Acyclovir is an antiviral medication used to treat herpes infections.
Valacyclovir is an antiviral drug used to treat patients with herpes infection. This drug speeds up the recovery from infection and relieves the pain of herpes sores and shingles.
In addition, it is used as a preventive treatment for cytomegalovirus infection in people with AIDS or in patients who have undergone organ transplantation or bone marrow transplantation, and the effect of the drug in the treatment of smallpox (Chickenpox) has been investigated.
Chemically speaking, acyclovir is derived from valacyclovir, as valacyclovir is broken down in the body to acyclovir.
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effect of Acyclovir in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. After ingestion, valacyclovir is metabolized to and actually enhances acyclovir bioavailability. It is effective and well tolerated for HSV suppression for up to 10y of continuous use. Neonatal herpes affects 1/15,000 newborns. The vast majority of infected infants are born to women with a primary infection during pregnancy. While there are no adequate reports or well-controlled studies of valacyclovir in pregnant women, it is used extensively for the listed indications. If initiated prophylactically at 36w, acyclovir reduces both the risk of recurrence and the frequency of a positive cervical culture at delivery in women who experience either a primary infection or at least one secondary episode during pregnancy. There is insufficient evidence to determine if antiviral prophylaxis reduces the incidence of neonatal herpes. However, patients should be counseled that antenatal antiviral prophylaxis reduces viral shedding and recurrences at delivery and reduces the need for cesarean delivery for genital herpes. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Valacyclovir crosses the human placenta. Maternal oral administration of valacyclovir leads to therapeutic concentrations in the maternal and fetal compartments, and in the instance of CMV, a decrease in the fetal viral load. However, it is unknown whether this decrease in CMV number is associated with decreased perinatal damage. Acyclovir crosses the rodent placenta. Post-marketing surveys suggest no increased frequency of birth defects. Rodent studies are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses higher than those used clinically. Breastfeeding
Valacyclovir is converted to acyclovir, which enters human breast milk. However, the amount of acyclovir in breast milk during valacyclovir administration is <5% of the dose used to treat neonates. Pregnancy
. Treatment is not curative, but rather intended to reduce the duration of symptoms and viral shedding. There is a long clinical experience free of obvious adverse effects. A recent meta-analysis concluded that prophylactic acyclovir beginning at 36w reduced the risks of clinical recurrence of genital herpes at delivery, cesarean section for recurrence, and herpes shedding at delivery. Suppression therapy is both effective and cost-effective whether or not the primary infection occurred during the current pregnancy. Because acyclovir is excreted via the kidneys, its t/2 may be reduced during pregnancy, but this has not been studied specifically. Its combination with zidovudine alters the clearance of both agents in pregnant rats. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. It is unknown whether acyclovir crosses the human placenta. It is unclear whether maternal prophylaxis reduces the incidence of neonatal herpes. Post-marketing surveillance by Glaxo-Wellcome has not revealed any increase in or pattern of malformations after acyclovir exposure during the 1st trimester (756 pregnancies). A recent population-based study fromthat included 90 systemic and 995 topical exposures was likewise reassuring. Rodent studies are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses higher than those used clinically. Breastfeeding
Acyclovir is passively secreted and achieves concentrations in breast milk higher than maternal serum, and is used to treat neonatal herpetic infection. It is generally considered compatible with breastfeeding. It has been estimated that the unsupplemented newborn would ingest 1-3mg/d.
the follwing drugs will increse Acyclovir by inhepiting cyp450
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the follwing drugs will decrease Acyclovir by inhancing cyp450
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