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MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd

Aciclovir

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Treats Alpha herpesviruses such as HSV 1 and 2 and Varicella but not CMV (use Ganciclovir).

About : Always check the BNF link here

Potentially life saving antiviral. Related drugs include Valaciclovir, Famciclovir
Only becomes active in infected cells. Active forms is Aciclovir triphosphate

Mode of action

Aciclovir is highly selective due to its affinity for the enzyme thymidine kinase
Aciclovir ? Aciclovir monophosphate by Herpes simplex enzyme thymidine kinase
Aciclovir monophosphate ? Aciclovir diphosphate by cellular guanylate kinase
Aciclovir diphosphate ? Aciclovir triphosphate by a number of cellular enzymes
The phosphorylation occurs only in infected herpes simplex and varicella-zoster containing cells
Aciclovir triphosphate inhibits herpes specified DNA polymerase

Indications

HSV Encephalitis/Meningitis, Cold sores, Genital herpes
Shingles and Severe Chickenpox
Immunocompromised HSV or Varicella zoster infection

Dose: Prolong course if immunocompromised

Mild/Moderate Genital infection: Aciclovir 800 mg 3 times a day for 2 days, alternatively 200 mg 5 times a day for 5 days, alternatively 400 mg 3 times a day for 3-5 days.
Severe genital HSV infection: Aciclovir 5-10 mg/kg every 8 hours over 1 hour continued 5 days
Herpes Simplex Encephalitis: Aciclovir 10 mg/kg every 8 hours iv given over 1 hour continued 14-21 days until CSF PCR negative. Take advice if needed.
Herpes Zoster Encephalitis: Aciclovir 10 mg/kg every 8 hours iv given over 1 hour continued 10-14 days until CSF PCR negative.

Dose range:You must check with BNF or drug datasheet

Name	Dose for Herpes Encephalitis	Frequency	Route
Aciclovir	10 mg/kg IV every 8 hours	8-hourly	IV
Name	Dose for Mild Oral/Genital Herpes	Frequency	Route
Aciclovir	800 mg PO every 8 hours PO then 200 mg 5/day	8-hourly	PO and reduce with time
Name	Severe Genital Herpes	Frequency	Route
Aciclovir	5-10 mg/kg IV every 8 hours	8-hourly	IV

Side effects

AKI due to crystal deposition in renal tubules
Encephalopathy at high doses and if dehydrated
Skin disorders, Headache, Seizures
Liver toxicity and reduced WCC and platelets

Caution

Ensure hydrated to prevent AKI
Pregnancy and Breastfeeding

Interactions

None significant but Probenecid can increase levels

References

Aciclovir at BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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