1 vial

$2.87

1 tablet

7c

1 tube

$13.47

Zovirax, Acyclovir, Aciclovir

  • Herpes Simplex encephalitis

  • Prophylaxis in an allogeneic bone marrow transplant patient (at risk of CMV)

  • Varicella Pneumonia

  • Uncomplicated Herpes Simplex or Varicella Zoster infection in an immunocompromised patient.

  • Treatment of Shingles

PO / NG:
Acyclovir is available in 200mg, 400mg and 800mg tablets; 200mg dispersible tablets are also available.

IV:
Acyclovir sodium for IV administration comes in a vial containing 250mg in 10ml. It is a clear, colourless to pale yellow solution. Do not refrigerate. Stable in compatible IV fluid for 24 hours at room temperature. Do not use solution if it appears cloudy or visible crystals are present. Acyclovir solution is highly alkaline. It should not be administered by mouth.
Administer as:
EITHER: 25mg/ml solution via a controlled rate infusion pump over at least one hour (preferred method if administering via a central line)
OR: dilute 25mg/ml solution to make a solution of 5mg/ml using a compatible IV fluid (eg dilute 5ml into 25ml total) and then administer by controlled infusion over at least one hour (preferred method if administering via a peripheral line)
Compatible with the following IV fluids:
Saline, Hartmann’s, Glucose and Sodium Chloride

TOP:
Each gram of Zovirax cream 5% contains 50 mg acyclovir in an aqueous cream base. It is supplied in 2 g tubes.


ADULT DOSE
Herpes Simplex Encephalitis
Adults and Adolescents (12 years of age and older):
10 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 10 days.

Herpes Simplex Infections in Immunocompromised Patients
Adults and Adolescents (12 years of age and older):
5 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 7 days.

Varicella Zoster Infections including Varicella Pneumonia
Adults and Adolescents (12 years of age and older):
10 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 7 days.
OR (for uncomplicated Shingles in the non-immunocompromised patient):
800 mg five times daily for 10 days (There are no data on treatment initiated more than 72 hours after onset of the zoster rash.)
NOTE: IV therapy is indicated in the immunocompromised and in patients with Varicella pneumonia

Cold sores (in the non-immunocompromised)
Acyclovir cream should be applied 5 times per day for 4 days. Therapy should be initiated as early as possible following onset of signs and symptoms. Data indicating efficacy are poor and use in the critically ill has not been studied.

NOTE: Obese patients should be dosed at the recommended adult dose using ideal body weight.

PAEDIATRIC DOSE
Herpes Simplex Encephalitis
Paediatrics (3 months to 12 years of age):
20 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 10 days.

Herpes Simplex Infections in Immunocompromised patients
Paediatrics (under 12 years of age):
10 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 7 days.

Varicella Zoster Infections including Varicella Pneumonia
Paediatrics (under 12 years of age):
20 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 7 days.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY

Dose in renal impairment [
GFR (ml/min)]
<10 2.5-5mg/kg every 24 hours
10-25 5-10mg/kg every 12 hours
>25-50 5-10mg/kg every 12 hours

Dose in renal replacement therapy
CAPD Dose as for GFR <10ml/min
HD Dose as for GFR <10ml/min
CVVHDF Dose as for GFR 10-25ml/min

Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and varicella-zoster virus (VZV).

CONTRAINDICATIONS:

  • hypersensitivity to acyclovir or valacyclovir


WARNINGS
Acyclovir for injection is intended for IV infusion only, and should not be administered topically, intramuscularly, orally, subcutaneously, or into the eye.
IV infusions must be given over a period of at least 1 hour to reduce the risk of renal tubular damage. Renal failure, in some cases resulting in death, has been observed with acyclovir therapy

Acyclovir

Thrombotic thrombocytopenic purpura/haemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients receiving acyclovir therapy.

PRECAUTIONS
General
Precipitation of acyclovir crystals in renal tubules can occur if the drug is administered by bolus injection. Ensuing renal tubular damage can produce acute renal failure.
Abnormal renal function (decreased creatinine clearance) can occur as a result of acyclovir administration and depends on the state of the patient's hydration, other treatments, and the rate of drug administration. Concomitant use of other nephrotoxic drugs, pre-existing renal disease, and dehydration make further renal impairment with acyclovir more likely.
Approximately 1% of patients receiving IV acyclovir have manifested encephalopathic changes characterised by either lethargy, obtundation, tremors, confusion, hallucinations, agitation, seizures, or coma.

Laboratory Tests
No tests are required in addition to routine ICU blood tests.

Drug/Laboratory Test Interactions
None reported

Coadministration with other nephrotoxic drugs increases the risk of renal toxicity

Body as a Whole:
Anaphylaxis, fever, pain, peripheral oedema.
Cardiovascular System:
Hypotension.
Digestive System:
Diarrhoea, gastrointestinal distress, nausea.
Nervous System:
Aggressive behavior, agitation, ataxia, coma, confusion, delirium, dizziness, hallucinations, obtundation, paraesthesia, psychosis, seizure, somnolence. These symptoms may be marked, particularly in older adults
Hematologic and Lymphatic:
Disseminated intravascular coagulation, haemolysis, leukopenia, lymphadenopathy.
Hepatobiliary Tract and Pancreas:
Elevated liver function tests, hepatitis, hyperbilirubinemia, jaundice.
Musculoskeletal:
Myalgia.
Skin:
Alopecia, erythema multiforme, photosensitive rash, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria. Severe local inflammatory reactions, including tissue necrosis, have occurred following infusion of acyclovir into extravascular tissues.
Special Senses:
Visual abnormalities.
Urogenital:
Renal failure, elevated blood urea nitrogen, elevated creatinine.

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