Acyclovir

C difficile risk
None
Oral Bioavailability
Poor (Less than 20%)
Cost
IV: $80.02 PO: $2.31

Dosing

  • Use ideal body wt for dosing or adjusted body wt for morbidly obese

  • For high dose (10 mg/kg) IV dosing, consider adding adequate fluid replacement to minimize crystalluria, especially in patients with other nephrotoxic agents or renal dysfunction

  • Valacyclovir has improved bioavailability/dosing for step-down therapy

10mg/kg IV q8h

5 mg/kg IV Q8

800 mg PO 5 times per day

  • 400 mg PO TID

  • Higher doses may be used in severe infections/immunocompromised hosts

Varies by indication

Creatinine Clearance >50mL/min/1.73m² Creatinine Clearance 25-50mL/min/1.73m² Creatinine Clearance 10-24mL/min/1.73m² Creatinine Clearance ≤ 10mL/min/1.73m²

  • Term neonatal to 3 months of age: 20mg/kg/dose IV Q8H*

  • Infant, Child, Adolescent: 10 mg/kg/dose IV Q8H*

  • Term neonatal to 3 months of age: 20mg/kg/dose IV Q12H*

  • Infant, Child, Adolescent: 10 mg/kg/dose IV Q12H*

  • Term neonatal to 3 months of age: 20mg/kg/dose IV Q24H*

  • Infant, Child, Adolescent: 10 mg/kg/dose IV Q24H*

  • Term neonatal to 3 months of age: 10mg/kg/dose IV Q24H*

  • Infant, Child, Adolescent: 5 mg/kg/dose IV Q24H*

*Dosing of acyclovir varies by PNA, weight, immune status and indication. Please consult Pediatric Infectious Diseases and/or the I.D. pharmacist (p92528) for dosing recommendations.

  • Obese patients should be dosed using ideal body weight

  • Use ideal body wt for dosing or adjusted body wt for morbidly obese

  • For high dose (10 mg/kg) IV dosing, consider adding adequate fluid replacement to minimize crystalluria, especially in patients with other nephrotoxic agents or renal dysfunction

  • Valacyclovir has improved bioavailability/dosing for step-down therapy

  • Infectious Diseases Pharmacy: RRMC p99917; SMH p91059

CrCl 25-50 ml/minCrCl 10-24 ml/minCrCl <10 ml/minDialysis10 mg/kg IV Q12h10 mg/kg IV Q24h5 mg/kg IV Q24h5 mg/kg IV x 1, then 5 mg/kg IV QPM

CrCl 25-50 ml/minCrCl 10-24 ml/minCrCl <10 ml/minDialysis5 mg/kg IV Q12h5 mg/kg IV Q24h2.5 mg/kg IV Q24h2.5 mg/kg IV x 1, then 2.5 mg/kg IV QPM

≤ 2 L/hr> 2 to 4 L/hr> 4 L/h5-10 mg/kg IV Q245-10 mg/kg IV Q12Contact Infectious Diseases Pharmacy for assistance

General Information

Therapy for herpesviral infections (HSV and VZV) including encephalitis

Prophylaxis of herpesviral infections if recurrent disease or immunocompromised

Laboratory

  • Cr twice weekly with IV acyclovir (dose adjustment and nephrotoxicity assessment)

Clinical

  • Phlebitis

  • CNS effects (IV)

  • GI effects

  • Ensure adequate hydration for IV acyclovir

  • Malaise

  • Nausea

  • Vomiting

  • Diarrhea

  • Phlebitis (with IV acyclovir)

  • Nephrotoxicity

  • CNS effects with high-dose IV therapy

Mycophenolate can increase the acyclovir concentration

May diminish efficacy of zoster or varicella vaccine

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

Antimicrobial class: Antiviral, nucleoside analogue

Pregnancy category: B

Average serum half life: 3 hours

CSF penetration: Therapeutic

Urine penetration: Therapeutic

Adapted from the UCLA Health Antimicrobial Stewardship Program

Terms of Use | Feedback
© Copyright 2021 Spectrum Mobile Health Inc., dba Firstline Clinical. All rights reserved.