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 &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 Dose as in normal renal function 10–25 Simplex: 200 mg 3–4 times daily. Zoster: 800 mg every 8–12 hours
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Simplex: 200 mg every 12 hours. Zoster: 400–800 mg every 12 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 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min. Give dose after dialysis
  • HDF/high flux &nbsp :Dialysed. Dose as in GFR
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min. Give dose after dialysis
  • CAV/VVHD &nbsp &nbsp &nbsp: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

    –

    Route

    Oral

    Rate of Administration

    –

    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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