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Valacyclovir

Valacyclovir

Dosing

Herpes labialis 2 g PO q12h x1d

Genital herpes initial episode 1 g PO q12h x10d

Genital herpes recurrent episode 500 mg PO q12h x3d

Genital herpes suppression in immunocompetent patients 0.5-1 g PO q24h

Genital herpes suppression in HIV-infected 500 mg PO q12h

Genital herpes transmission reduction 500 mg PO q24h

Herpes zoster 1 g PO q8h x7d

Herpes labialis Age ≥12y 2 g PO q12h x1d

Chickenpox Age ≥2y 20 mg/kg (max 1 g/dose) PO q8h x5d

No dose adjustment

CrCl ≥50CrCl 30-49CrCl 10-29CrCl <102 g PO q12h1 g PO q12h500 mg PO q12h500 mg PO q24h

CrCl ≥30CrCl 10-29CrCl <101 g PO q12h1 g PO q24h500 mg PO q24h

CrCl ≥30CrCl 10-29CrCl <10500 mg PO q12h500 mg PO q24h500 mg PO q24h

CrCl ≥30CrCl <300.5-1 g PO q24h500 mg PO q24-48h

CrCl ≥30CrCl <30500 mg PO q12h500 mg PO q24h

CrCl ≥50CrCl 30-49CrCl 10-29CrCl <101 g PO q8h1 g PO q12h1 g PO q24h500 mg PO q24h

General Information

  • Genital herpes simplex, Initial and recurrent episodes

  • Herpes labialis

  • Herpes zoster, Shingles

  • HIV infection - Recurrent genital herpes, Suppression

  • Recurrent genital herpes simplex, Suppression and transmission reduction

  • Varicella

Monitor for symptomatic improvement, total lesion count; renal function.

Common

  • Rash

  • Abdominal pain

  • Nausea

  • Vomiting

  • Headache

  • Fatigue

Serious

  • Thrombotic thrombocytopenic purpura

  • Aseptic meningitis

  • Encephalopathy

  • Seizure

  • Hemolytic uremic syndrome

  • Nitisinone

  • Teriflunomide

  • Leflunomide

  • Dichlorphenamide

  • Foscarnet

Antimicrobial class: Antiviral, Nucleoside analog

Pregnancy category: B

Average serum half life: 3 hours

Precautions:

  • Acute renal failure may occur; increased risk in patients who are elderly or dehydrated.

  • Dose reduction recommended for patients in renal impairment.

  • Discontinue if CNS reactions occur.

  • Give cautiously to patients who are dehydrated as acyclovir precipitation in renal tubules may occur when solubility (2.5 mg/mL) in intratubular fluid is exceeded.