times daily for 5 days
- Episodic, recurrent Orolabial Herpes
- Topicals
- Acyclovir cream apply 5 times per day for 4 days
- Sitavig buccal one tablet per episode placed in upper gum on same side of mouth as symptoms
- Very expensive ($300 for 2 tabs in 2014) and only shortens Cold Sore course by <1 day
- (2014) Presc Lett 21(9): 53
- Systemic
- Child: 15 mg/kg (max: 200 mg) orally 5 times per day for 5 days
- Adult: 400 mg orally 3 times daily for 5 days (or 200 mg orally 5 times daily for 5 days)
- Topicals
VII. Dosing: Herpes Neonatorum
-
HSV Encephalitis or Herpes Neonatorum
- Child: 30 mg/kg/day (1500 mg/m2/day) divided every 8 hours IV
VIII. Dosing: Genital Herpes
- Initial Genital HSV
- Adult: 200 mg orally 5 times per day (or every 4 hours) for 10 days
- Episodic Genital HSV
- Adult: 200 mg orally 5 times per day for 5 days
- Apply topical Acyclovir to affected area 6 times per day for 7 days
- Prophylaxis of Genital HSV
- Adult: 400 mg orally twice daily for up to 12 months
IX. Dosing: Varicella Zoster
- Precaution: Adust IV dosing in obese patients
- Use Adjusted body weight (ABW), which is 120% of Ideal Body Weight
-
Herpes Zoster (Shingles) or Herpes Ophthalmicus
- Adult Oral: 800 mg orally 5 times/day for 7-10 days
- Adult IV: 10-12 mg/kg/dose every 8 hours for 7-14 days
-
Varicella Zoster Virus (Chicken Pox)
- Child
- Dose: 10-20 mg/kg/dose to 800 mg orally four times daily for 5 days
- Adult
- Dose: 600-800 mg/dose orally every 4 hours while awake (5x/day)
- Dose: 1000 mg/dose orally every 6 hours for 5 days
- Intravenous
- Dose: 30 mg/kg/day (1500 mg/m2/day) divided every 8 hours IV
- Child
X. Dosing: Renal
- eGFR 25 to 50 ml/min: Give usual dose every 12 hours
- eGFR 10 to 25 ml/min: Give usual dose every 24 hours
- eGFR <10 ml/min: Give 50% of usual dose every 24 hours
- Give another dose following each Hemodialysis session
XI. Adverse Effects
- Headache
- Gastrointestinal Upset
- Impaired Renal Function
- CNS depression
- Lethargy
- Confusion
- Coma
- Tremors
- Agitation
XII. Pharmacokinetics
- Base Weight calculations on Lean Body Mass
- Metabolized by Kidney
- Decrease interval in renal Impairment to q12-24h
- Hemodialysis: 50-100% dialyzable
XIII. Safety: Pregnancy and Lactation
- FDA Pregnancy Class C
- Safety unclear in Breast Feeding
XIV. Drug Interactions (prolong Acyclovir half life)
XV. Precautions
- Overdose may result in Renal Failure
- Maintain adequate urine to flush renal tubules
- Avoid rapid infusion (risk of crystal nephropathy)
- Base intravenous dosing on adjusted body weight (120% of Ideal Body Weight) in obese patients
XVI. Efficacy: Herpes Labialis (Oral Herpes)
- Only effective if used at outset of symptoms (first sense of Paresthesias such as burning or tingling)
- Shortens Vesicle life and decreases shedding
- Prevents recurrence in Immunocompromised
- Reduction in episodes: 53%
- Quicker healing: 4 days instead of 8 for Placebo
- Reduction in number of Fever Blisters: 71%
XVII. Resources
XVIII. References
Images: Related links to external sites (from Bing)
Related Studies
| acyclovir (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ACYCLOVIR 200 MG CAPSULE | Generic | $0.11 each |
| ACYCLOVIR 200 MG/5 ML SUSP | Generic | $0.15 per ml |
| ACYCLOVIR 400 MG TABLET | Generic | $0.11 each |
| ACYCLOVIR 5% CREAM | Generic | $38.38 per gram |
| ACYCLOVIR 5% OINTMENT | Generic | $0.77 per gram |
| ACYCLOVIR 800 MG TABLET | Generic | $0.19 each |
| zovirax (on 9/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZOVIRAX 5% CREAM | Generic | $38.38 per gram |