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Acyclovir A to Z Drug Facts Acyclovir Action Indications Contraindications Route/Dosage Interactions Lab Test Interferences Adverse Reactions Precautions Patient Care Considerations Administration/Storage Assessment/Interventions Patient/Family Education (A-SIKE-low-vihr) Zovirax, Acyclovir Sodium, Avirax, Nu-Acyclovir, Zovirax, Zovirax 200 Class: Anti-infective/antiviral Action Inhibits viral DNA replication by interfering with viral DNA polymerase. Indications Parenteral form: Treatment of initial or recurrent mucosal and cutaneous herpes simplex viruses (HSV) and varicella zoster (shingles) infections in immunocompromised patients; treatment of herpes simplex encephalitis in infants > 6 mo; treatment of severe clinical episodes of genital herpes. Oral form: Treatment of initial and recurrent episodes of genital herpes in certain patients; acute treatment of shingles and chickenpox; suppressive therapy for frequent recurrence of genital herpes. Topical form: Treatment of initial episodes of herpes genitalis and some mucotaneous HSV infections in immunocompromised patients. Unlabeled use(s): Treatment of cytomegalovirus and HSV infection after bone marrow or renal transplant; treatment of infectious mononucleosis, varicella pneumonia, chickenpox, and other HSV infections. Contraindications Standard considerations. Route/Dosage PARENTERAL For IV infusion only; rapid or bolus IV must be avoided. ADULTS: IV 15 to 30 mg/kg/day in 3 divided doses given q 8 hr over 1 hr. CHILDREN: IV 250 to 500 mg/m2 q 8 hr. ORAL INITIAL GENITAL HERPES: ADULTS: PO 200 mg q 4 hr 5 times/day for 10 days. SUPPRESSIVE THERAPY FOR RECURRENT GENITAL HERPES: ADULTS: PO 400 mg bid or 200 mg q 8 hr. INTERMITTENT THERAPY FOR RECURRENT GENITAL HERPES: ADULTS: PO 200 mg q 4 hr 5 times/day for 5 days at earliest sign or symptom of recurrence. HERPES ZOSTER ADULTS: PO 800 mg q 4 hr 5 times/day for 7 to 10 days. CHICKENPOX ADULTS & CHILDREN: PO 20 mg/kg/dose (maximum 800 mg/dose) qid for 5 days. Topical ADULTS & CHILDREN: Apply to lesions q 3 hr 6 times/day. Interactions Zidovudine: Increased propensity for lethargy. INCOMPATIBILITIES: Precipitation may occur with bacteriostatic water. Do not add acyclovir to biologic or colloidal fluids. Lab Test Interferences None well documented. Adverse Reactions CV: Phlebitis at injection site. CNS: Encephalopathic changes; lethargy; obtundation; tremor; confusion; hallucinations; headache; agitation; seizures; coma. DERM: Inflammation at injection site; itching; rash; hives. GI: Nausea; vomiting. HEPA: Transient elevations of serum creatinine, BUN, transaminases. OTHER: Asthenia; paresthesis. Topical form: Burning or stinging; pruritis. Topical use may cause same adverse reactions as systemic use. Precautions Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy in children < 2 yr not established. Encephalopathic changes: Patients with underlying neurologic abnormalities or severe hypoxia may have increased risk of neurotoxic effects. Cutaneous use: Care must be taken to avoid getting drug in eyes. Renal impairment: Dosage adjustment may be needed. With parenteral use, acyclovir may precipitate as crystals in renal tubules. Genital herpes: Sexual intercourse must be avoided when lesions are present. Use of acyclovir does not prevent transmission. PATIENT CARE CONSIDERATIONS Administration/Storage Topical Use finger cot or rubber glove when applying topical ointment to prevent spread of infection. Cover entire lesion with ointment 6 times/day for 7 days. A ½-inch ribbon of ointment covers » 4 sq inches. Parenteral Administer at room temperature. Be certain any precipitate in refrigerated solution dissolves at room temperature. Administer after hemodialysis. Avoid rapid or bolus IV administration. Establish infusion rate to administer over ³ 1 hr. Use reconstituted solution within 12 hr. Oral/Suspension/Capsules Shake suspension before using. Store capsules at room temperature. Assessment/Interventions Obtain patient history, including drug history and any known allergies. Monitor IV site for redness, swelling, or heat. Rotate IV sites frequently. Monitor vital signs frequently during infusion. Monitor serum BUN and creatinine. Assess for nausea and vomiting. Monitor I&O. Notify physician if lesion does not improve or recurs. OVERDOSAGE: SIGNS & SYMPTOMS Increased BUN and serum creatinine, renal failure Patient/Family Education Advise patient to avoid sexual intercourse while genital herpes lesions are present. Tell patient that acyclovir is a treatment, not a cure. Instruct patient to notify physician if there is no reduction in severity or frequency of lesions. Advise patient that ointment is for external use only. Teach patient to apply ointment with finger cot or glove and to completely cover lesion every 3 hr 6 times/day. Advise patient that transient burning, stinging, itching, or rash may occur, and to notify physician if these symptoms are pronounced or persistent. Caution patient to start treatment as soon as symptoms occur. Tell patient not to use medication on or near eyes. Advise patient to notify physician if nausea, vomiting, diarrhea, headache, numbness, tingling, or general body discomfort occurs with oral dosing. Books@Ovid Copyright © 2003 Facts and Comparisons David S. Tatro A to Z Drug Facts