Aciclovir

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 20.12.2020

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Definition
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Viral agent that is used locally and systematically against herpes simplex and herpes zoster viruses.

Half-life
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2–3 h

Pharmacodynamics (Effect)
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Only in virus-infected cells is transformed into the triphosphate by means of the viral thymidine kinase, which selectively inhibits the DNA polymerase of the viruses, therefore good tolerability. Aciclovir-resistant herpes viruses lack thymidine kinase!

Indication
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Local: Herpes simplex infection, systemic, p.o. or i.v. Eccema herpeticatum or herpes zoster.

Limited indication
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Pregnancy, lactation, children and adolescents < 16 years, renal insufficiency.

Dosage and method of use
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  • Internal therapy:
    • Adults
      :Zoster, Eccema herpeticatum: 5 times/day 800 mg p.o. or 3 times/day 5 mg/kg bw i.v. over 5 days.
      • In immunocompromised patients: up to 3 times/day 10-30 mg/kg bw i.v., depending on the severity of the herpes infection, treatment lasts 7-10 days.
        Herpes encephalitis, herpes zoster generalisatus, herpes esophagitis, ulcerated genital herpes simplex: 10 mg/kg bw every 8 hours i.v. for 7-10 days.
        Dose reduction for renal insufficiency:
      • creatinine clearance 25-50 ml/min. Extend the dose interval to 12 hours.
      • 10-25 ml/min. Extend the dose interval to 24 hours.
      • < 10 ml/min.: administration of half the single dose once/day.
      • Dialysis patients: 5 mg/kg bw after each haemodialysis.
    • Children:
      • Children from 3 months: 110 mg/day i.v. divided into 2-3 single doses.
      • Children from 6 months: 130 mg/day i.v.
      • Children from 1 year: 160 mg/day i.v.
      • children from 3 years: 220 mg/day i.v. or twice a day 100 mg p.o.
      • children from 7,5 years: 325 mg/day i.v. or 2 times/day 200 mg p.o.
      • Children from 12 years of age: 440 mg/day i.v. or 3 times/day 200 mg p.o.
    • Prophylactically:
      • Recurrent genital herpes simplex: 2 times 200 mg/day p.o.
      • Herpes simplex recidivans with immunosuppression: 2 times/day 400 p.o.
  • External therapy:
    • Herpes ophthalmicus: eye ointments 3%.
    • Skin: 5% in creams, start treatment at the first signs of the herpes disease (burning, itching, feeling of tension, redness), apply thinly 5 times/day to the infected and immediately adjacent skin areas.

Notice! Never administer Aciclovir s.c., i.m. or in bolus, let infusions run for at least 1 hour. Check creatinine level!

Undesirable effects
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With external application: Allergic skin reactions, contact eczema. In case of systemic application: nausea, vomiting, allergic exanthema, urticaria, increase of creatinine, urea, bilirubin or transaminases. Rarely: drowsiness, confusion, hallucinations, seizures; in i.v. application: phlebitis at the infusion site.

Interactions
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No WW are known for topical application, for systemic application see table 1.

Contraindication
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Contact lenses (eye ointment), application on mucous membranes.

Preparations
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Acic, Aciclovir, Herpetad, Mapox, Supraviran, Virzin, Zovirax, Juviral

Patientinformation
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In case of recurrence, the patient should take the medication at the first signs of illness (stinging, burning, pain). Apply ointment with protective gloves (1 cm of ointment is sufficient for an area of 5×5 cm), the lesions should always be carefully covered. In the case of genital herpes, sexual contact should be avoided until the lesions have healed!

Tables
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Major interactions of aciclovir with systemic application

Atovaquone

Atovaquone effect ↓

Foscarnet

Renal damage

Ganciclovir

reciprocal toxicity ↑

Ifosfamide

Myelosuppression ↑, renal damage ↑, CNS toxicity ↑

Interferon

reciprocal effect ↑.

Pethidine

Pethidine toxicity ↑.

Probenecid

HZW of aciclovir ↑

Zidovudine

Seizures, lethargy

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Last updated on: 20.12.2020