acyclovir (Rx)

Brand and Other Names:Zovirax
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 50mg/mL

injection, lyophilized powder for reconstitution

  • 500mg/vial
  • 1000mg/vial

oral suspension

  • 200mg/5mL

tablet

  • 400mg
  • 800mg

capsule

  • 200mg

Genital Herpes

Initial treatment: 200 mg PO q4hr while awake (5 times daily) for 10 days or 400 mg PO q8hr for 7-10 days

Intermittent treatment for recurrence: 200 mg PO q4hr while awake (5 times daily) for 5 days; initiate at earliest sign or symptom of recurrence

Chronic suppression for recurrence: 400 mg PO q12hr for up to 12 months; alternatively, 200 mg 3-5 times daily

Herpes Simplex Virus Encephalitis

10-15 mg/kg IV q8hr for 10 days; up to 14-21 days reported  

Mucocutaneous Herpes Simplex Virus Infection

Treatment in immunocompromised patients

IV: 5 mg/kg q8hr for 7 days; dosing up to 14 days reported  

PO (off-label): 400 mg q4hr while awake (5 times daily) for 7 days

Herpes Zoster (Shingles)

Acute treatment: 800 mg PO q4hr while awake (5 times daily) for 7-10 days

Immunocompromised patients

  • 10 mg/kg IV q8hr for 7 days  
  • CrCl 25-50 mL/min: Full recommended IV dose q12hr
  • CrCl 10-25 mL/min: Full recommended IV dose once daily
  • CrCl 0-10 mL/min: 50% of recommended IV dose once daily

Varicella Zoster (Chickenpox)

>40 kg (immunocompetent): 800 mg PO q6hr for 5 days

Immunocompromised patients: 10-15 mg/kg IV q8hr for 7-10 days  

Dosage Modifications

Dose adjustment based on renal clearance and normal dosage regimen

200 mg every 4 hr

  • <10 mL/min/1.73 m²: 200 mg q12hr
  • ≥10 mL/min/1.73 m²: 200 mg q4hr (five times daily)

400 mg every 12 hr

  • <10 mL/min/1.73 m²: 200 mg q12hr
  • ≥10 mL/min/1.73 m²: 400 mg q12hr

800 mg every 4 hr

  • <10 mL/min/1.73 m²: 800 mg q12hr
  • 10-25 mL/min/1.73 m²: 800 mg q8hr
  • >25 mL/min/1.73 m²: 800 mg q4hr (five times daily)

Dose adjustment based on dosage form

Renal impairment (IV)

  • CrCl 25-50 mL/min/1.73 m²: Give recommended dose q12hr
  • CrCl 10-25 mL/min/1.73 m²: Give recommended dose q24hr
  • CrCl <10 mL/min/1.73 m²: Give 50% of recommended dose q24hr

Renal impairment (PO)

  • Normal dosage 200 mg q4hr or 400 mg q12hr and CrCl <10 mL/min/1.73 m²: Decrease to 200 mg q12hr
  • Normal dosage 800 mg q4hr and CrCl 10-25 mL/min/1.73 m²: Decrease to 800 mg q8hr
  • Normal dosage 800 mg q4hr and CrCl <10 mL/min/1.73 m²: Decrease to 800 mg q12hr

Herpetic Keratitis (Orphan)

Orphan designation for treatment of herpetic keratitis

Sponsor

  • Cumulus Pharmaceuticals LLC; 1712 Pioneer Avenue, Suite 1377; Cheyenne, Wyoming 82001

Dosage Forms & Strengths

injectable solution

  • 50mg/mL

injection, lyophilized powder for reconstitution

  • 500mg/vial
  • 1000mg/vial

oral suspension

  • 200mg/5mL

powder for injection

  • 500mg/vial
  • 1g/vial

tablet

  • 400mg
  • 800mg

capsule

  • 200mg

Neonatal Herpes Simplex Virus Infection

Following doses based on research of the NIH National Institute of Child Health and Human Development (NICHD) that updated prescribing information was based on

Infuse IV over 1 hr

PMA ≥34 weeks: 20 mg/kg IV q8hr for 21 days  

PMA <34 weeks: 20 mg/kg IV q12hr for 21 days

Caution if renal function beyond the effect of prematurity occurs

Herpes Simplex Virus Encephalitis

3 months-12 years: 20 mg/kg IV q8hr for 10 days; up to 14-21 days reported  

≥12 years: 10-15 mg/kg IV q8hr for 14-21 days

Mucocutaneous Herpes Simplex Virus Infection

Treatment in immunocompromised patients

<12 years: 10 mg/kg IV q8hr for 7 days  

≥12 years: 5-10 mg/kg/day IV divided q8hr for 5-7 days; up to 14 days reported

Herpes Zoster (Shingles)

<12 years (immunocompromised): 20 mg/kg IV q8hr for 7 days  

≥12 years (immunocompetent): 800 mg PO q4hr while awake (5 times daily) for 7-10 days

≥12 years (immunocompromised): 30 mg/kg/day IV divided q8hr for 7-10 days

Varicella Zoster (Chickenpox)

≥2 years and <40 kg: 20 mg/kg/dose PO q6hr for 5 days; not to exceed 800 mg/dose  

≥40 kg: 800 mg PO q6hr for 5 days

Immunocompromised patients

  • <12 years: 20 mg/kg/dose IV q8hr for 7 days
  • ≥12 years: 10 mg/kg/dose IV q8hr for 7 days

Dosing Considerations

Use ideal body weight (IBW) for obese patients

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Interactions

Interaction Checker

and acyclovir

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (5)

              • amphotericin B deoxycholate

                acyclovir and amphotericin B deoxycholate both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • bacitracin

                acyclovir and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

              • cidofovir

                acyclovir and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • neomycin PO

                acyclovir and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • talimogene laherparepvec

                acyclovir decreases effects of talimogene laherparepvec by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Although no drug interactions studies have been performed, antiherpetic viral agents may interfere with the effectiveness of talimogene laherparepvec.

              Monitor Closely (26)

              • amikacin

                acyclovir and amikacin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • amoxicillin

                amoxicillin, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • capreomycin

                acyclovir and capreomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • carboplatin

                acyclovir and carboplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • cephaloridine

                acyclovir and cephaloridine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • cisplatin

                acyclovir and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • colistin

                acyclovir and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • contrast media (iodinated)

                acyclovir and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • cyclosporine

                acyclovir and cyclosporine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                acyclovir, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Either increases toxicity of the other by decreasing renal clearance. Use Caution/Monitor. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion .

                acyclovir and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • emtricitabine

                acyclovir increases levels of emtricitabine by Other (see comment). Use Caution/Monitor. Comment: Coadministration of emtricitabine with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of emtricitabine.

              • gentamicin

                acyclovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • ioversol

                acyclovir and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • mycophenolate

                acyclovir will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • oxaliplatin

                acyclovir and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • peramivir

                acyclovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • pivmecillinam

                pivmecillinam, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • polymyxin B

                acyclovir and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • probenecid

                acyclovir will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • streptozocin

                acyclovir and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • tacrolimus

                acyclovir and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • teicoplanin

                acyclovir and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • temocillin

                temocillin, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • tenofovir DF

                acyclovir and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                acyclovir increases levels of tenofovir DF by Other (see comment). Use Caution/Monitor. Comment: Coadministration of tenofovir with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of tenofovir.

              • ticarcillin

                ticarcillin, acyclovir. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.

              • tobramycin

                acyclovir and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              Minor (62)

              • aceclofenac

                aceclofenac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • acemetacin

                acemetacin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • adefovir

                acyclovir and adefovir both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • aminohippurate sodium

                acyclovir will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin

                aspirin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin rectal

                aspirin rectal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • astragalus

                astragalus increases effects of acyclovir by pharmacodynamic synergism. Minor/Significance Unknown.

              • balsalazide

                balsalazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • bendroflumethiazide

                bendroflumethiazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefadroxil

                cefadroxil will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefamandole

                cefamandole will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cefpirome

                cefpirome will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ceftazidime

                ceftazidime will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • celecoxib

                celecoxib will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cephalexin

                cephalexin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chlorpropamide

                acyclovir will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • chlorthalidone

                chlorthalidone will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • cyclopenthiazide

                cyclopenthiazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • diclofenac

                diclofenac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • diflunisal

                diflunisal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • etodolac

                etodolac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • fenoprofen

                fenoprofen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • flurbiprofen

                flurbiprofen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • foscarnet

                acyclovir and foscarnet both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • ganciclovir

                acyclovir will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ibuprofen

                ibuprofen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ibuprofen IV

                ibuprofen IV will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • indapamide

                indapamide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • indomethacin

                indomethacin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ketoprofen

                ketoprofen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ketorolac

                ketorolac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • ketorolac intranasal

                ketorolac intranasal will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • lornoxicam

                lornoxicam will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • meclofenamate

                meclofenamate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • mefenamic acid

                mefenamic acid will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • meloxicam

                meloxicam will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • mesalamine

                mesalamine will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • methoxyflurane

                acyclovir and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • methyclothiazide

                methyclothiazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • metolazone

                metolazone will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • nabumetone

                nabumetone will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • naproxen

                naproxen will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • oxaprozin

                oxaprozin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • parecoxib

                parecoxib will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • paromomycin

                acyclovir and paromomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • pentamidine

                acyclovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • piroxicam

                piroxicam will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • rose hips

                rose hips will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • salsalate

                salsalate will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • streptomycin

                acyclovir and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • sulindac

                sulindac will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • tolfenamic acid

                tolfenamic acid will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • tolmetin

                tolmetin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • valganciclovir

                acyclovir will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • vancomycin

                acyclovir and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • willow bark

                willow bark will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Oral

              • Malaise (≤12%)

              1-10%

              Parenteral

              • Inflammation or phlebitis at injection site (9%)
              • Nausea (7%)
              • Vomiting (7%)
              • Rash or hives (2%)
              • Elevated transaminase levels (1-2%)

              Oral

              • Nausea (2-5%)
              • Vomiting (≤3%)
              • Diarrhea (2-3%)
              • Headache (2%)

              <1%

              Abdominal pain

              Aggression/confusion

              Agitation

              Alopecia

              Anaphylaxis

              Anemia

              Angioedema

              Anorexia

              Ataxia

              Coma

              Disseminated intravascular coagulation (DIC)

              Dizziness

              Fatigue

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              Warnings

              Contraindications

              Hypersensitivity

              Cautions

              Avoid rapid infusion because of risk of renal damage

              Renal failure, resulting in death, has occurred

              Use with caution in immunocompromised patients (potential risk of thrombotic thrombocytopenic purpura [TTP]/hemolytic uremic syndrome [HUS])

              Use with caution in patients with renal impairment

              Treatment should begin within 24 hours of appearance of rash

              Use with caution in patients receiving nephrotoxic drugs

              Maintain adequate hydration during PO or IV therapy

              Thrombocytopenic purpura/hemolytic uremic syndrome reported

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              Pregnancy & Lactation

              Pregnancy

              Drug is minimally absorbed systemically following topical route of administration, and maternal use is not expected to result in fetal exposure to drug; experience with topical acyclovir use in pregnant women over several decades, based on published literature including observational studies, has not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

              Animal data

              • Animal reproduction studies with systemic exposure of acyclovir have been conducted; refer to acyclovir prescribing information for additional details

              Lactation

              Drug is minimally absorbed systemically following topical route of administration, and breastfeeding is not expected to result in exposure of child to drug; there are no data on effects of drug on breastfed infant or on milk production; Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Interferes with DNA polymerase to inhibit DNA replication via chain termination

              Absorption

              Absorption: PO, 15-30%

              Peak serum time: 1.5-2 hr (PO); 1 hr (IV)

              Distribution

              Distributed widely (brain, kidney, lungs, liver, spleen, muscle, uterus, vagina, cerebrospinal fluid [CSF])

              Protein bound: 9-33%

              Vd: 0.8 L/kg (63.6 L)

              Metabolism

              Metabolized by liver (in small amounts)

              Elimination

              Half-life: 4 hr (Neonates); 2-3 hr (children 1-12 years); 3 hr (adults)

              Excretion: Urine (62-90% as unchanged drug)

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              Administration

              IV Incompatibilities

              Blood products and protein-containing solutions

              Additive: Dobutamine, dopamine, meropenem (?)

              Syringe: Caffeine

              Y-site: Amifostine, amsacrine, aztreonam, cefepime, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, morphine sulfate (?), ondansetron, piperacillin-tazobactam, sargramostim, vinorelbine

              IV Compatibilities

              Additive: Fluconazole

              Y-site (partial list): Allopurinol, ampicillin, cefazolin, cimetidine, diphenhydramine, fluconazole, heparin, linezolid, lorazepam, magnesium sulfate, potassium chloride, propofol, trimethoprim-sulfamethoxazole, vancomycin

              IV Preparation

              Lyophilized powder

              • Reconstitute with 10 mL (500-mg vial) or 20 mL (1000-mg vial) with Sterile Water
              • Do not bacteriostatic water containing benzyl alcohol
              • Concentrations >10 mg/mL increase risk of phlebitis; usually recommended not to exceed 7 mg/mL in D5W

              Injection

              • For IV infusion, dilute solution in D5W or 0.9% NaCl to a final concentration ≤7 mg/mL. Concentrations >10 mg/mL increase the risk of phlebitis

              IV Administration

              For IV infusion only

              Avoid rapid infusion; infuse over 1 hr at constant rate to prevent renal damage

              Maintain adequate hydration

              Check for phlebitis, and rotate infusion sites

              Storage

              Capsule, oral suspension, tablet: Store at room temperature of 15-25°C (59-77°F); protect from moisture

              Powder for injection: Store undiluted vials at 15-25°C (59-77°F); following reconstitution (final concentration 50 mg/mL), solution is stable for 12 hr at room temperature

              Solution for injection: Store solution at 20-25°C (68-77°F)

              Reconstituted solutions: Do not refrigerate; once diluted with 0.9% NaCl or D5W, use within 24 hr

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Zovirax topical
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              5 % ointment
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              acyclovir topical
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              5 % cream
              Zovirax oral
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              400 mg tablet
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              200 mg/5 mL suspension
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              400 mg tablet
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              200 mg capsule
              acyclovir oral
              -
              200 mg/5 mL suspension
              acyclovir oral
              -
              800 mg tablet
              acyclovir oral
              -
              200 mg capsule
              acyclovir oral
              -
              800 mg tablet
              acyclovir oral
              -
              800 mg tablet
              acyclovir oral
              -
              200 mg capsule
              acyclovir oral
              -
              800 mg tablet
              acyclovir oral
              -
              200 mg/5 mL suspension
              acyclovir oral
              -
              200 mg capsule
              acyclovir oral
              -
              200 mg/5 mL suspension

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              acyclovir topical

              ACYCLOVIR OINTMENT - TOPICAL

              (ay-SYE-kloe-vir)

              COMMON BRAND NAME(S): Zovirax

              USES: This medication is used to treat the first outbreak of genital herpes infection. It is also used to treat non-life-threatening herpes infections of the skin and around the mouth (cold sores) in people with a weakened immune system. This medication may decrease the length of time you have pain and help the sores heal faster. Acyclovir is an antiviral drug. It stops the growth of certain viruses.This medication does not cure herpes or prevent the infection from coming back. Also, it does not prevent the spread of herpes to others.Other antiviral medications taken by mouth may be more effective in treating these conditions. Discuss your treatment options with your doctor.

              HOW TO USE: Apply this medication to skin only. Avoid getting this medication in your eyes. If this happens, wash right away with plenty of water.Begin using acyclovir as soon as symptoms of a herpes infection appear. Wash your hands with soap and water before and after using this medication. Clean and dry the affected areas before applying the medication. Use a finger cot or rubber glove when applying acyclovir to prevent spreading the infection to other parts of your body and to other people. Apply enough ointment to cover all sores, usually every 3 hours, 6 times a day, or as directed by your doctor. Continue to use this medication for the full time prescribed.Tell your doctor if your condition does not improve after 7 days of treatment or if it worsens.

              SIDE EFFECTS: This medication may cause mild, temporary burning or stinging when you apply it. If either of these effects persists or worsens, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using acyclovir, tell your doctor or pharmacist if you are allergic to it; or to valacyclovir; or if you have any other allergies. This product may contain inactive ingredients (such as polyethylene glycol), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Cold sores can spread easily. Avoid close physical contact with others (such as kissing) during an outbreak until the cold sores have completely healed. Try not to touch the cold sore. If you do, wash your hands afterward.To lower the chance of giving genital herpes to your partner, do not have sexual contact during an outbreak or if you have symptoms. You can spread genital herpes even if you do not have symptoms. Always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity. Consult your doctor or pharmacist for more details.Tell your doctor if you are pregnant before using this medication. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding. Avoid breastfeeding if you have herpes sores on or near your breast.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.Wear loose-fitting clothing over your herpes sores to keep from irritating them.Cold sore outbreaks can be caused by many factors such as stress, hormonal changes (such as pregnancy, menstrual period), injury/surgery on the mouth (such as dental work), tiredness, sunlight, cold weather, or fever/cold/flu. Talk to your doctor about identifying and managing these triggers.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
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              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.