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 orally1
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:
- Acute kidney injury from crystal deposition, so maintain hydration
- Phlebitis
- Neurotoxicity, with lethargy, confusion, tremor, myoclonus, agitation, hallucinations, and extrapyramidal symptoms
References
- ^ Tony H. Huynh, Mark W. Johnson, Grant M. Comer, Douglas N. Fish. Vitreous Penetration of Orally Administered Valacyclovir. American Journal of Ophthalmology. 2008;145(4):682-686. doi:10.1016/j.ajo.2007.11.016.
