Meningitis
Acyclovir

Acyclovir

None
Poor (Less than 20%)
IV or PO: $ (<$25/day)

Spectrum of Activity

Dosing

General Information

  • BUN/SCr, urine output

  • CBC

  • LFTs

  • AKI

  • Extravasation

  • Neurotoxicity

  • Thrombotic microangiopathy

  • Use Ideal Body Weight (IBW) unless BMI ≥30
  • For oral indications, valacyclovir is the pro-drug with higher bioavailability
  • Absorption: Oral: Poorly absorbed (bioavailability decreases with increased dose)
  • Distribution:
    • Widely (e.g. brain, kidney, lungs, liver, spleen, muscle, uterus, vagina, CSF)
    • CSF acyclovir concentration is ~50% of plasma concentrations
  • Vd: Adults: 0.8 L/kg (63.6 L)
  • Protein Binding: 9% to 33%
  • Metabolism: Converted by viral enzymes to acyclovir monophosphate, and further converted to diphosphate then triphosphate (active form) by cellular enzymes
  • Half-Life Elimination:
    • Normal renal function: ~2.5 hours
    • ESRD: 20 hours
    • Hemodialysis: ~5 hours
  • Excretion: Urine (62% to 91% as unchanged drug and metabolite)