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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Acyclovir

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
11-23-2010

Zambia Specific Information

  • Available formulation in Zambia: Powder for injection: 250 mg (as sodium salt) vial; Tablet: 200 mg; Ointment: 3%.
  • HSV (first episode): acyclovir 400 mg PO q8h x7d
  • HSV (episodic reoccurrence in HIV-co-infected): acyclovir 400 mg PO q8h x10d
  • HSV encephalitis: acyclovir 10mg/kg IV q8h x 21 d
  • Herpes zoster ophthalmicus: acyclovir 800mg PO 5x/d for 7-10 d (should consider IV acyclovir 10 mg/kg q8h in severe cases).
  • Herpes stomatitis: acyclovir 400 mg PO q8h

REFERENCES

Zambia Information Author: Paul A. Pham Pharm.D.

INDICATIONS

FDA

  • Treatment of initial episode of herpes genitalis in immunocompromised pts.
  • Treatment of herpes simplex encephalitis in immunocompetent pts.
  • Treatment of herpes zoster.
  • Treatment of varicella in immunocompetent pts when started within 24 hrs of onset of typical chickenpox rash (American Academy of Pediatrics does not recommend its use for treatment of uncomplicated chickenpox in healthy children).

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Zovirax AcyclovirGeneric Manufactureroral
capsule
200 mg
$1.12
      oral
tablet
800 mg
$4.13
      IV
vial
500 mg
$20.00
      oral
tablet
400 mg
$1.79
      topical
ointment
5%
$15.20
      oral
suspension
200 mg/5 mL
$134.70 per 480 5 mL

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Some expert recommends higher doses for pts with AIDS. Valacyclovir or famciclovir generally preferred due to better pharmacokinetic parameter and more convenient dosing.

  • Mild HSV labialis: 400 mg PO thrice-daily x7d.
  • Mild genital or perirectal HSV: 400 PO thrice-daily x7d.
  • Severe genital or perirectal HSV: 5-10 mg/kg IV q8h x7-14d.
  • Mild Chickenpox: 800 mg PO 5x/d.
  • HSV or VZV encephalitis:10 mg/kg IV q8h x 21 days. In children a total dose of 462mg and 14.8+/-3.5 days of therapy associated with decreased HSV relapse rate (Yoshinori et al. CID 2000)
  • Severe chickenpox: 10 mg/kg IV q8h x7-10 d.
  • Severe dermatomal or visceral zoster: 10 mg/kg IV q8h until lesions resolved.
  • VZV retinal necrosis: 10 mg/kg IV q8h plus IV foscarnet 90 mg/kg IV 12h

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

5-10 mg/kg IV q8h; 200-800 mg 5x d.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

GFR 25-50 ml/min: 5-10 mg/kg q12. GFR 10-24 ml/min: 5-10 mg/kg IV q24h; 200-800 mg q8h.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

2.5-5 mg/kg IV q24h; 200-800 mg q12h.

DOSING IN HEMODIALYSIS

2.5-5 mg/kg IV q24h, dose after HD.

DOSING IN PERITONEAL DIALYSIS

2.5-5 mg/kg IV q24h.

DOSING IN HEMOFILTRATION

CAVH: 3.5 mg/kg/d.. CVVHD: 5-10 mg/kg/d (10 mg/kg/d for zoster and CNS)

ADVERSE DRUG REACTIONS

GENERAL

  • Generally very well tolerated.
OCCASIONAL

  • Irritation and phlebitis at infusion site.
  • Nausea and vomiting.
  • Rash.
  • Renal toxicity (esp crystallization w/rapid IV infusion, underlying renal disease & nephrotoxic drugs co-administration).
RARE

  • Dizziness, transaminase elevation, pruritis, and headache.
  • CNS (esp with high dose in renal failure): agitation, encephalopathy, lethargy, tremor, transient hemiparesis, disorientation, seizures, hallucinations.
  • Anemia, neutropenia, hypotension.

DRUG INTERACTIONS

  • Meperidine: May increase normeperidine plasma concentration.
  • Probenecid: Increase in acyclovir levels due to competitive tubular secretion by probenecid; no dose adjustment needed.
  • Theophylline: May increase theophylline plasma concentration.

SPECTRUM

HSV-1, HSV-2, and EBV; less effective against VZV (requires high dose acyclovir); poor activity against CMV and HHV-6 and HHV-8.

PHARMACOLOGY

Pharmacology

COMMENTS

Well tolerated oral and parenteral antiviral agent with activity against HSV and VZV. In AIDS pts valacyclovir or famciclovir generally preferred over oral acyclovir due to better pharmacokinetic profiles and more convenient dosing. Topical use not effective. Monitor for crystalluria in pts receiving large IV doses with dehydration and/or renal insufficiency.

Basis for Recommendations

  • Centers for Disease Control and Prevention, Workowski KA, Berman SM; Sexually transmitted diseases treatment guidelines, 2006.; MMWR Recomm Rep; 2006; Vol. 55; pp. 1-94;
    ISSN: 1545-8601;
    PUBMED: 16888612
    Rating: Basis for recommendation
    Comments:STD treatment recommendations

REFERENCES

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