Acyclovir: Difference between revisions

(Replace manual dosing with dynamic SMW tables (Adult + Pediatric))
(Restore original dosing content alongside dynamic SMW tables)
 
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==Adult Dosing==
==Adult Dosing==
*[[HSV]] [[Encephalitis]]
**10mg/kg IV q8h x 10 d
*[[Herpes Simplex Virus-2|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
*[[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
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Acyclovir]] [[Has Population::Adult]]
{{#ask: [[Has DrugName::Acyclovir]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
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==Pediatric Dosing==
==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
*HSV-1/[[Herpes labialis]]
**15 mg/kg PO (max dose of 200 mg) 5 times per day
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Acyclovir]] [[Has Population::Pediatric]]
{{#ask: [[Has DrugName::Acyclovir]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
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Latest revision as of 02:37, 20 March 2026

General

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


Indications by Disease

DiseaseDoseContext
Bell's palsy400mg 5x per day x1 weekAntiviral
Encephalitis10mg/kg (10-15mg/kg for pediatrics) every 8hrsHSV
Herpes Simplex Virus-2400mg PO q8hrs x 7-10 days or 200mg PO 5x/day x 7-10 daysInitial Episode
Herpes Simplex Virus-2400mg PO q8hrs x 5 days or 800mg PO q12hrs x 5 days or 800mg PO q8hrs x 2 daysRecurrence
Herpes Simplex Virus-2400mg PO q12hrs dailySuppressive
Herpes gingivostomatitis400 mg PO 5x/day (q4hrs while awake) x 5 daysNormal host
Herpes gingivostomatitis5 mg/kg IV q8h x 7 daysImmunocompromised
Herpes gingivostomatitis400mg PO 5x/day x 14-21 daysImmunocompromised (oral)
Herpes labialis400 mg PO 5x/day (q4hrs while awake) x 5 daysNormal host
Herpes labialis5 mg/kg IV q8h x 7 daysImmunocompromised
Herpes labialis400mg PO 5x/day x 14-21 daysImmunocompromised (oral)

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
  • HSV-1/Herpes labialis
    • 15 mg/kg PO (max dose of 200 mg) 5 times per day


Indications by Disease

DiseaseDoseContext
Encephalitis20mg/kg IV q8hrs x 21 days (neonates); 10-15mg/kg IV q8hrs x 14-21 days (children)Pediatric HSV
Herpes gingivostomatitis40-80mg/kg PO divided in 3-4 doses for 5-7 daysNormal host
Herpes labialis40-80mg/kg PO divided in 3-4 doses for 5-7 daysNormal host
Neonatal conjunctivitis20mg/kg IV q8h x 14-21 daysHerpetic conjunctivitis
Pediatric fever of uncertain source20mg/kg/doseNeonatal 0-28 days if HSV suspected

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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