Acyclovir

Brands

DEA Class; Rx

Common Brand Names; Zovirax, Avaclyr, Zovirax topical, Sitavig

  • Antivirals, Other; 
  • Antivirals, HSV; 
  • Antivirals, VZV

Synthetic antiviral with activity against herpes simplex virus type 1 and 2 and varicella-zoster virus
Used to treat herpes labialis, herpes genitalis, herpes simplex encephalitis, herpes simplex keratitis, neonatal herpes infection, chickenpox (varicella), shingles (zoster)
Potent activity against herpes simplex viruses type 1 and 2 and much less activity against varicella-zoster virus

Indicated for the treatment of neonatal herpes simplex virus infection.

For the treatment of viral encephalitis.
For the treatment of herpes zoster (shingles) infection.

Hypersensitivity

Oral

  • Malaise (≤12%)

Parenteral

  • Inflammation or phlebitis at injection site (9%)
  • Nausea (7%)
  • Vomiting (7%)
  • Rash or hives (2%)
  • Elevated transaminase levels (1-2%)

Eye pain (stinging)

Punctuate keratitis

Follicular conjunctivitis

Burning/stinging (30%)

Pruritus (4%)

Dry lips (<1%)

Rash (0.3%)

Avoid rapid infusion because of risk of renal damage

Renal failure, resulting in death, has occurred

Use with caution in immunocompromised patients (potential risk of thrombotic thrombocytopenic purpura [TTP]/hemolytic uremic syndrome [HUS])

Use with caution in patients with renal impairment

Treatment should begin within 24 hours of appearance of rash

Use with caution in patients receiving nephrotoxic drugs

Maintain adequate hydration during PO or IV therapy

Thrombocytopenic purpura/hemolytic uremic syndrome reported

Drug is minimally absorbed systemically following topical route of administration, and maternal use is not expected to result in fetal exposure to drug

Drug is minimally absorbed systemically following topical route of administration, and breastfeeding is not expected to result in exposure of child to drug

Adults

30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 4,000 mg/day PO; 50 mg/dose buccal.

Geriatric

30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 4,000 mg/day PO; 50 mg/dose buccal.

Adolescents

30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label. 80 mg/kg/day PO (Max: 3,200 mg/day) per FDA-approved product labeling; however, 4,000 mg/day has been used off-label; safety and efficacy of buccal tablet not established.

Children

12 years: 30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 80 mg/kg/day PO (Max: 3,200 mg/day) per FDA-approved product labeling; however, 4,000 mg/day has been used off-label; safety and efficacy of buccal tablet not established.
2 to 11 years: 60 mg/kg/day IV; 80 mg/kg/day PO (Max: 3,200 mg/day); safety and efficacy of buccal tablet not established.
1 year: 60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 80 mg/kg/day PO has been used off-label.

Infants

60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 80 mg/kg/day PO has been used off-label.

Neonates

60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 900 mg/m2/day PO has been used off-label for suppressive therapy of neonatal herpes.

Acyclovir sodium

injectable solution

  • 50mg/mL

injection, lyophilized powder for reconstitution

  • 500mg/vial
  • 1000mg/vial

oral suspension

  • 200mg/5mL

tablet

  • 400mg
  • 800mg

capsule

  • 200mg

ophthalmic ointment

  • 3% (3.5g tube)

topical cream

  • 5%

topical ointment

  • 5%

mucoadhesive buccal tablet

  • 50mg (Sitavig)
Drugs Generic
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