Acyclovir: Difference between revisions
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| + | == Background == |
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| + | |||
*Acyclic guanosine analog that competes with deoxyguanosine triphosphate to inhibit viral DNA polymerase |
*Acyclic guanosine analog that competes with deoxyguanosine triphosphate to inhibit viral DNA polymerase |
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*Resistance mediated by mutation in or decrease of thymidine kinase |
*Resistance mediated by mutation in or decrease of thymidine kinase |
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*Good penetration into CNS and vitreous if administered intravenously, though not orally[[CiteRef::huynh2008vi]] |
*Good penetration into CNS and vitreous if administered intravenously, though not orally[[CiteRef::huynh2008vi]] |
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| + | |||
| + | == Dosing == |
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| + | |||
| + | * Usual dose: |
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| + | ** 5-10 mg/kg ideal body weight IV q8h |
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| + | ** 200-400 mg PO 5 times daily |
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| + | ** 800 mg PO 5 times daily (high dose) |
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| + | * [[Herpes encephalitis]]: 10 mg/kg ideal body weight IV q8h |
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| + | === Renal Adjustment === |
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| + | |||
| + | * Oral |
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| + | ** CrCl 30-49: usual dose |
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| + | ** CrCl 10-29: usual dose |
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| + | ** CrCl <10: usual dose q12h |
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| + | ** Intermittent dialysis: 50% of usual dose q24h, given after dialysis on dialysis days |
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| + | ** Continuous dialysis: usual dose |
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| + | * Intravenous |
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| + | ** CrCl 30-49: usual dose q12h |
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| + | ** CrCl 10-29: usual dose q24h |
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| + | ** CrCl <10: 50% of dose q24h |
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| + | ** Intermittent dialysis: 50% of usual dose q24h, given after dialysis on dialysis days |
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| + | ** Continuous dialysis: usual dose |
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| + | |||
| + | == Safety == |
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| + | |||
*Adverse drug reactions include: |
*Adverse drug reactions include: |
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**[[Adverse drug reaction::Acute kidney injury]] from crystal deposition, so maintain hydration |
**[[Adverse drug reaction::Acute kidney injury]] from crystal deposition, so maintain hydration |
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Latest revision as of 20:25, 2 May 2021
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.
