Uses
Herpes simplex virus infections:
• HSV encephalitis
• HSV genital, labial, peri-anal and rectal infections Varicella zoster virus infections:
• Beneficial in the immunocompromised patients when given IV within 72 hours: prevents complications of pneumonitis, hepatitis or thrombocytopenia
• In patients with normal immunity, may be considered if the ophthalmic branch of the trigeminal nerve is involved
Contraindications
Not suitable for CMV or EBV infections
Administration
• IV: 5–10 mg/kg 8 hourly
Available in 250 mg/10 ml and 500 mg/20 ml ready-diluted or in 250 mg and 500 mg vials for reconstitution.
Reconstitute 250 mg vial with 10 ml WFI or sodium chloride 0.9% (25 mg/ml).
Reconstitute 500 mg vial with 20 ml WFI or sodium chloride 0.9% (25 mg/ml).
Take the reconstituted solution (25 mg/ml) and make up to 50 ml (for 250 mg vial) or 100 ml (for 500 mg vial) with sodium chloride 0.9% or glucose 5%, and give over 1 hour.
Ensure patient is well hydrated before treatment is administered.
If fluid-restricted, can give centrally via syringe pump undiluted (unlicensed).
In renal impairment:
CC
(ml/min)
|
Dose
(mg/kg)
|
Interval
(h)
|
25–50
|
5–10
|
12
|
10–25
|
5–10
|
24
|
< 10
|
2.5–5
|
24
|
How not to use aciclovir
Rapid IV infusion (precipitation of drug in renal tubules leading to renal impairment)
Adverse effects
Phlebitis
Reversible renal failure
Elevated liver function tests
CNS toxicity (tremors, confusion and fits)
Cautions
Concurrent use of methotrexate
Renal impairment (reduce dose)
Dehydration/hypovolaemia (renal impairment due to precipitation in renal tubules)
Renal replacement therapy
CVVH dose as for CC 10–25 ml/min, i.e 5–10 mg/kg IV every 24 hours (some units use 3.5–7 mg/kg every 24 hours). Not significantly cleared by PD or HD, dose as if CC <10 ml/min, i.e. 2.5–5 mg/kg IV every 24 hours.The dose is dependent upon the indication.
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