Acyclovir: Difference between revisions
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==General==
==General==
*Type:  
*Type: Antiviral: guanosine analog
*Dosage Forms: IV, PO
*Dosage Forms: IV, PO
*Common Trade Names: Zovirax
*Common Trade Names: Zovirax
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**10 mg/kg IV q8h x 10 d
**10 mg/kg IV q8h x 10 d


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


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


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


==Special Populations==
==Special Populations==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Hallucinations / psychosis
*Seizure
*Coma
*Encephalopathy
*Thrombocytopenia
*Leukopenia
*Anaphylaxis
*Angioedema
*Erythema Multiforme
*SJS / TEN / TTP
*Hepatitis
*Renal failure


===Common===
===Common===
*Nausea/vomiting/diarrhea
*Headache
*Dizziness
*Rash
*Arthralgia
*Confusion / lethargy
*Elev. BUN/Cr
*Photosensitivity


==Pharmacology==
==Pharmacology==
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==Sources==
==Sources==
*Epocrates 2015


<references/>
<references/>
[[Category:Drugs]]
[[Category:Drugs]]

Revision as of 11:32, 11 March 2015

General

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

Adult Dosing

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

Herpes Zoster

  • Immunocompetent
    • 800 mg PO 5x/day x 7 d
  • Immunocompromised
    • 10 mg/kg IV q8h x 7 d
  • HSV prophylaxis in immunocompromised
    • 400-800 mg PO BID-TID

Pediatric Dosing

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


Special Populations

  • Pregnancy Rating: B
  • Lactation: Safe
  • Renal Dosing
    • Adult
      • IV
        • CrCl 25-50 give q12h
        • CrCl 10-24 give q24h
        • CrCl <10 decr. 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
  • 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/Cr
  • 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

Sources

  • Epocrates 2015


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