Valacyclovir

C difficile risk
None
Oral Bioavailability
Excellent
Cost
$3-5/d

Dosing

2 g PO BID x 2 doses

1000 mg PO BID x 7-10 days

or 500 mg PO BID x 3 days 1000 mg PO once daily for 5 days

1000 mg PO TID for 7-10 days

CrCl > 50 mL/minCrCl 30 - 50 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment required1 g PO q12h x 2 doses500 mg PO q12h x 2 doses500 mg PO x 1 dose

CrCl > 30 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment required500 mg - 1 g PO q24h (higher dose for initial episode or immune compromised)500 mg PO q24h

CrCl > 50 mL/minCrCl 30 - 50 mL/minCrCl 10 - 30 mL/minCrCl < 10 mL/minNo renal adjustment required1 g PO q12h1 g PO q24h500 mg PO q24h

Oral HSV, Genital HSV, and Herpes Zoster500 mg PO q24h

  • Give dose after dialysis on HD days

Oral HSV, Genital HSV, and Herpes Zoster500 mg PO q24h

Oral HSV, Genital HSV, and Herpes ZosterNo data

General Information

Therapy for herpes viral infections (HSV and VZV). Not for CMV (cytomegalovirus)

Prophylaxis of herpes viral infections if recurrent disease or immunocompromised.

Follow serum creatinine.

  • GI upset

  • Headache

  • Increased ALT/AST

  • Nasopharyngitis

Mycophenolate can increase valacyclovir/acyclovir concentration

May diminish efficacy of zoster or varicella vaccine

Antimicrobial class: Antiviral. Nucleoside analogue.

Pregnancy category: B

Average serum half life: 3 hours (active metabolite acyclovir)

CSF penetration: None

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