Neonatal Drug Therapy Manual

Acyclovir

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated April 9, 2025 - 4:20pm

Alternate Name(s): 
Zovirax
Classification: 
Antiviral
Original Date: 
March 1992
Revised Date: 
June 2012
Indications: 
  • Treatment of neonatal herpes simplex virus infection
  • Treatment of varicella zoster infection
Administration: 
  • IV intermittent infusion: over 1 hour
  • Pre-hydration with 1.5 x the fluid intake (as in the CHEO Parenteral Manual) may not be feasible with neonates and infants. Assess fluid status and at minimum, ensure patient is well hydrated and kidney function is normal 
Dosage: 
  • < 32 weeks GA: 40 mg/kg/day divided Q12H
  • > 32 weeks GA: 60 mg/kg/day divided Q8H
Side Effects: 
  • Hematologic: decrease neutrophils and platelets
  • Hepatic: liver enzymes elevated
  • Local: phlebitis
  • Renal: increase in urea and serum creatinine, crystalluria-minimize by ensuring adequate hydration and slow infusion rate
Parameters to Monitor: 
  • Serum creatinine
  • Urine output
  • CBC
  • Liver enzymes
Reconstitution and Stability: 
  • Acyclovir 50 mg/mL
    • Take 5 mL (250 mg) and add to 45 mL D5W
    • Final concentration: 5 mg/mL

 

Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: ampicillin, ceftazidime, cefuroxime, cefotaxime, clindamycin, dexamethasone, erythromycin, fluconazole, gentamicin, heparin, hydrocortisone sodium succinate, KCL, lorazepam, magnesium sulfate, morphine (10-50 mcg/mL), ranitidine, sodium bicarbonate, tobramycin, vancomycin.

Incompatible: dobutamine, dopamine, ketamine, SMOF, TPN

Notes: 
  • Room Temperature
  • Refrigeration may result in the formation of a precipitate, which will redissolve at room temperature. Ensure to warm to room temperature 30 minutes before using. 
References: 

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 9th-11th Editions. Hudson: Lexi-Comp Inc.; 2002-2004.

-Kimberlin DW, Lin C, Jacobs RF, et al. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics 2001; 108:230-8.

-Trissel LA. Handbook on Injectable Drugs. 12th-13th Editions. Bethesda: American Society of Health-System Pharmacists; 2003-2005.

 -Young TE, Mangum B. Neofax(R). 13th-16th Editions. Raleigh: Acorn Publishing; 2000-2003.

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