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Acyclovir

    Brands

    DEA Class; Rx

    Common Brand Names; Zovirax, Avaclyr, Zovirax topical, Sitavig

    • Antivirals, Other; 
    • Antivirals, HSV; 
    • Antivirals, VZV

    Synthetic antiviral with activity against herpes simplex virus type 1 and 2 and varicella-zoster virus
    Used to treat herpes labialis, herpes genitalis, herpes simplex encephalitis, herpes simplex keratitis, neonatal herpes infection, chickenpox (varicella), shingles (zoster)
    Potent activity against herpes simplex viruses type 1 and 2 and much less activity against varicella-zoster virus

    Indicated for the treatment of neonatal herpes simplex virus infection.

    For the treatment of viral encephalitis.
    For the treatment of herpes zoster (shingles) infection.

    Hypersensitivity

    Oral

    • Malaise (≤12%)

    Parenteral

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

    Eye pain (stinging)

    Punctuate keratitis

    Follicular conjunctivitis

    Burning/stinging (30%)

    Pruritus (4%)

    Dry lips (<1%)

    Rash (0.3%)

    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

    Drug is minimally absorbed systemically following topical route of administration, and maternal use is not expected to result in fetal exposure to drug

    Drug is minimally absorbed systemically following topical route of administration, and breastfeeding is not expected to result in exposure of child to drug

    Adults

    30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 4,000 mg/day PO; 50 mg/dose buccal.

    Geriatric

    30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 4,000 mg/day PO; 50 mg/dose buccal.

    Adolescents

    30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label. 80 mg/kg/day PO (Max: 3,200 mg/day) per FDA-approved product labeling; however, 4,000 mg/day has been used off-label; safety and efficacy of buccal tablet not established.

    Children

    12 years: 30 mg/kg/day IV per FDA-approved product labeling; however, up to 45 mg/kg/day IV is used off-label; 80 mg/kg/day PO (Max: 3,200 mg/day) per FDA-approved product labeling; however, 4,000 mg/day has been used off-label; safety and efficacy of buccal tablet not established.
    2 to 11 years: 60 mg/kg/day IV; 80 mg/kg/day PO (Max: 3,200 mg/day); safety and efficacy of buccal tablet not established.
    1 year: 60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 80 mg/kg/day PO has been used off-label.

    Infants

    60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 80 mg/kg/day PO has been used off-label.

    Neonates

    60 mg/kg/day IV; safety and efficacy of oral acyclovir have not been established; however, 900 mg/m2/day PO has been used off-label for suppressive therapy of neonatal herpes.

    Acyclovir sodium

    injectable solution

    • 50mg/mL

    injection, lyophilized powder for reconstitution

    • 500mg/vial
    • 1000mg/vial

    oral suspension

    • 200mg/5mL

    tablet

    • 400mg
    • 800mg

    capsule

    • 200mg

    ophthalmic ointment

    • 3% (3.5g tube)

    topical cream

    • 5%

    topical ointment

    • 5%

    mucoadhesive buccal tablet

    • 50mg (Sitavig)