Antimicrobials
Acyclovir

Acyclovir

None
Moderate
See below under General Info

Spectrum of Activity

Dosing

General Information

Hospital Formulary Status Yes (PO solid, PO soln, parenteral inj)

In-Hospital Cost will be updated

PharmaCare Formulary Status Yes (PO solid, PO susp, topical)

Special Authority None

PharmaCare Coverage 200mg PO - $0.6909/tab 400mg PO - $1.3716/tab 800mg PO - $1.3687/tab 200mg/5ml PO susp - $0.2801/ml 5% ointment - $13.2963/g

Outpatient Cost 200mg PO - $0.69-0.94/tab 400mg PO - $1.37-1.60/tab 800mg PO - $1.39-1.60/tab 200mg/5ml PO susp - $0.28-0.31/ml 50mg/ml inj - $135.91-149.50/vial (10ml) 50mg/ml inj - $271.79-298.97/vial (20ml) 5% ointment - $13.30-14.63/g 5% cream - $16.59-18.25/g

Therapy for herpesviral infections (HSV and VZV) including encephalitis

Prophylaxis of herpesviral infections if recurrent disease or immunocompromised

If IV acyclovir, follow SCr daily; pre-hydration helpful

Check urine for crystals if suspect AKI

Malaise (PO)

  • adults: 12%
  • can occur at doses of 800mg PO 5 times daily for 7 or 10 days

Acute renal failure (IV)

  • caused by acyclovir crystals in renal tubules
  • can be minimized by prior hydration (with urine output >75ml/hr) and slow infusion over 1-2 hr

Decrease in absolute neutrophil count (IV)

  • neonates: 3-16%
  • can occur at high doses of 60mg/kg/day

Decrease in hemoglobin (IV)

  • neonates: 10-13%
  • can occur at high doses of 60mg/kg/day

Neurotoxicity (PO and IV)

  • sx: agitation, tremors, delirium, hallucinations and myoclonus
  • especially in patients with renal failure and peritoneal dialysis
  • severe neurotoxicity (delirium and coma) can occur at doses as low as 800mg BID in patients requiring dialysis

Concomitant nephrotoxins

Acyclovir may increase serum concentration of clozapine, mycophenolate, zidovudine, tenofovir

May diminish efficacy of zoster or varicella vaccine

Antimicrobial class: Antiviral, Nucleoside Analogue

Pregnancy category: B

For oral indications, Valacyclovir is the pro-drug and is more bioavailable with more convenient dosing

Average serum half life: 3.0 hr

CSF penetration: Therapeutic

Urine penetration: Therapeutic