acyclovir

Pronunciation

Generic Name: acyclovir (oral) (a SYE klo veer)
Brand Name: Sitavig, Zovirax

What is acyclovir?

Acyclovir is an antiviral drug. It slows the growth and spread of the herpes virus in the body. Acyclovir will not cure herpes, but it can lessen the symptoms of the infection.

Acyclovir is used to treat infections caused by herpes viruses, such as genital herpes, cold sores, shingles, and chicken pox.

Acyclovir may also be used for purposes not listed in this medication guide.

What is the most important information I should know about acyclovir?

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

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What should I discuss with my healthcare provider before taking acyclovir?

You should not take this medicine if you are allergic to acyclovir or valacyclovir (Valtrex). You should not take acyclovir buccal tablets (Sitavig) if you are allergic to milk proteins.

To make sure acyclovir is safe for you, tell your doctor if you have:

  • kidney disease; or

  • a weak immune system (caused by disease or by using certain medicine).

FDA pregnancy category B. Acyclovir is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Herpes can be passed to your baby during childbirth if you have a genital lesion when your baby is born. If you have genital herpes, it is very important to prevent herpes lesions during pregnancy. Take your medicine as directed to best control your infection.

Acyclovir passes into breast milk and may harm a nursing infant. Do not take this medication without telling your doctor if you are breast-feeding a baby.

Do not give an acyclovir buccal tablet to a young child or choking could occur.

How should I take acyclovir?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Treatment with acyclovir should be started as soon as possible after the first appearance of symptoms (such as tingling, burning, blisters).

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

To take the buccal tablet (Sitavig):

  • Keep the tablet in its blister pack until you are ready to take it. Use a dry finger to remove the tablet.

  • Do not chew or swallow a buccal tablet. Place the flat side of the tablet against your upper gum, behind your lip and above your canine tooth. Place the tablet on the same side of the mouth as your cold sore.

  • Close your mouth and gently press on the outside of your lip over the tablet, holding it in place for 30 seconds. Avoid touching or pressing on the tablet once it is in place.

  • Allow the tablet to dissolve in your mouth throughout the day. You may eat and drink normally while the buccal tablet is in place.

  • During the first 6 hours of wearing time: If the tablet falls off or does not stick well, you may replace it with a new tablet. If you accidentally swallow the tablet, drink a glass of water and put a new tablet in place.

Tell your doctor if you have any changes in weight. Acyclovir doses are based on weight (especially in children and teenagers), and any changes may affect the dose.

Drink plenty of water while you are taking acyclovir to keep your kidneys working properly.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely treated. Acyclovir will not treat a viral infection such as the flu or a common cold.

Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include agitation, seizure (convulsions), or loss of consciousness.

What should I avoid while taking acyclovir?

Avoid brushing your teeth, chewing gum, or wearing an upper denture while you have a buccal tablet in your mouth. You may rinse your mouth gently. Drink plenty of liquids to prevent dry mouth.

Herpes infections are contagious and you can infect other people, even while you are being treated with acyclovir. Avoid letting infected areas come into contact with other people. Avoid touching an infected area and then touching your eyes. Wash your hands frequently to prevent passing the infection to others.

Taking this medicine will not prevent you from passing genital herpes to your sexual partner. Avoid sexual intercourse while you have active lesions or the first symptoms of an outbreak. Genital herpes may still be contagious through "viral shedding" from your skin, even if you have no symptoms.

Acyclovir side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • easy bruising or bleeding, purple or red pinpoint spots under your skin; or

  • signs of a kidney problem--little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath.

Common side effects may include:

  • nausea, vomiting;

  • diarrhea;

  • general ill feeling;

  • headache; or

  • mouth pain while using an acyclovir buccal tablet.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Acyclovir dosing information

Usual Adult Dose for Herpes Simplex -- Mucocutaneous/Immunocompetent Host:

Initial episode or intermittent therapy: 200 mg orally every 4 hours (5 times a day) for 10 days
Alternatively, the US Centers for Disease Control and Prevention (CDC) recommends 400 mg orally 3 times a day or 200 mg orally 5 times a day for 7 to 10 days.

Recurrent episodes: 200 mg orally every 4 hours (5 times a day) for 5 days
Alternatively, the CDC recommends 400 mg orally 3 times a day for 5 days, 800 mg orally twice a day for 5 days, or 800 mg orally 3 times a day for 2 days.

Orolabial HSV infection treatment: 400 mg orally 5 times a day for 5 days

IV:
Severe initial episode: 5 to 10 mg/kg IBW IV every 8 hours for 5 to 7 days

Therapy should be initiated at the earliest sign or symptom of primary infection (initial episode) or recurrence.

Usual Adult Dose for Herpes Simplex -- Mucocutaneous/Immunocompromised Host:

Treatment:
Oral: 400 mg orally every 8 hours for 7 to 14 days
IV: 5 mg/kg IV every 8 hours for 7 to 14 days
Treatment dosages recommended by the CDC.

Episodic outbreaks: 200 mg orally every 4 hours (5 times a day) for 5 to 10 days
Alternatively, the CDC recommends 400 mg orally 3 times a day for 5 to 10 days or 7 to 14 days

Orolabial HSV infection treatment:
HIV-infected patients: 400 mg 3 times a day for 7 to 14 days; dosage recommended by the CDC

Therapy should be initiated at the earliest sign or symptom of primary infection (initial episode) or recurrence. Intravenous therapy is indicated for the treatment of primary infection in immunocompromised patients or patients with severe infection.

Usual Adult Dose for Herpes Simplex Encephalitis:

10 to 15 mg/kg IBW IV every 8 hours for 10 to 21 days

Usual Adult Dose for Herpes Simplex -- Suppression:

Chronic suppressive therapy:
Immunocompetent patient: 400 mg orally twice a day; alternatively, 200 mg orally 3 to 5 times a day may be used
HIV-infected patient: 200 mg orally 3 times a day or 400 mg orally 2 times a day
HIV-infected patient, genital herpes: 400 to 800 mg orally 2 to 3 times a day

The safety and efficacy of daily acyclovir suppressive therapy have been documented among patients treated orally for up to six years. However, since the frequency and severity of recurrences may change over time, patients should be reevaluated after one year of therapy to assess the need for continued administration.

Daily suppressive therapy reduces but does not eliminate asymptomatic viral shedding, thus the extent to which it may prevent transmission of infection to others is unknown.

Usual Adult Dose for Herpes Zoster:

Acute herpes zoster:
800 mg orally every 4 hours (5 times a day) for 7 to 10 days
Severe, immunocompromised host: 10 mg/kg IBW IV every 8 hours for 7 to 14 days

Therapy should be initiated within 72 hours after onset of rash, although, during clinical trials, acyclovir was most effective when initiated within the first 48 hours.

Usual Adult Dose for Varicella-Zoster:

Chickenpox:
Immunocompetent host: 800 mg orally four times a day for 5 days

Immunocompromised host: 10 mg/kg IBW IV every 8 hours for 7 to 10 days or until no new lesions for 48 hours; after fever abates and if there is no proof of visceral involvement, the patient may be switched to 800 mg orally four times a day

Therapy should be initiated at the earliest sign of chickenpox, no later than 24 hours after onset of rash.

Usual Pediatric Dose for Herpes Simplex:

Neonatal HSV infection:
Less than 3 months: 10 to 20 mg/kg or 500 mg/m2 IV every 8 hours for 10 to 21 days
Some clinicians recommend 10 mg/kg every 12 hours for premature neonates.

Usual Pediatric Dose for Herpes Simplex -- Mucocutaneous/Immunocompetent Host:

3 months to 11 years:
Initial episode: 10 to 20 mg/kg orally 4 times a day or 8 to 16 mg/kg orally 5 times a day for 7 to 10 days
The American Academy of Pediatrics (AAP) recommends 40 to 80 mg/kg orally per day in 3 to 4 divided doses for 5 to 10 days.
Maximum dose: 1 g per day

12 years or older, over 40 kg:
Initial episode, severe initial episode, and recurrent episodes: Adult dose

Usual Pediatric Dose for Herpes Simplex -- Mucocutaneous/Immunocompromised Host:

Treatment of mucocutaneous HSV infection:
Oral: 1 g orally per day in 3 to 5 divided doses for 7 to 14 days; dosage recommended by the AAP

IV:
3 months to 11 years: 5 to 10 mg/kg or 250 to 500 mg/m2 IV every 8 hours for 7 to 14 days
12 years or older, over 40 kg: Adult dose

Usual Pediatric Dose for Herpes Simplex Encephalitis:

3 months to 11 years: 10 to 20 mg/kg or 500 mg/m2 IV every 8 hours for 10 to 21 days
12 years or older: Adult dose

Usual Pediatric Dose for Herpes Simplex -- Suppression:

Oral:
Less than 12 years: 80 mg/kg/day orally in divided doses 3 to 4 times a day, not to exceed 1 g/day
12 years or older: Adult dose

Immunocompromised host: 5 mg/kg IV every 8 or 12 hours or 250 mg/m2 IV every 8 hours during risk period

Oral acyclovir prophylaxis is recommended by the U.S. Public Health Service and Infectious Diseases Society of America for chronic suppressive therapy in HIV-infected individuals, including infants and children, with frequent or severe recurrences. Daily suppressive therapy reduces but does not eliminate asymptomatic viral shedding, thus the extent to which it may prevent transmission of infection to others is unknown.

Usual Pediatric Dose for Herpes Zoster:

Oral:
Immunocompetent host:
12 years or older: 800 mg orally every 4 hours (5 times a day) for 5 to 10 days

HIV-infected host: 20 mg/kg (up to 800 mg per dose) orally 4 times a day for 7 to 10 days; dosage recommended by the CDC

IV:
Immunocompetent host:
Less than 1 year: 10 mg/kg IV every 8 hours for 7 to 10 days
1 year to 11 years: 10 to 20 mg/kg or 500 mg/m2 IV every 8 hours for 7 to 10 days
12 years or older: Adult dose

Immunocompromised host:
Less than 12 years: 10 to 20 mg/kg IV every 8 hours for 7 to 10 days
12 years or older: 10 mg/kg IV every 8 hours for 7 to 10 days

Therapy should be initiated within 72 hours after onset of rash, although, during clinical trials, acyclovir was most effective when initiated within the first 48 hours.

Usual Pediatric Dose for Varicella-Zoster:

Chickenpox:
Immunocompetent host:
2 years or older, 40 kg or less: 20 mg/kg orally 4 times a day for 5 days (maximum: 3200 mg/day)
2 years or older, over 40 kg: Adult dose

Immunocompromised host:
Oral:
HIV-infected host: 20 mg/kg (up to 800 mg per dose) orally 4 times a day for 7 days or until no new lesions for 48 hours

IV:
Less than 1 year: 10 mg/kg every 8 hours for 7 to 10 days or until no new lesions for 48 hours
1 year to 12 years: 10 to 20 mg/kg or 500 mg/m2 IV every 8 hours for 7 to 10 days or until no new lesions for 48 hours
12 years or older: Adult dose

Therapy should be initiated at the earliest sign of chickenpox, no later than 24 hours after onset of rash.

What other drugs will affect acyclovir?

Acyclovir can harm your kidneys. This effect is increased when you also use certain other medicines, including: antivirals, chemotherapy, injected antibiotics, medicine for bowel disorders, medicine to prevent organ transplant rejection, injectable osteoporosis medication, and some pain or arthritis medicines (including aspirin, Tylenol, Advil, and Aleve).

Other drugs may interact with acyclovir, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about acyclovir.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.07. Revision Date: 2014-07-14, 10:52:21 PM.

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