Dosing & Uses
Dosage Forms & Strengths
ophthalmic ointment
- 3% (3.5g tube)
Acute Herpetic Keratitis
Indicated for acute herpetic keratitis (dendritic ulcers) in patients with herpes simplex virus (HSV-1 and HSV-2)
Initial: Apply 1-cm ribbon to affected eye 5x/day (~q3hr while awake) until healed, followed by 7-day maintenance regimen
Maintenance: Apply 1-cm ribbon to affected eye 3x/day for 7 days
Dosage Forms & Strengths
ophthalmic ointment
- 3% (3.5g tube)
Acute Herpetic Keratitis
<2 years: Safety and efficacy not established
≥2 years
- Indicated for acute herpetic keratitis (dendritic ulcers) in patients with herpes simplex virus (HSV-1 and HSV-2)
- Initial: Apply 1-cm ribbon to affected eye 5x/day (~q3hr while awake) until healed, followed by 7-day maintenance regimen
- Maintenance: Apply 1-cm ribbon to affected eye 3x/day for 7 days
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (0)
Serious - Use Alternative (0)
Monitor Closely (0)
Minor (0)
Adverse Effects
2-10%
Eye pain (stinging)
Punctuate keratitis
Follicular conjunctivitis
Frequency Not Defined
Blepharitis
Hypersensitivity reactions (eg, angioedema, urticaria)
Warnings
Contraindications
Hypersensitivity to acyclovir or valacyclovir
Cautions
For ophthalmic use only
Patients should not wear contact lenses if they have signs or symptoms of herpetic keratitis or during the course of therapy
Product is sterile when packaged; patients should be advised to not allow the tip of the container to touch any surface; this may contaminate the ointment; if pain develops, or redness, itching, or inflammation becomes aggravated, patient should consult a physician
Pregnancy & Lactation
Pregnancy
A prospective epidemiologic registry of acyclovir use from 1984-1999 reported birth defects in women exposed to systemic acyclovir during the first trimester of pregnancy
Likewise, oral and SC administration of acyclovir to pregnant mice, rats, and rabbits during organogenesis did not produce teratogenicity at clinically relevant doses
Lactation
Acyclovir concentrations reported in breast milk following oral administration of acyclovir
There is no information regarding presence of acyclovir in human milk following ocular administration, effects on the breastfed infant, or effects on milk production
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
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.Pharmacology
Mechanism of Action
Synthetic purine nucleoside analogue is converted by the viral encoded thymidine kinase into acyclovir monophosphate, a nucleotide analogue then further converted to acyclovir triphosphate by other cellular enzymes
Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with nucleotides for viral DNA polymerase and being incorporated into viral DNA
Administration
Ophthalmic Administration
Advise patients to wash hands well and pull down lower lid of the affected eye to form a pocket
Apply 1-cm (1/2 inch) ribbon of ointment in the pocket formed by the lower lid (the lower cul-de-sac)
After application, advise patient to close their eye for 1-2 minutes Wipe any excess ointment away
Storage
Store at 20-25°C (68-77°F)
Images
Formulary
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.