Aciclovir oral

CLINICAL USE

Antiviral agent:

Herpes simplex and herpes zoster infection

DOSE IN NORMAL RENAL FUNCTION

Simplex treatment: 200–400 mg 5 times daily

Prophylaxis (immunocompromised): 200–400 mg every 6 hours

Suppression: 200 mg every 6 hours, or 400 mg every 12 hours

Zoster: 800 mg 5 times a day for 7 days

PHARMACOKINETICS

Molecular weight :225.2

%Protein binding :9–33

%Excreted unchanged in urine : 40–70

Volume of distribution (L/kg) :0.7

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

25–50 Dose as in normal renal function 10–25 Simplex: 200 mg 3–4 times daily. Zoster: 800 mg every 8–12 hours

<10 : Simplex: 200 mg every 12 hours. Zoster: 400–800 mg every 12 hours

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

HD :Dialysed. Dose as in GFR

<10 : mL/min. Give dose after dialysis

HDF/high flux :Dialysed. Dose as in GFR

<10 : mL/min. Give dose after dialysis

CAV/VVHD :Dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Ciclosporin: reports of increase and decrease in 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 administration

Tacrolimus: possibly increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

Dispersible tablets may be dispersed in a minimum of 50 mL of water or swallowed whole with a little water

OTHER INFORMATION

Consider IV therapy for herpes zoster infection if patient severely immunocompromised

Plasma aciclovir concentration is reduced by 60% during haemodialysis

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