Acyclovir

From IDWiki

Background

  • Acyclic guanosine analog that competes with deoxyguanosine triphosphate to inhibit viral DNA polymerase
  • Resistance mediated by mutation in or decrease of thymidine kinase
  • Good penetration into CNS and vitreous if administered intravenously, though not orallyhuynh2008vi

Dosing

  • Usual dose:
    • 5-10 mg/kg ideal body weight IV q8h
    • 200-400 mg PO 5 times daily
    • 800 mg PO 5 times daily (high dose)
  • Herpes encephalitis: 10 mg/kg ideal body weight IV q8h

Renal Adjustment

  • Oral
    • CrCl 30-49: usual dose
    • CrCl 10-29: usual dose
    • CrCl <10: usual dose q12h
    • Intermittent dialysis: 50% of usual dose q24h, given after dialysis on dialysis days
    • Continuous dialysis: usual dose
  • Intravenous
    • CrCl 30-49: usual dose q12h
    • CrCl 10-29: usual dose q24h
    • CrCl <10: 50% of dose q24h
    • Intermittent dialysis: 50% of usual dose q24h, given after dialysis on dialysis days
    • Continuous dialysis: usual dose

Safety

  • Adverse drug reactions include: