Acyclovir
General
- Type: Antiviral: guanosine analog
- Dosage Forms: IV, PO
- Common Trade Names: Zovirax
Adult Dosing
- HSV Encephalitis
- 10mg/kg IV q8h x 10 d
- 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
- Immunocompetent
- Varicella
- Immunocompetent
- 800mg PO QID x 5-7 d
- Immunocompromised
- 10mg/kg IV q8h x 7 d
- Immunocompetent
- Herpes Zoster
- Immunocompetent
- 800mg PO 5x/day x 7 d
- Immunocompromised
- 10mg/kg IV q8h x 7 d
- Immunocompetent
- Herpes Zoster
- Immunocompetent
- 800mg PO 5x/day x 7 d
- Immunocompromised
- 10mg/kg IV q8h x 7 d
- Immunocompetent
- Herpes zoster ophthalmicus
- 800mg PO 5x/day x 7 d
- HSV prophylaxis in immunocompromised
- 400-800mg PO BID-TID
- HSV keratitis
- 400mg PO 5x/day
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
- 3 mo - 11 y/o
- 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
- 1st episode, 2-11 y/o
- 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
- Immunocompetent
- 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
- Immunocompetent
- 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
- Immunocompetent
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
- IV
- Pediatric
- Geriatric
- Refer to adult dosing. Oral: Initial doses should begin at the low end of the dosage range
- Adult
- Hepatic Dosing
- Not defined
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Hallucinations / psychosis
- Seizure
- Coma
- Encephalopathy
- Thrombocytopenia
- Leukopenia
- Anaphylaxis
- Angioedema
- Erythema Multiforme
- SJS / TEN
- TTP
- Hepatitis
- Renal failure
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.