Aciclovir

Herpes Zoster Infections : Acyclovir is indicated for the acute treatment of herpes zoster (shingles). Genital Herpes : Acyclovir is indicated for the treatment of initial episodes and the management of recurrent episodes of genital herpes. Chickenpox : Acyclovir is indicated for the treatment of chickenpox (varicella).

• Acute Treatment of Herpes Zoster : 800 mg every 4 hours orally, 5 times daily for 7 to 10 days
• Genital Herpes : Treatment of Initial Genital Herpes: 200 mg every 4 hours, 5 times daily for 10 days
• Chronic Suppressive Therapy for Recurrent Disease: 400 mg 2 times daily for up to 12 months, followed by re-evaluation
• Alternative regimens have included doses ranging from 200 mg 3 times daily to 200 mg 5 times daily
• The frequency and severity of episodes of untreated genital herpes may change over time
• After 1 year of therapy, the frequency and severity of the patient's genital herpes infection should be re-evaluated to assess the need for continuation of therapy with acyclovir
• Intermittent Therapy: 200 mg every 4 hours, 5 times daily for 5 days
• Therapy should be initiated at the earliest sign or symptom (prodrome) of recurrence
• Treatment of Chickenpox : Children (2 years of age and older): 20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days
• Children over 40 kg should receive the adult dose for chickenpox
• Adults and Children over 40 kg: 800 mg 4 times daily for 5 days
• Intravenous acyclovir is indicated
• For the treatment of varicella-zoster infections in immunocompromised patients
• When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox

• Safety and effectiveness of oral formulations of acyclovir
• In pediatric patients younger than 2 years of age have not been established

Of 376 subjects who received acyclovir in a clinical study of herpes zoster treatment in immunocompetent subjects ≥50 years of age, 244 were 65 and over while 111 were 75 and over. No overall differences in effectiveness for time to cessation of new lesion formation or time to healing were reported between geriatric subjects and younger adult subjects. The duration of pain after healing was longer in patients 65 and over. …

• Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become pregnant or intend to become pregnant, they intend to breast feed while taking orally administered acyclovir, or they have any other questions
• Patients should be advised to maintain adequate hydration
• Herpes Zoster : There are no data on treatment initiated more than 72 hours after onset of the zoster rash
• Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster
• Genital Herpes Infections: Patients should be informed that acyclovir is not a cure for genital herpes. …

Acyclovir is contraindicated for patients who develop hypersensitivity to acyclovir or valacyclovir.

See CLINICAL PHARMACOLOGY: Pharmacokinetics .

Acyclovir capsules are intended for oral ingestion only. Renal failure, in some cases resulting in death, has been observed with acyclovir therapy (see ADVERSE REACTIONS: Observed During Clinical Practice and OVERDOSAGE ). Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients receiving acyclovir therapy.

Herpes Simplex: Short-Term Administration: The most frequent adverse events reported during clinical trials of treatment of genital herpes with acyclovir 200 mg administered orally 5 times daily every 4 hours for 10 days were nausea and/or vomiting in 8 of 298 patient treatments (2.7%). Nausea and/or vomiting occurred in 2 of 287 (0.7%) patients who received placebo. Long-Term Administration: The most frequent adverse events reported in a clinical trial for the prevention of recurrences with continuous administration of 400 mg (two 200-mg capsules) 2 times daily for 1 year in 586 patients treated with acyclovir were nausea (4.8%) and diarrhea (2.4%). …

Pregnancy: Teratogenic Effects: Pregnancy Category B. Acyclovir administered during organogenesis was not teratogenic in the mouse (450 mg/kg/day, p.o.), rabbit (50 mg/kg/day, s.c. and IV), or rat (50 mg/kg/day, s.c.). These exposures resulted in plasma levels 9 and 18, 16 and 106, and 11 and 22 times, respectively, human levels. There are no adequate and well-controlled studies in pregnant women. …

Overdoses involving ingestion of up to 100 capsules (20 g) have been reported. Adverse events that have been reported in association with overdosage include agitation, coma, seizures, and lethargy. Precipitation of acyclovir in renal tubules may occur when the solubility (2.5 mg/mL) is exceeded in the intratubular fluid. Overdosage has been reported following bolus injections or inappropriately high doses and in patients whose fluid and electrolyte balance were not properly monitored. This has resulted in elevated BUN and serum creatinine and subsequent renal failure. …

تناولها عندما تتذكر، إلا إذا اقترب موعد الجرعة التالية. عندها تخطَّ الجرعة المنسية. لا تتناول جرعتين معًا أبدًا للتعويض. راجع النشرة، فبعض الأدوية مختلفة.