acyclovir

Pronunciation: ay-SYE-kloe-ver Trade Drug: Zovirax

acyclovir sodium Trade Drug: Zovirax

PREGNANCY RISK CATEGORY B

Pharmacologic classification: synthetic Therapeutic classification: antiviral Available Forms

purine nucleoside

Capsules: 200 mg Injection: 500 mg/vial, 1 g/vial Suspension: 200 mg/5 ml Tablets: 400 mg, 800 mg
Indications and Dosages First and recurrent episodes of mucocutaneous herpes simplex virus (HSV-1 and HSV-2) infections in immunocompromised patients; severe first episodes of genital herpes in patients who aren't immunocompromised

Adults and children age 12 and older: 5 mg/kg given I.V. over 1 hour every 8 hours for 7 days. Give for 5 to 7 days for severe first episode of genital herpes. Children younger than age 12: Give 10 mg/kg I.V. over 1 hour every 8 hours for 7 days.
First genital herpes episode

Adults: 200 mg P.O. every 4 hours while awake, five times daily; or 400 mg P.O. every 8 hours. Continue for 7 to 10 days.
Intermittent therapy for recurrent genital herpes

Adults: 200 mg P.O. every 4 hours while awake, five times daily. Continue for 5 days. Begin therapy at first sign of recurrence.
Long-term suppressive therapy for recurrent genital herpes

Adults: 400 mg P.O. b.i.d. for up to 12 months. Or, 200 mg P.O. three to five times daily for up to 12 months.
Varicella (chickenpox) infections in immunocompromised patients

Adults and children age 12 and older: 10 mg/kg I.V. over 1 hour every 8 hours for 7 days. Dosage for obese patients is 10 mg/kg based on ideal body weight every 8 hours for 7 days. Don't exceed maximum dosage equivalent of 20 mg/kg every 8 hours. Children younger than age 12: Give 20 mg/kg I.V. over 1 hour every 8 hours for 7 days.
Varicella infection in immunocompetent patients

Adults and children who weigh more than 40 kg (88 lb): 800 mg P.O. q.i.d. for 5 days. Children age 2 and older, who weigh less than 40 kg: 20 mg/kg (maximum 800 mg/dose) P.O. q.i.d. for 5 days. Start therapy as soon as symptoms appear.
Acute herpes zoster infection in immunocompetent patients

Adults and children age 12 and older: 800 mg P.O. every 4 hours five times daily for 7 to 10 days.
Herpes simplex encephalitis

Adults and children age 12 and older: 10 mg/kg I.V. over 1 hour every 8 hours for 10 days. Children ages 3 months to 12 years: 20 mg/kg I.V. over 1 hour every 8 hours for 10 days.
Neonatal herpes simplex virus infection

Neonates to 3 months old: 10 mg/kg I.V. over 1 hour every 8 hours for 10 days.

Adjust-a-dose: For patients receiving the I.V. form, if creatinine clearance is 25 to 50 ml/minute, give 100% of dose every 12 hours; if clearance is 10 to 24 ml/minute, give 100% of dose every 24 hours; if clearance is less than 10 ml/minute, give 50% of dose every 24 hours. For patients receiving the P.O. form, if normal dose is 200 mg every 4 hours five times daily and creatinine clearance is less than 10 ml/minute , give 200 mg P.O. every 12 hours. If normal dose is 400 mg every 12 hours and clearance is less than 10 ml/minute, give 200 mg every 12 hours. If normal dose is 800 mg every 4 hours five times daily and clearance is 10 to 25 ml/minute, give 800 mg every 8 hours; if clearance is less than 10 ml/minute, give 800 mg every 12 hours.
Administration P.O.

Give drug without regard for meals, but give with food if stomach irritation occurs. Patient should take drug as prescribed, even after he feels better.
I.V.

Solutions concentrated at 7 mg/ml or more may cause a higher risk of phlebitis. Encourage fluid intake because patient must be adequately hydrated during infusion. Bolus injection, dehydration (decreased urine output), renal disease, and use with other nephrotoxic drugs increase the risk of renal toxicity. Don't give by bolus injection. Give I.V. infusion over at least 1 hour to prevent renal tubular damage. Monitor intake and output, especially during the first 2 hours after administration. Alert: Don't give I.M. or subcutaneously. Incompatibilities: Amifostine, aztreonam, biological or colloidal solutions, cefepime, cisatracurium besylate, diltiazem hydrochloride, dobutamine hydrochloride, dopamine hydrochloride, fludarabine phosphate, foscarnet sodium, gemcitabine hydrochloride, idarubicin hydrochloride, levofloxacin, meperidine hydrochloride, meropenem, morphine sulfate, ondansetron hydrochloride, parabens, piperacillin sodium and tazobactam sodium, sargramostim, tacrolimus, vinorelbine tartrate.
Action

Interferes with DNA synthesis and inhibits viral multiplication.

Pharmacokinetics Route Onset Peak Duration

P.O. I.V.

Unknown 2 hr Unknown Immediate Immediate Unknown Half Life: 2 to 3 hours with normal renal function; up to 19 hours with renal impairment.
Adverse Reactions CNS headache malaise encephalopathic changes (including lethargy, obtundation, tremor, confusion, hallucinations, agitation, seizures, coma) GI nausea vomiting

diarrhea
GU acute renal failure

hematuria
Hematologic leukopenia

thrombocytopenia

thrombocytosis
Skin inflammation or phlebitis at injection site

itching rash urticaria

Interactions Drug-drug Interferon

Effect: May have synergistic effect. Action: Monitor patient closely.

Probenecid

Effect: May increase acyclovir level. Action: Monitor patient for possible toxicity.
Zidovudine

Effect: May cause drowsiness or lethargy. Action: Use together cautiously.

Effects on Lab Test Results

May increase BUN and creatinine levels. May decrease WBC count. May increase or decrease platelet count.
Contraindications and Cautions

Contraindicated in patients hypersensitive to drug. Use cautiously in patients with neurologic problems, renal disease, or dehydration, and in those receiving other nephrotoxic drugs. Adequate studies haven't been done in pregnant women; use only if potential benefits outweigh risks to fetus.
Clinical Considerations

In patients with renal disease or dehydration and in those taking other nephrotoxic drugs, monitor renal function. Encephalopathic changes are more likely to occur in patients with neurologic disorders and in those who have had neurologic reactions to cytotoxic drugs. Look alike-sound alike: Don't confuse acyclovir sodium (Zovirax) with acetazolamide sodium (Diamox) vials, which may look alike. Look alike-sound alike: Don't confuse Zovirax with Zyvox.
Patient Teaching

Tell patient to take drug as prescribed, even after he feels better. Tell patient drug is effective in managing herpes infection but doesn't eliminate or cure it. Warn patient that drug won't prevent spread of infection to others. Tell patient to avoid sexual contact while visible lesions are present. Teach patient about early signs and symptoms of herpes infection (such as tingling, itching, or pain). Tell him to notify prescriber and get a prescription for drug before the infection fully develops. Early treatment is most effective. Canada Off-label use OTC * Liquid contains alcohol. Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING. Interactions may have a rapid onset or delayed onset.