Acyclovir - Renal Dosing

In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.

If improving renal function, actual CrCl is likely higher than calculated CrCl.

If worsening renal function, actual CrCl is likely lower than calculated CrCl.

CrCl > 50 mL/min

No renal adjustment required

CrCl 30 - 50 mL/min

100% of indicated dose IV q12h

CrCl 10 - 30 mL/min

100% of indicated dose IV q24h

CrCl < 10 mL/min

50% of indicated dose IV q24h

CrCl > 30 mL/min

No renal adjustment required

CrCl 10 - 30 mL/min

400 mg PO TID

CrCl < 10 mL/min

400 mg PO BID

IV

50% of indicated dose IV q24h

  • Give dose after dialysis on HD days

PO (Most Indications)

400 mg PO BID

IV

50% of indicated dose IV q24h

PO (Most Indications)

400 mg PO BID

IV

50% of indicated dose IV q12h

PO (Most Indications)

No Data - use IV

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