Adult Dosing
Herpes simplex infections
- Adults and adolescents (
12 yrs): Infuse 5-10 mg/kg at constant rate over 1hr q8 hrs x 7 days
Genital herpes, initial treatment in immunocompetent individuals
- Adults and adolescents ( 12 yrs): Infuse 5 mg/kg at constant rate over 1hr q8 hrs x 5 days
Herpes simplex encephalitis
- Adults and adolescents ( 12 yrs): Infuse 10 mg/kg at constant rate over 1hr q8 hrs x 10 days
Varicella zoster infections, immunocompromised individuals
- Adults and adolescents ( 12 yrs): Infuse 10-15 mg/kg at constant rate over 1hr q8 hrs x 7 days
Notes:- Avoid rapid, bolus intravenous injection, intramuscular, subcutaneous injection
- Initiate therapy on onset of signs and symptoms of herpes infections
- Max dose: 20 mg/kg q8 hrs
- Dose obese patients at the recommended adult dose using Ideal body weight
Pediatric Dosing
Herpes simplex infections
- <12 yrs: Infuse 10 mg/kg at constant rate over 1hr q8 hrs x 7 days
Herpes simplex encephalitis
- 3 months-12 yrs: Infuse 20 mg/kg at constant rate over 1hr q8 hrs x 10 days
Neonatal herpes
- Birth - 3 months: Infuse 10 mg/kg at constant rate over 1hr q8 hrs x 10 days
Varicella zoster infections, immunocompromised patients
- <12 yrs: Infuse 20 mg/kg at constant rate over 1hr q8 hrs x 7 days
Notes:- Avoid rapid, bolus intravenous injection, intramuscular, subcutaneous injection
- Initiate therapy on onset of signs and symptoms of herpes infections
- Max dose: 20 mg/kg q8 hrs
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >50 mL/min: 100% of the dose q8 hrs
- 25-50 mL/min: 100% of the dose q12 hrs
- 10-25 mL/min: 100% of the dose q24 hrs
- <10 mL/min: 50% of the dose q24 hrs
- Hemodialysis: Supplement after treatment. HIV patients may require additional adjustment
Hepatic Dose Adjustment
- Hepatic impairment: Caution advised
- Maintain adequate hydration to prevent precipitation of acyclovir in renal tubules
- For intravenous infusion only; do not administer orally, subcutaneously, topically, intramuscularly or in the eye
- Do not administer by bolus injection due to risk of precipitation of acyclovir crystals in renal tubules. Infuse over a period of at least 1 hour to reduce the risk of renal tubular damage
- Fatal renal failure may occur
- Fatal thrombotic thrombocytopenic purpura/hemolytic uremic syndrome may occur in immunocompromised patients on acyclovir therapy
- Pre-existing renal disease, dehydration and concurrent use with nephrotoxic agents may impair renal function
- Do not exceed maximum dose equivalent to 20 mg/kg q8 hrs
- Adjust dose based on estimated creatinine clearance
- Encephalopathic changes may occur in patients receiving intravenous therapy
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section )
- Hepatic impairment
- Pre-existing neurological abnormalities
- Pulmonary, or fluid and electrolyte abnormalities
- Dehydration
- Patients with hypoxia
- Concomitant use with nephrotoxic agents
- Geriatrics
Pregnancy Category:B
Breastfeeding: This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776).With highest maternal dosages, the amount excreted in breast milk is equivalent to 1% of a typical infant dosage. Since it is excreted in negligible amounts, it would not be expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 September 2010).
