- Treatment of mucocutaneous HSV infections.
- Treatment of herpes simplex encephalitis
- Treatment of varicella zoster infections in immunocompromised patients
- Prophylaxis during immunosuppression of seropositive patients
- Available as a 50 mg/mL solution stored at room temperature.
- Punctured vial stable 7 days refrigerated.
- Diluted solutions (5 mg/mL) stable 30 days refrigerated and at room temperature.
- Refrigeration may result in the formation of a precipitate, which will redissolve at room temperature. Warm to room temperature 30 minutes before using,
- DO NOT use bacteriostatic water for injection.
- Solution Compatible: D5W, 0.9% NaCl, lactated ringer's
- Additives/Above Cassette Compatible: fluconazole
- Y-site Compatible: ampicillin, ceftazidine, cefuroxime, cefotaxime, clindamycin, dexamethasone, dimenhydrinate, diphenhydramine, G-CSF, heparin sodium, hydrocortisone sodium succinate, lorazepam, magnesium sulfate, methylprednisolone sodium succinate, metronidazole, ranitidine, sodium bicarbonate, tobramycin, KCl, cotrimoxazole, vancomycin.
INCOMPATIBLE: morphine, ondansetron, amino acid solutions, TPN, dopamine, dobutamine, meropenem, levofloxaxin, piperacillin/tazobactam.
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct | NO |
| IV Intermittent Infusion |
YES |
| IV Continuous Infusion | NO |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
*** Dosage should be based according to ideal body weight ***
Suspected or Confirmed HSV Meningoencephalitis:
- 1 month to less than 4 months of age: 60 mg /kg/day IV ÷ q8 hours
- 4 months to less than 12 years of age: 45 mg/kg/day IV ÷ q8 hours
- Greater than or equal to 12 years of age: 30 - 35 mg/kg/day ÷ q8 hours
Herpes simplex mucous membrane or cutaneous disease OR Varicella zoster infection (disseminated disease or Zoster)
- 30 mg/kg/day ÷ q8 hours
Prophylaxis of HSV infection: 750 mg/m2/day ÷ q8 hours during risk period
Dosing adjustment in renal impairment:
- CrCl 25-50 mL/min: Administer normal dose q12 hours
- CrCl 10-25 mL/min: Administer normal dose q24 hours
- CrCl < 10 mL/min: 50% decrease in dose, administer q24 hours
- Administering acyclovir over less than 1 hour increases the risk of renal tubule damage. Infuse over 1 hour
- It is especially important to maintain adequate hydration during the first two hours after IV infusion to reduce the risk of nephrotoxicity. Give 1½ times maintenance hydration 1 hour before and 1 hour after IV infusion.
- Phlebitis, inflammation, pain at injection site.
- Elevated BUN and serum creatinine are the most common adverse reactions.
- May cause nausea, vomiting, headache, dizziness, fatigue, insomnia, fever.
- Adjust dose in patients with renal failure.
- Acyclovir may precipitate in kidneys if the solution is infused too quickly (< 1 hr) or is too concentrated, or if the patient is dehydrated. Maintain adequate hydration and urine output. The manufacturer suggests a minimum urine output of 500 mL/24 hr per gram of acyclovir administered.
- Measure baseline serum creatinine. Monitor urinalysis, BUN, serum creatinine, liver enzymes, CBC, accurate ins and outs.