(

A-SIKE-low-vihr)
Zovirax,  Acyclovir Sodium, Avirax, Nu-Acyclovir, Zovirax, Zovirax 200
Class: Anti-infective/antiviral

 Action Inhibits viral DNA replication by interfering with viral DNA polymerase.

 Indications Parenteral form: Treatment of initial or recurrent mucosal and cutaneous herpes simplex viruses (HSV) and varicella zoster (shingles) infections in immunocompromised patients; treatment of herpes simplex encephalitis in infants > 6 mo; treatment of severe clinical episodes of genital herpes. Oral form: Treatment of initial and recurrent episodes of genital herpes in certain patients; acute treatment of shingles and chickenpox; suppressive therapy for frequent recurrence of genital herpes. Topical form: Treatment of initial episodes of herpes genitalis and some mucotaneous HSV infections in immunocompromised patients.

Unlabeled use(s): Treatment of cytomegalovirus and HSV infection after bone marrow or renal transplant; treatment of infectious mononucleosis, varicella pneumonia, chickenpox, and other HSV infections.

 Contraindications Standard considerations.

 Route/Dosage

PARENTERAL

For IV infusion only; rapid or bolus IV must be avoided. ADULTS: IV 15 to 30 mg/kg/day in 3 divided doses given q 8 hr over 1 hr. CHILDREN: IV 250 to 500 mg/m2 q 8 hr.

ORAL

INITIAL GENITAL HERPES: ADULTS: PO 200 mg q 4 hr 5 times/day for 10 days. SUPPRESSIVE THERAPY FOR RECURRENT GENITAL HERPES: ADULTS: PO 400 mg bid or 200 mg q 8 hr. INTERMITTENT THERAPY FOR RECURRENT GENITAL HERPES: ADULTS: PO 200 mg q 4 hr 5 times/day for 5 days at earliest sign or symptom of recurrence. HERPES ZOSTER ADULTS: PO 800 mg q 4 hr 5 times/day for 7 to 10 days. CHICKENPOX ADULTS & CHILDREN: PO 20 mg/kg/dose (maximum 800 mg/dose) qid for 5 days.

Topical

ADULTS & CHILDREN: Apply to lesions q 3 hr 6 times/day.

 Interactions

Zidovudine: Increased propensity for lethargy. INCOMPATIBILITIES: Precipitation may occur with bacteriostatic water. Do not add acyclovir to biologic or colloidal fluids.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Phlebitis at injection site. CNS: Encephalopathic changes; lethargy; obtundation; tremor; confusion; hallucinations; headache; agitation; seizures; coma. DERM: Inflammation at injection site; itching; rash; hives. GI: Nausea; vomiting. HEPA: Transient elevations of serum creatinine, BUN, transaminases. OTHER: Asthenia; paresthesis. Topical form: Burning or stinging; pruritis. Topical use may cause same adverse reactions as systemic use.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy in children < 2 yr not established. Encephalopathic changes: Patients with underlying neurologic abnormalities or severe hypoxia may have increased risk of neurotoxic effects. Cutaneous use: Care must be taken to avoid getting drug in eyes. Renal impairment: Dosage adjustment may be needed. With parenteral use, acyclovir may precipitate as crystals in renal tubules. Genital herpes: Sexual intercourse must be avoided when lesions are present. Use of acyclovir does not prevent transmission.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

Topical

  • Use finger cot or rubber glove when applying topical ointment to prevent spread of infection.
  • Cover entire lesion with ointment 6 times/day for 7 days. A ½-inch ribbon of ointment covers » 4 sq inches.

Parenteral

  • Administer at room temperature. Be certain any precipitate in refrigerated solution dissolves at room temperature.
  • Administer after hemodialysis.
  • Avoid rapid or bolus IV administration.
  • Establish infusion rate to administer over ³ 1 hr.
  • Use reconstituted solution within 12 hr.

Oral/Suspension/Capsules

  • Shake suspension before using.
  • Store capsules at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor IV site for redness, swelling, or heat.
  • Rotate IV sites frequently.
  • Monitor vital signs frequently during infusion.
  • Monitor serum BUN and creatinine.
  • Assess for nausea and vomiting.
  • Monitor I&O.
  • Notify physician if lesion does not improve or recurs.
OVERDOSAGE: SIGNS & SYMPTOMS
  Increased BUN and serum creatinine, renal failure

 Patient/Family Education

  • Advise patient to avoid sexual intercourse while genital herpes lesions are present.
  • Tell patient that acyclovir is a treatment, not a cure.
  • Instruct patient to notify physician if there is no reduction in severity or frequency of lesions.
  • Advise patient that ointment is for external use only.
  • Teach patient to apply ointment with finger cot or glove and to completely cover lesion every 3 hr 6 times/day.
  • Advise patient that transient burning, stinging, itching, or rash may occur, and to notify physician if these symptoms are pronounced or persistent.
  • Caution patient to start treatment as soon as symptoms occur.
  • Tell patient not to use medication on or near eyes.
  • Advise patient to notify physician if nausea, vomiting, diarrhea, headache, numbness, tingling, or general body discomfort occurs with oral dosing.

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