Acyclovir: Difference between revisions

Latest revision as of 21:25, 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.

@@ Line 1: / Line 1: @@
+== Background ==
-* Acyclic guanosine analog that competes with deoxyguanosine triphosphate to inhibit viral DNA polymerase
-* Resistance mediated by mutation in or decrease of thymidine kinase
+*Acyclic guanosine analog that competes with deoxyguanosine triphosphate to inhibit viral DNA polymerase
-* Adverse drug reactions include:
+*Resistance mediated by mutation in or decrease of thymidine kinase
-** AKI from crystal deposition, so maintain hydration
+*Good penetration into CNS and vitreous if administered intravenously, though not orally[[CiteRef::huynh2008vi]]
-** Phlebitis
-** Neurotoxicity, with lethargy, confusion, tremor, myoclonus, agitation, hallucinations, and extrapyramidal symptoms
+== 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:
+**[[Adverse drug reaction::Acute kidney injury]] from crystal deposition, so maintain hydration
+**[[Adverse drug reaction::Phlebitis]]
+**[[Adverse drug reaction::Neurotoxicity]], with lethargy, confusion, tremor, myoclonus, agitation, hallucinations, and extrapyramidal symptoms
 [[Category:Antivirals]]