acyclovir (Rx)

Brand and Other Names:Zovirax
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL

oral suspension

  • 200mg/5mL

powder for injection

  • 500mg/vial
  • 1g/vial

tablet

  • 400mg
  • 800mg

capsule

  • 200mg
more...

Genital Herpes

Initial treatment: 200 mg PO q4hr while awake (5 times daily) for 10 days or 400 mg PO q8hr for 7-10 days

Intermittent treatment for recurrence: 200 mg PO q4hr while awake (5 times daily) for 5 days; initiate at earliest sign or symptom of recurrence

Chronic suppression for recurrence: 400 mg PO q12hr for up to 12 months; alternatively, 200 mg 3-5 times daily

Herpes Simplex Virus Encephalitis

10-15 mg/kg IV q8hr for 10 days; up to 14-21 days reported 

In obese patients, use IBW

Mucocutaneous Herpes Simplex Virus Infection

Treatment in immunocompromised patients

IV: 5 mg/kg q8hr for 7 days; dosing up to 14 days reported 

In obese patients, use IBW

PO (off-label): 400 mg q4hr while awake (5 times daily) for 7 days

Herpes Zoster (Shingles)

Acute treatment: 800 mg PO q4hr while awake (5 times daily) for 7-10 days

Immunocompromised patients

  • 10 mg/kg IV q8hr for 7 days 
  • In obese patients, use IBW
  • CrCl 25-50 mL/min: Full recommended IV dose q12hr
  • CrCl 10-25 mL/min: Full recommended IV dose once daily
  • CrCl 0-10 mL/min: 50% of recommended IV dose once daily

Varicella Zoster (Chickenpox)

>40 kg (immunocompetent): 800 mg PO q6hr for 5 days

Immunocompromised patients: 10-15 mg/kg IV q8hr for 7-10 days 

In obese patients, use IBW

Dosing Modifications

Dose adjustment based on renal clearance and normal dosage regimen

200 mg every 4 hr

  • 0-10 mL/min/1.73 m²: 200 mg q12hr
  • >10 mL/min/1.73 m²: 200 mg q4hr (five times daily)

400 mg every 12 hr

  • 0-10 mL/min/1.73 m²: 200 mg q12hr
  • >10 mL/min/1.73 m²: 400 mg q12hr

800 mg every 4 hr

  • 0-10 mL/min/1.73 m²: 800 mg q12hr
  • 10-25 mL/min/1.73 m²: 800 mg q8hr
  • >25 mL/min/1.73 m²: 800 mg q4hr (five times daily)

Dose adjustment based on dosage form

Renal impairment (IV)

  • CrCl 25-50 mL/min/1.73 m²: Give recommended dose q12hr
  • CrCl 10-25 mL/min/1.73 m²: Give recommended dose q24hr
  • CrCl <10 mL/min/1.73 m²: Give 50% of recommended dose q24hr

Renal impairment (PO)

  • Normal dosage 200 mg q4hr or 400 mg q12hr and CrCl <10 mL/min/1.73 m²: Decrease to 200 mg q12hr
  • Normal dosage 800 mg q4hr and CrCl 10-25 mL/min/1.73 m²: Decrease to 800 mg q8hr
  • Normal dosage 800 mg q4hr and CrCl <10 mL/min/1.73 m²: Decrease to 800 mg q12hr

Herpetic Keratitis (Orphan)

Orphan designation for treatment of herpetic keratitis

Sponsor

  • Cumulus Pharmaceuticals LLC; 1712 Pioneer Avenue, Suite 1377; Cheyenne, Wyoming 82001

Dosage Forms & Strengths

injectable solution

  • 50mg/mL

oral suspension

  • 200mg/5mL

powder for injection

  • 500mg/vial
  • 1g/vial

tablet

  • 400mg
  • 800mg

capsule

  • 200mg
more...

Neonatal Herpes Simplex Virus Infection

30 mg/kg/day IV divided q8hr for 14-21 days; alternatively, 20 mg/kg IV q8hr for 14-21 days  

In obese patients, use IBW

Herpes Simplex Virus Encephalitis

3 months-12 years: 20 mg/kg IV q8hr for 10 days; up to 14-21 days reported  

In obese patients, use IBW

>12 years: 10-15 mg/kg IV q8hr for 14-21 days

Mucocutaneous Herpes Simplex Virus Infection

Treatment in immunocompromised patients

<12 years: 10 mg/kg IV q8hr for 7 days 

In obese patients, use IBW

>12 years: 5-10 mg/kg/day IV divided q8hr for 5-7 days; up to 14 days reported

Herpes Zoster (Shingles)

<12 years (immunocompromised): 20 mg/kg IV q8hr for 7 days  

In obese patients, use IBW

>12 years (immunocompetent): 800 mg PO q4hr while awake (5 times daily) for 7-10 days

>12 years (immunocompromised): 30 mg/kg/day IV divided q8hr for 7-10 days

Varicella Zoster (Chickenpox)

≥2 years and <40 kg: 20 mg/kg/dose PO q6hr for 5 days; not to exceed 800 mg/dose 

In obese patients, use IBW

>40 kg: 800 mg PO q6hr for 5 days

Immunocompromised patients

  • <12 years: 20 mg/kg/dose IV q8hr for 7 days
  • >12 years: 10 mg/kg/dose IV q8hr for 7 days
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Interactions

Interaction Checker

and acyclovir

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Oral

            • Malaise (≤12%)

            1-10%

            Parenteral

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

            Oral

            • Nausea (2-5%)
            • Vomiting (≤3%)
            • Diarrhea (2-3%)
            • Headache (2%)

            <1%

            Abdominal pain

            Aggression/confusion

            Agitation

            Alopecia

            Anaphylaxis

            Anemia

            Angioedema

            Anorexia

            Ataxia

            Coma

            Disseminated intravascular coagulation (DIC)

            Dizziness

            Fatigue

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            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

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug enters breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Interferes with DNA polymerase to inhibit DNA replication via chain termination

            Absorption

            Absorption: PO, 15-30%

            Peak serum time: 1.5-2 hr (PO); 1 hr (IV)

            Distribution

            Distributed widely (brain, kidney, lungs, liver, spleen, muscle, uterus, vagina, cerebrospinal fluid [CSF])

            Protein bound: 9-33%

            Vd: 0.8 L/kg (63.6 L)

            Metabolism

            Metabolized by liver (in small amounts)

            Elimination

            Half-life: 4 hr (Neonates); 2-3 hr (children 1-12 years); 3 hr (adults)

            Excretion: Urine (62-90% as unchanged drug)

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            Administration

            IV Incompatibilities

            Blood products and protein-containing solutions

            Additive: Dobutamine, dopamine, meropenem (?)

            Syringe: Caffeine

            Y-site: Amifostine, amsacrine, aztreonam, cefepime, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, morphine sulfate (?), ondansetron, piperacillin-tazobactam, sargramostim, vinorelbine

            IV Compatibilities

            Additive: Fluconazole

            Y-site (partial list): Allopurinol, ampicillin, cefazolin, cimetidine, diphenhydramine, fluconazole, heparin, linezolid, lorazepam, magnesium sulfate, potassium chloride, propofol, trimethoprim-sulfamethoxazole, vancomycin

            IV Preparation

            Reconstitution: Concentrations >10 mg/mL increase risk of phlebitis; usually recommended not to exceed 7 mg/mL in D5W

            IV Administration

            Maximum dosage: 20 mg/kg q8hr

            For IV infusion only

            Avoid rapid infusion; infuse over 1 hour at constant rate to prevent renal damage

            Maintain adequate hydration

            Check for phlebitis, and rotate infusion sites

            Storage

            Reconstituted solutions remain stable for 24 hours at room temperature

            To prevent precipitation, avoid refrigerating reconstituted solutions

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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