Acyclovir: Difference between revisions

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==General==
==General==
*Type: Antiviral: guanosine analog
*Type: [[Antiviral]]: guanosine analog
*Dosage Forms: IV, PO
*Dosage Forms: IV, PO
*Common Trade Names: Zovirax
*Common Trade Names: Zovirax


==Adult Dosing==
==Adult Dosing==
*HSV [[Encephalitis]]
*[[HSV]] [[Encephalitis]]
**10 mg/kg IV q8h x 10 d
**10mg/kg IV q8h x 10 d


*[[Herpes Simplex Virus-2|Genital/Mucocutaneous HSV]]
*[[Herpes Simplex Virus-2|Genital/Mucocutaneous HSV]]
**Immunocompetent
**Immunocompetent
***1st episode, Mild-mod: 400 mg PO TID x 7-10 d
***1st episode, Mild-mod: 400mg PO TID x 7-10 d
***1st episode, Severe: 5-10 mg/kg IV q8h x 2-7 d
***1st episode, Severe: 5-10mg/kg IV q8h x 2-7 d
***Recurrence: 400 mg PO TID x 5 d
***Recurrence: 400mg PO TID x 5 d
***Suppression: 400 mg PO BID
***Suppression: 400mg PO BID
**Immunocompromised  
**Immunocompromised  
***1st episode: 400 mg PO TID x 5-10 d
***1st episode: 400mg PO TID x 5-10 d
***Recurrence: 400 mg PO TID x 5-10 d
***Recurrence: 400mg PO TID x 5-10 d
***Suppression: 400-800 mg PO BID-TID
***Suppression: 400-800mg PO BID-TID


*[[Varicella]]
*[[Varicella]]
**Immunocompetent
**Immunocompetent
***800 mg PO QID x 5-7 d
***800mg PO QID x 5-7 d
**Immunocompromised
**Immunocompromised
***10 mg/kg IV q8h x 7 d
***10mg/kg IV q8h x 7 d
*Herpes Zoster
*Herpes Zoster
**Immunocompetent
**Immunocompetent
***800 mg PO 5x/day x 7 d
***800mg PO 5x/day x 7 d
**Immunocompromised
**Immunocompromised
***10 mg/kg IV q8h x 7 d
***10mg/kg IV q8h x 7 d


*[[Herpes Zoster]]
*[[Herpes Zoster]]
**Immunocompetent
**Immunocompetent
***800 mg PO 5x/day x 7 d
***800mg PO 5x/day x 7 d
**Immunocompromised
**Immunocompromised
***10 mg/kg IV q8h x 7 d
***10mg/kg IV q8h x 7 d


*[[Herpes zoster ophthalmicus]]
*[[Herpes zoster ophthalmicus]]
**800 mg PO 5x/day x 7 d
**800mg PO 5x/day x 7 d


*HSV prophylaxis in immunocompromised
*HSV prophylaxis in immunocompromised
**400-800 mg PO BID-TID
**400-800mg PO BID-TID


*[[HSV keratitis]]
*[[HSV keratitis]]
**400 mg PO 5x/day
**400mg PO 5x/day


==Pediatric Dosing==
==Pediatric Dosing==
*Neonatal HSV  
*Neonatal HSV  
**40-60 mg/kg/day IV divided q12h x 14-21 d  
**40-60mg/kg/day IV divided q12h x 14-21 d  
*HSV encephalitis  
*HSV encephalitis  
**3 mo - 11 y/o  
**3 mo - 11 y/o  
***30-45 mg/kg/day IV divided q8h x 14-21 d  
***30-45mg/kg/day IV divided q8h x 14-21 d  
**>12 y/o  
**>12 y/o  
***30 mg/kg/day IV divided q8h x 14-21 d  
***30mg/kg/day IV divided q8h x 14-21 d  
*Genital/mucocutaneous HSV   
*Genital/mucocutaneous HSV   
**Immunocompetent  
**Immunocompetent  
***1st episode, 2-11 y/o  
***1st episode, 2-11 y/o  
****40-80 mg/kg/day PO divided q6-8 h x 5 d, max 1g/day  
****40-80mg/kg/day PO divided q6-8 h x 5 d, max 1g/day  
***1st episode, >12 y/o  
***1st episode, >12 y/o  
****1g/day PO divided 5x/day x 7-10 d  
****1g/day PO divided 5x/day x 7-10 d  
**Immunocompromised  
**Immunocompromised  
***PO: >2 y/o: 1g/day PO divided 3-5x/day x 7-14 d   
***PO: >2 y/o: 1g/day PO divided 3-5x/day x 7-14 d   
***IV: >1 y/o: 30 mg/kg/day IV divided q8h x 7-14 d  
***IV: >1 y/o: 30mg/kg/day IV divided q8h x 7-14 d  
*Varicella  
*Varicella  
**Immunocompetent  
**Immunocompetent  
***PO: > 2 y/o: 80 mg/kg/day PO divided q6h x 5 d  
***PO: > 2 y/o: 80mg/kg/day PO divided q6h x 5 d  
***IV: > 1 y/o: 30 mg/kg/day IV divided q8h x 7-10 d  
***IV: > 1 y/o: 30mg/kg/day IV divided q8h x 7-10 d  
**Immunocompromised  
**Immunocompromised  
***30 mg/kg/day IV divided q8h x 7-10 d  
***30mg/kg/day IV divided q8h x 7-10 d  
*Herpes zoster  
*Herpes zoster  
**Immunocompetent  
**Immunocompetent  
***PO: > 12 y/o: 4g/day PO divided 5x/day x 5-7 d  
***PO: > 12 y/o: 4g/day PO divided 5x/day x 5-7 d  
***IV: 30 mg/kg/day IV divided q8h x 7-10 d  
***IV: 30mg/kg/day IV divided q8h x 7-10 d  
**Immunocompromised  
**Immunocompromised  
***30 mg/kg/day IV divided q8h x 7-10 d  
***30mg/kg/day IV divided q8h x 7-10 d  




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****CrCl 25-50 give q12h
****CrCl 25-50 give q12h
****CrCl 10-24 give q24h
****CrCl 10-24 give q24h
****CrCl <10 decr. dose 50%, give q24h
****CrCl <10 decrease dose 50%, give q24h
****HD give usual dose as supplement
****HD give usual dose as supplement
****PD no supplement
****PD no supplement
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****PD: no supplement
****PD: no supplement
**Pediatric
**Pediatric
**Geriatric
***Refer to adult dosing. Oral: Initial doses should begin at the low end of the dosage range
*Hepatic Dosing
*Hepatic Dosing
**Not defined
**Not defined
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Hallucinations / psychosis  
*[[Hallucinations]] / [[psychosis]]
*Seizure  
*[[Seizure]]
*Coma  
*[[Coma]]
*Encephalopathy  
*[[Encephalopathy]]
*Thrombocytopenia  
*[[Thrombocytopenia]]
*Leukopenia  
*[[Leukopenia]]
*Anaphylaxis  
*[[Anaphylaxis]]
*Angioedema  
*[[Angioedema]]
*Erythema Multiforme  
*[[Erythema Multiforme]]
*SJS / TEN / TTP  
*[[SJS]] / [[TEN]]
*Hepatitis  
*[[TTP]]
*Renal failure  
*[[Hepatitis]]
*[[Renal failure]]


===Common===
===Common===
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*Arthralgia  
*Arthralgia  
*Confusion / lethargy  
*Confusion / lethargy  
*Elev. BUN/Cr
*Elev. BUN/creatinine
*Photosensitivity  
*Photosensitivity  


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==References==
==References==
*Epocrates 2015
*Epocrates 2015
*Acetazolamide injection [prescribing information]. Big Flats, NY: X-Gen Pharmaceuticals, Inc; October 2015.
*Acetazolamide tablets [prescribing information]. Hawthorne, NY: Taro Pharmaceuticals; September 2013.


<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:ID]]

Latest revision as of 16:38, 19 September 2019

General

  • Type: Antiviral: guanosine analog
  • Dosage Forms: IV, PO
  • Common Trade Names: Zovirax

Adult Dosing

  • Genital/Mucocutaneous HSV
    • Immunocompetent
      • 1st episode, Mild-mod: 400mg PO TID x 7-10 d
      • 1st episode, Severe: 5-10mg/kg IV q8h x 2-7 d
      • Recurrence: 400mg PO TID x 5 d
      • Suppression: 400mg PO BID
    • Immunocompromised
      • 1st episode: 400mg PO TID x 5-10 d
      • Recurrence: 400mg PO TID x 5-10 d
      • Suppression: 400-800mg PO BID-TID
  • Varicella
    • Immunocompetent
      • 800mg PO QID x 5-7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • Herpes Zoster
    • Immunocompetent
      • 800mg PO 5x/day x 7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • Herpes Zoster
    • Immunocompetent
      • 800mg PO 5x/day x 7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • HSV prophylaxis in immunocompromised
    • 400-800mg PO BID-TID

Pediatric Dosing

  • Neonatal HSV
    • 40-60mg/kg/day IV divided q12h x 14-21 d
  • HSV encephalitis
    • 3 mo - 11 y/o
      • 30-45mg/kg/day IV divided q8h x 14-21 d
    • >12 y/o
      • 30mg/kg/day IV divided q8h x 14-21 d
  • Genital/mucocutaneous HSV
    • Immunocompetent
      • 1st episode, 2-11 y/o
        • 40-80mg/kg/day PO divided q6-8 h x 5 d, max 1g/day
      • 1st episode, >12 y/o
        • 1g/day PO divided 5x/day x 7-10 d
    • Immunocompromised
      • PO: >2 y/o: 1g/day PO divided 3-5x/day x 7-14 d
      • IV: >1 y/o: 30mg/kg/day IV divided q8h x 7-14 d
  • Varicella
    • Immunocompetent
      • PO: > 2 y/o: 80mg/kg/day PO divided q6h x 5 d
      • IV: > 1 y/o: 30mg/kg/day IV divided q8h x 7-10 d
    • Immunocompromised
      • 30mg/kg/day IV divided q8h x 7-10 d
  • Herpes zoster
    • Immunocompetent
      • PO: > 12 y/o: 4g/day PO divided 5x/day x 5-7 d
      • IV: 30mg/kg/day IV divided q8h x 7-10 d
    • Immunocompromised
      • 30mg/kg/day IV divided q8h x 7-10 d


Special Populations

  • Pregnancy Rating: B
  • Lactation Risk Categories: Safe
  • Renal Dosing
    • Adult
      • IV
        • CrCl 25-50 give q12h
        • CrCl 10-24 give q24h
        • CrCl <10 decrease dose 50%, give q24h
        • HD give usual dose as supplement
        • PD no supplement
      • PO
        • CrCl <25: see package insert
        • HD: give usual dose as supplement
        • PD: no supplement
    • Pediatric
    • Geriatric
      • Refer to adult dosing. Oral: Initial doses should begin at the low end of the dosage range
  • Hepatic Dosing
    • Not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

  • Nausea/vomiting/diarrhea
  • Headache
  • Dizziness
  • Rash
  • Arthralgia
  • Confusion / lethargy
  • Elev. BUN/creatinine
  • Photosensitivity

Pharmacology

  • Half-life: 2.5 - 3.3 hrs
  • Metabolism: virally infected cells (intracellularly); liver
  • Excretion: Urine
  • Mechanism of Action: Inhibits DNA polymerase

See Also

References

  • Epocrates 2015
  • Acetazolamide injection [prescribing information]. Big Flats, NY: X-Gen Pharmaceuticals, Inc; October 2015.
  • Acetazolamide tablets [prescribing information]. Hawthorne, NY: Taro Pharmaceuticals; September 2013.


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