Aciclovir IV

CLINICAL USE

Antiviral agent:Herpes simplex and herpes zoster infection

DOSE IN NORMAL RENAL FUNCTION

  • Herpes simplex treatment: normal or immunocompromised 5 mg/kg every 8 hours
  • Recurrent varicella zoster infection: normal immune status 5 mg/kg every 8 hours
  • Primary and recurrent varicella zoster infection: immunocompromised 10 mg/kg every 8 hours
  • Herpes simplex encephalitis: normal or immunocompromised 10 mg/kg every 8 hours

    • PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :225.2
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :9–33
  • %Excreted unchanged in urine &nbsp &nbsp : 40–70

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.7

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2.9/19.5 (dialysis: 5.7)

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    25–50 5–10 mg/kg every 12 hours10–25 5–10 mg/kg every 24 hours (some units use 3.5–7 mg/kg every 24 hours)
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : 2.5–5 mg/kg every 24 hours

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Dialysed. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Dialysed. Dose as in GFR=10–25 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs
  • Ciclosporin: reports of increased and decreased ciclosporin levels. Some editors report no experience of interaction locally; possibly increased risk of nephrotoxicity
  • Higher plasma levels of aciclovir and mycophenolate mofetil with concomitant administrationTacrolimus: possibly increased risk of nephrotoxicity

    ADMINISTRATION

    Reconstition

    Sodium chloride 0.9% or water for injection; 10 mL to each 250 mg vial; 20 mL to 500 mg vial (Resulting solution contains 25 mg/mL)

    Route

    IV

    Rate of Administration

    1 hour; can worsen renal impairment if injected too rapidly!

    Comments

  • Reconstituted solution may be further diluted to concentrations not greater than 5 mg/mL
  • Use 100 mL infusion bags for doses of 250–500 mg; use 2 × 100 mL bags for 500–1000 mg
  • Compatible with sodium chloride 0.9% and glucose 5%
  • DO NOT REFRIGERATE
  • Do not use turbid or crystal-containing solutions
  • Reconstituted solution very alkaline (pH 11)

    OTHER INFORMATION

  • Aciclovir clearance in CAVHD is approximately equivalent to urea clearance, i.e. lower clearance than in intermittent haemodialysis
  • Monitor aciclovir levels in critically ill patients. Reports of neurological toxicity at maximum recommended doses
  • Renal impairment developing during treatment with aciclovir usually responds rapidly to rehydration of the patient, and/or dosage reduction or withdrawal of the drug. Adequate hydration of the patient should be maintained
  • Plasma aciclovir concentration is reduced by 60% during haemodialysis
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