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What Is Acyclovir?
Acyclovir is a synthetic nucleoside analogue, meaning it mimics natural guanosine, and as such, has antiviral properties. Its chemical name is acycloguanosine or ACV. Acyclovir is used in the treatment of herpes simplex, varicella zoster (chicken pox), and herpes zoster (shingles). Acyclovir is also used to treat eczema herpeticum, a skin infection resulting from the herpes virus. It is on the World Health Organization’s list of most essential medicines for any global health care system.
How Should Acyclovir Be Taken?
Acyclovir is available in a number of different formulations and routes of administration. It can be taken orally as a capsule, tablet, or liquid suspension, and there is a topical formulation as well, which is available as an ointment or cream. It can also be administered intravenously.
Oral acyclovir can be taken with food or on an empty stomach. It should be taken with a full 8 oz. glass of water. Plenty of water should be consumed during the entire course of acyclovir therapy to avoid becoming dehydrated.
It is recommended that acyclovir be taken as soon as symptoms of a herpes or shingles outbreak are noticed, such as tingling, burning, itching, pain, or blistering. Likewise, at the first signs of varicella virus (chicken pox), acyclovir should be commenced following doctor’s orders. Acyclovir in the liquid suspension form should be taken using a medicine cup with proper dosing intervals clearly visible. It should not be taken using a household spoon, as the correct dose is important to its efficacy.
It is important to note that acyclovir therapy should be taken for the entire length of treatment as prescribed by a physician or other health care provider, even if symptoms get better before the medication is completely used up.
For the treatment of genital herpes with oral formulations, dosing is as follows: for adults and children 12 years old and up, 200 mg,five times per day, for 10 days. Dosing in children under 12 is per physician instruction.
For oral administration to prevent herpetic outbreaks, dosing is as follows: for adults and children 12 years old and up, 200-400 mg, 2-5 times per day, for 5 days, or up to 12 months, depending on physician orders based on how often outbreaks occur. Dosing in children under 12 is per physician instruction.
To treat varicella virus (chicken pox) with oral formulations, dosing is weight-based and is as follows: for adults and children weighing over 88 pounds or 40 kilograms, 800 mg, 4 times per day, for 5 days; for children over 2 years of age and weighing 88 pounds (40 kilograms) or less, the dose must be set by a physician based on body weight. The usual dosing regimen is 20 mg/kg, with a maximum dose of 800 mg, 4 times per day, for 5 days. Dosing for varicella virus in children under age 2 is strictly by physician instruction.
For the treatment of shingles with oral formulations, dosing is as follows: for adults and children age 12 and up, 800 mg, 5 times per day, for 7-10 days. Dosing in children under 12 is by physician instruction. Treatment for shingles is rare in children.
For injectable acyclovir used intravenously to treat herpes or shingles, the dosing regimen is as follows: for adults and children 12 years and up, the dose is weight-based as determined by a physician, typically 5-10 mg/kg of body weight (the equivalent of 2.3-4.5 mg per pound of weight). Injectable acyclovir should be run in slowly over a minimum of a one-hour period. This should be repeated every 8 hours, for 5-10 days.
The intravenous acyclovir dosing regimen for children under 12 years of age is a higher dose for a longer period of time: 10-20 mg/kg of body weight (4.5 mg-9.1 mg per pound) injected slowly for at least one hour, every 8 hours, for 7-10 days. In newborns up to three months with large-scale herpes outbreaks, the dose is determined by the physician, typically 10 mg/kg of body weight (4.5 mg per pound) run in over at least one hour, every 8 hours, for 10 days.
There is a buccal tablet form of acyclovir that is indicated for patients with recurrent herpes cold sores on the mouth. This formulation is indicated for adults only, as the buccal tablet may pose a choking concern for pediatric users. A buccal tablet is held in place between the cheek and gum in the area of the canine tooth (the canine fossa) on the side where symptoms are first felt. It is important to take the buccal tablet before any actual herpetic lesions appear—ideally within one hour of feeling any tingling, burning, itching, or pain that could indicate the onset of a sore. The buccal tablet dissolves slowly throughout the day, providing a slow release of acyclovir.
Buccal tablets come in a blister pack, which must be peeled back to reveal the tablet without damaging it. The tablet should be removed with a clean, dry finger and placed in the area of the gum above the incisor. Once in place, the tablet should be held down via gentle pressure over the upper lip for about 30 seconds to secure its location. The tablet dissolves slowly over the course of the day; it should not be sucked, swallowed, or chewed. Users of the buccal tablet can eat and drink as normal while the tablet is in place. Sometimes patients on acyclovir become thirstier than normal, and it is fine to drink more water should this happen.
While the buccal acyclovir tablet is in place, users should avoid wearing their upper dentures, brushing their teeth, or chewing gum. If the tablet falls out within 6 hours and is still intact, it can be put back into place. If it will not adhere to the gum, it can be replaced with another tablet. If the tablet is accidentally swallowed within 6 hours, the patient should drink a full glass of water then replace it with a new tablet.
For patients prescribed a topical formulation of acyclovir, they should apply the ointment or cream as soon as any symptoms of a cold sore appear (burning, itching, tingling, pain, etc.). This initial part of a herpes outbreak is sometimes referred to as the prodromal phase. Any lesions should be fully covered every 3 hours, 6 times per day, for 7 days. Users can wear a glove or finger cot to prevent spreading infection to other areas of their body or to another person.
What Are Other Names for Acyclovir?
Acyclovir is used worldwide, and it is marketed and sold under many different names, including Cyclovir, Acivir, Zoral, Herpex, Acivirax, Zovirax, Imavir, Sitavig, and Zovir.