Adult Dosing
Mucocutaneous (oral/genital) Herpes Simplex Virus (HSV), initial outbreak (same protocol as immunocompromised or immunocompetent)
- Adults
12 yrs: 200 mg PO, every 4 hours (5x day) for 10 days - In severe cases, consider IV treatment (review IV monograph)
Mucocutaneous (oral/genital) HSV, episodic or recurrent episodes (same protocol for immunocompetent or immunocompromised)
- 200 mg PO, 5 times daily, or 400 mg PO tid, or 800 mg PO bid x 5 days
Genital HSV; chronic suppressive therapy (same protocol for immunocompetent or immunocompromised)
- Adults and adolescents: 200 mg PO tid or 400 mg PO bid (some sources recommend up to 800 mg tid for immunocompromised)
Varicella (chickenpox)
Herpes zoster (shingles)
- Adults 12 yrs (Immunocompetent): 800 mg PO, every 4 hours (5x daily) for 7-10 days
Herpes zoster ophthalmicus (not FDA approved)
- Adults (Immunocompetent): 800 mg PO, 5 times daily for 7-10 days (in combination with ophthalmic topical antiviral treatment); if immunocompromised, IV acyclovir often recommended
HSV keratitis treatment, with HIV (not FDA approved)
HSV keratitis prevention, in immunocompromised (not FDA approved)
- Adults 12 yrs: 400 mg bid for 12 mo
HSV proctitis
- 400 mg PO tid for 10 days or resolution; or 800 mg PO tid for 7-10 days
Pharyngitis (Acute) [Non-FDA Approved]
- 800 mg PO bid x 5 days, or 400 mg tid x 5 days, or 800 mg tid daily x 2 days
Pediatric Dosing
- Note: Safety and effectiveness in pediatric patients < 2 years of age have not been established
Varicella (chickenpox)
- Child 2 years: 20 mg/kg/dose PO qid (80 mg/kg/day)
- Max: 3200 mg/day
- Children over 40kg give adult dose
Herpes zoster (shingles)
- Child (Immunocompetent): 80 mg/kg/day PO divided 5 times daily
- Max: 4000 mg/day
Mucocutaneous (oral/genital) Herpes Simplex Virus (HSV), initial outbreak (same protocol immunocompromised or immunocompetent)
- 40-80 mg/kg/day PO, divided 3-5 times/day x 7-14 days
- Max 1600 mg/day
- In severe cases, consider IV treatment (review IV monograph)
Mucocutaneous (oral/genital) HSV, episodic or recurrent episodes (same protocol for immunocompetent or immunocompromised)
- 40-80 mg/kg/day divided bid/tid x 5 days
- Max: 1200 mg/day if tid, 1600 mg/day if bid
Genital HSV; chronic suppressive therapy (same protocol for immunocompetent or immunocompromised) (not FDA approved)
- 40-80 mg/kg/day PO, divided tid/qid
- Max: 1000 mg/day
Pharyngitis (Acute) [Non-FDA Approved]
- 15 mg/kg PO, 5 times daily x 7 days
[Outline]
Renal Dose Adjustment (Based on CrCl)
- > 25 mL/min
- If normal dose is 800 mg 5 times daily: Give 800 mg 5 times daily
- 10-25 mL/min
- If normal dose is 800 mg 5 times daily: Give 800 mg PO tid
- < 10 mL/min
- If normal dose is 200 mg 5 times daily: Give 200 mg PO bid
- If normal dose is 400 mg bid: Give 200 mg PO bid
- If normal dose is 800 mg 5 times daily: 800 mg PO bid
- Hemodialysis: Supplemental dose needed after each dialysis
- Peritoneal dialysis: No supplemental dose needed
Hepatic Dose Adjustment
- Hepatic impairment: Caution advised; dose adjustments not defined
See Supplemental Patient Information
- For oral ingestion only
- Fatal renal failure may occur
- Fatal thrombotic thrombocytopenic purpura/hemolytic uremic syndrome may occur in immunocompromised patients on acyclovir therapy
- Adjust dose while administering in patients with renal impairment
- Adequate hydration should be maintained
- Patients with underlying neurologic abnormalities or severe hypoxia are at increased risk of neurotoxic effects
- Treatment should be started as soon as possible after the first appearance of symptoms; there are no data on treatment started more than 72 hrs after the onset of the zoster rash
Cautions: Use cautiously in
- Renal impairment (refer dose adjustment section )
- Pre-existing serious neurologic, hepatic, pulmonary, or fluid and electrolyte abnormalities
- Patients with hypoxia
- Obese patients
- Nephrotoxic agent use
Supplemental Patient Information
- Advise patients to maintain adequate hydration
- Advise patients to avoid sexual intercourse when genital lesions are present. Use of acyclovir does not prevent transmission
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).
Pricing data from www.DrugStore.com in U.S.A.
- Acyclovir 200 MG/5ML SUSP [Bottle] (HI-TECH)
473 5ml = $126
1419 5ml = $356.01 - Zovirax 200 MG CAPS [Bottle] (GLAXO SMITH KLINE)
30 mg = $96.99
90 mg = $279.97 - Zovirax 800 MG TABS [Bottle] (GLAXO SMITH KLINE)
30 mg = $336.31
90 mg = $1008.93 - Zovirax 400 MG TABS [Bottle] (GLAXO SMITH KLINE)
60 mg = $361.98
180 mg = $1057.02
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
