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Acyclovir and Hydrocortisone

Medically reviewed by Last updated on Aug 9, 2019.


(ay SYE kloe veer & hye droe KOR ti sone)

Index Terms

  • Acyclovir/Hydrocortisone
  • Hydrocortisone and Acyclovir
  • ME-609
  • Xerclear

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Xerese: Acyclovir 5% and hydrocortisone 1% (5 g) [contains cetostearyl alcohol, propylene glycol]

Brand Names: U.S.

  • Xerese

Pharmacologic Category

  • Antiviral Agent, Topical
  • Corticosteroid, Topical


Acyclovir: Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA.

Hydrocortisone: Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties.

Use: Labeled Indications

Herpes labialis: Treatment of recurrent herpes labialis (cold sores) in children ≥6 years and adults.


There are no contraindications listed in the manufacturer’s US labeling.

Canadian labeling:Known or suspected history of hypersensitivity to acyclovir, valacyclovir, hydrocortisone or any component of the cream.

Dosing: Adult

Herpes labialis (cold sores): Topical: Apply 5 times/day for 5 days

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Herpes labialis (cold sores): Children ≥6 years and Adolescents: Topical: Apply 5 times daily for 5 days; initiate therapy at first sign of infection (ie, during the prodrome or when lesions appear)


For external use only; not for use in the eye, inside the mouth or nose, or on the genitals. Wash hands before and after application. Use sufficient amount to cover the affected area(s), including the outer margin of cold sore; do not rub affected area. Initiate therapy early (ie, during the prodrome or when lesions appear).


Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F); do not freeze.

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Calcipotriene: Hydrocortisone (Topical) may diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with hydrocortisone valerate. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification

Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Monitor therapy

Talimogene Laherparepvec: Antiherpetic Antivirals may diminish the therapeutic effect of Talimogene Laherparepvec. Monitor therapy

Adverse Reactions

<1%, postmarketing, and/or case reports: Allergic contact sensitivity, application site reaction, burning sensation of skin, contact dermatitis (when applied under occlusion), dyschromia, erythema, exfoliation of skin, tingling of skin, xeroderma


Concerns related to adverse effects:

• Sensitization: Use has been associated with local sensitization (irritation).

Disease-related concerns:

• Herpes labialis: Appropriate use: Treatment should begin with the first signs or symptoms. For external use only to the lips and around the mouth; do not apply to eye, inside the mouth or nose, or on the genitals. Contact healthcare provider if cold sore does not heal in 2 weeks.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Immunocompromised patients: Use with caution in immunocompromised patients.

Pregnancy Considerations

Systemic exposure of acyclovir and hydrocortisone after topical administration is minimal. See individual agents for additional information.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience bad taste, dry skin, burning, skin tingling, or skin discoloration. Have patient report immediately to prescriber severe skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.