acyclovir (Rx)

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  

Mucocutaneous Herpes Simplex Virus Infection

Treatment in immunocompromised patients

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

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  
• 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  

Dosage Modifications

Dose adjustment based on renal clearance and normal dosage regimen

200 mg every 4 hr

• <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

• <10 mL/min/1.73 m²: 200 mg q12hr
• ≥10 mL/min/1.73 m²: 400 mg q12hr

800 mg every 4 hr

• <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

Neonatal Herpes Simplex Virus Infection

Following doses based on research of the NIH National Institute of Child Health and Human Development (NICHD) that updated prescribing information was based on

Infuse IV over 1 hr

PMA ≥34 weeks: 20 mg/kg IV q8hr for 21 days  

PMA <34 weeks: 20 mg/kg IV q12hr for 21 days

Caution if renal function beyond the effect of prematurity occurs

Herpes Simplex Virus Encephalitis

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

≥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  

≥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  

≥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  

≥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

Dosing Considerations

Use ideal body weight (IBW) for obese patients