C difficile risk
Oral Bioavailability


Serious Infections (e.g. CNS and Disseminated Zoster) Use IBW unless patient >120% above IBW, then use AdjBW 10mg/kg IV q8h

HSV Treatment 5 mg/kg IV q8h OR 800 mg PO q12h

Shingles 800mg PO 5 times per day

Prophylaxis dosing varies by indication

CrCl 0 - 10CrCl 10 - 29CrCl 30 - 50CrCl > 50- CNS Infx: 5mg/kg IV q24h

  • HSV Tx: 200 mg PO 12h or 2.5 mg/kg IV q24h

  • Shingles: 800 mg PO q12h- CNS Infx: 10 mg/kg IV q24h

  • HSV Tx: 800 mg PO 12h or 5 mg/kg IV q24h

  • Shingles: 800 mg PO q8h- CNS Infx: 10 mg/kg IV q12h

  • HSV Tx: 800 mg PO 12h or 5 mg/kg IV q12h

  • Shingles: 800 mg PO 5xdayUsual adult dose

2.5-5mg/kg IV q24h

Consider loading dose for serious infections

5-7.5mg/kg IV q24h

Use upper end for CNS infections

General Information

Therapy for herpesviral infections (HSV and VZV) including encephalitis.

Prophylaxis of herpesviral infections if recurrent disease or immunocompromised.

Follow SCr as appropriate.

Check urine for crystals if AKI suspected.

  •  GI upset

  •  Phlebitis

  •  Increased SCr

  •  AKI from crystal nephropathy

Mycophenolate can increase the acyclovir concentration.

May diminish efficacy of zoster or varicella vaccine.

For oral indications, valacyclovir is the pro-drug, which is more bioavailable with more convenient dosing. Valacyclovir not available inpatient.

Antimicrobial class: Antiviral. Nucleoside analogue.

Pregnancy category: B

Average serum half life: 3 hours

CSF penetration: Therapeutic

Urine penetration: Therapeutic

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