Acyclovir: Difference between revisions
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==General==
==General==
*Type: [[Antiviral]]: guanosine analog
*Type: [[Antiviral]]: [[Is DrugClass:: nucleoside analoge]]
*Dosage Forms: IV, PO
*Dosage Forms: IV, PO (200 mg, 400 mg, and 800 mg)
*Common Trade Names: Zovirax
*Common Trade Names: Zovirax


==Adult Dosing==
==Adult Dosing==
*HSV [[Encephalitis]]
*[[HSV]] [[Encephalitis]]
**10mg/kg IV q8h x 10 d
**10mg/kg IV q8h x 10 d


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*[[HSV keratitis]]
*[[HSV keratitis]]
**400mg PO 5x/day
**400mg PO 5x/day
===Indications by Disease===
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|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Pediatric Dosing==
==Pediatric Dosing==
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***IV: 30mg/kg/day IV divided q8h x 7-10 d  
***IV: 30mg/kg/day IV divided q8h x 7-10 d  
**Immunocompromised  
**Immunocompromised  
***30mg/kg/day IV divided q8h x 7-10 d  
***30mg/kg/day IV divided q8h x 7-10 d
*HSV-1/[[Herpes labialis]]
**15 mg/kg PO (max dose of 200 mg) 5 times per day
 


===Indications by Disease===
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|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
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==Special Populations==
==Special Populations==
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Hallucinations / psychosis  
*[[Hallucinations]] / [[psychosis]]
*[[Seizure]]  
*[[Seizure]]  
*Coma  
*[[Coma]]
*Encephalopathy  
*[[Encephalopathy]]
*Thrombocytopenia  
*[[Thrombocytopenia]]
*Leukopenia  
*[[Leukopenia]]
*[[Anaphylaxis]]  
*[[Anaphylaxis]]  
*Angioedema  
*[[Angioedema]]
*Erythema Multiforme  
*[[Erythema Multiforme]]
*SJS / TEN / TTP  
*[[SJS]] / [[TEN]]
*Hepatitis  
*[[TTP]]
*Renal failure  
*[[Hepatitis]]
*[[Renal failure]]


===Common===
===Common===
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<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:ID]]

Latest revision as of 02:37, 20 March 2026

General

Adult Dosing

  • Genital/Mucocutaneous HSV
    • Immunocompetent
      • 1st episode, Mild-mod: 400mg PO TID x 7-10 d
      • 1st episode, Severe: 5-10mg/kg IV q8h x 2-7 d
      • Recurrence: 400mg PO TID x 5 d
      • Suppression: 400mg PO BID
    • Immunocompromised
      • 1st episode: 400mg PO TID x 5-10 d
      • Recurrence: 400mg PO TID x 5-10 d
      • Suppression: 400-800mg PO BID-TID
  • Varicella
    • Immunocompetent
      • 800mg PO QID x 5-7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • Herpes Zoster
    • Immunocompetent
      • 800mg PO 5x/day x 7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • Herpes Zoster
    • Immunocompetent
      • 800mg PO 5x/day x 7 d
    • Immunocompromised
      • 10mg/kg IV q8h x 7 d
  • HSV prophylaxis in immunocompromised
    • 400-800mg PO BID-TID


Indications by Disease

DiseaseDoseContext
Bell's palsy400mg 5x per day x1 weekAntiviral
Encephalitis10mg/kg (10-15mg/kg for pediatrics) every 8hrsHSV
Herpes Simplex Virus-2400mg PO q8hrs x 7-10 days or 200mg PO 5x/day x 7-10 daysInitial Episode
Herpes Simplex Virus-2400mg PO q8hrs x 5 days or 800mg PO q12hrs x 5 days or 800mg PO q8hrs x 2 daysRecurrence
Herpes Simplex Virus-2400mg PO q12hrs dailySuppressive
Herpes gingivostomatitis400 mg PO 5x/day (q4hrs while awake) x 5 daysNormal host
Herpes gingivostomatitis5 mg/kg IV q8h x 7 daysImmunocompromised
Herpes gingivostomatitis400mg PO 5x/day x 14-21 daysImmunocompromised (oral)
Herpes labialis400 mg PO 5x/day (q4hrs while awake) x 5 daysNormal host
Herpes labialis5 mg/kg IV q8h x 7 daysImmunocompromised
Herpes labialis400mg PO 5x/day x 14-21 daysImmunocompromised (oral)

Pediatric Dosing

  • Neonatal HSV
    • 40-60mg/kg/day IV divided q12h x 14-21 d
  • HSV encephalitis
    • 3 mo - 11 y/o
      • 30-45mg/kg/day IV divided q8h x 14-21 d
    • >12 y/o
      • 30mg/kg/day IV divided q8h x 14-21 d
  • Genital/mucocutaneous HSV
    • Immunocompetent
      • 1st episode, 2-11 y/o
        • 40-80mg/kg/day PO divided q6-8 h x 5 d, max 1g/day
      • 1st episode, >12 y/o
        • 1g/day PO divided 5x/day x 7-10 d
    • Immunocompromised
      • PO: >2 y/o: 1g/day PO divided 3-5x/day x 7-14 d
      • IV: >1 y/o: 30mg/kg/day IV divided q8h x 7-14 d
  • Varicella
    • Immunocompetent
      • PO: > 2 y/o: 80mg/kg/day PO divided q6h x 5 d
      • IV: > 1 y/o: 30mg/kg/day IV divided q8h x 7-10 d
    • Immunocompromised
      • 30mg/kg/day IV divided q8h x 7-10 d
  • Herpes zoster
    • Immunocompetent
      • PO: > 12 y/o: 4g/day PO divided 5x/day x 5-7 d
      • IV: 30mg/kg/day IV divided q8h x 7-10 d
    • Immunocompromised
      • 30mg/kg/day IV divided q8h x 7-10 d
  • HSV-1/Herpes labialis
    • 15 mg/kg PO (max dose of 200 mg) 5 times per day


Indications by Disease

DiseaseDoseContext
Encephalitis20mg/kg IV q8hrs x 21 days (neonates); 10-15mg/kg IV q8hrs x 14-21 days (children)Pediatric HSV
Herpes gingivostomatitis40-80mg/kg PO divided in 3-4 doses for 5-7 daysNormal host
Herpes labialis40-80mg/kg PO divided in 3-4 doses for 5-7 daysNormal host
Neonatal conjunctivitis20mg/kg IV q8h x 14-21 daysHerpetic conjunctivitis
Pediatric fever of uncertain source20mg/kg/doseNeonatal 0-28 days if HSV suspected

Special Populations

  • Pregnancy Rating: B
  • Lactation Risk Categories: Safe
  • Renal Dosing
    • Adult
      • IV
        • CrCl 25-50 give q12h
        • CrCl 10-24 give q24h
        • CrCl <10 decrease dose 50%, give q24h
        • HD give usual dose as supplement
        • PD no supplement
      • PO
        • CrCl <25: see package insert
        • HD: give usual dose as supplement
        • PD: no supplement
    • Pediatric
    • Geriatric
      • Refer to adult dosing. Oral: Initial doses should begin at the low end of the dosage range
  • Hepatic Dosing
    • Not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

  • Nausea/vomiting/diarrhea
  • Headache
  • Dizziness
  • Rash
  • Arthralgia
  • Confusion / lethargy
  • Elev. BUN/creatinine
  • Photosensitivity

Pharmacology

  • Half-life: 2.5 - 3.3 hrs
  • Metabolism: virally infected cells (intracellularly); liver
  • Excretion: Urine
  • Mechanism of Action: Inhibits DNA polymerase

See Also

References

  • Epocrates 2015
  • Acetazolamide injection [prescribing information]. Big Flats, NY: X-Gen Pharmaceuticals, Inc; October 2015.
  • Acetazolamide tablets [prescribing information]. Hawthorne, NY: Taro Pharmaceuticals; September 2013.


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