Aciclovir

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 21.03.2024

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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 the case of recurrences, the patient should take the medication as soon as the first signs of the disease appear (itching, stinging, burning, pain). Apply ointment with a protective glove (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 skin 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: 21.03.2024