Parenteral Manual


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

Alternate Name(s): 
Original Date: 
August 2005
Revised Date: 
June 2020
  • Treatment of mucocutaneous HSV infections.
  • Treatment of herpes simplex encephalitis
  • Treatment of varicella zoster infections in immunocompromised patients
  • Prophylaxis during immunosuppression of seropositive patients


Reconstitution and Stability: 
  • 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.)

IV Direct NO
IV Intermittent Infusion

Usual dilution: 5 mg/mL
Infusion time: 1 hour

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
Potential hazards of parenteral administration: 
  • 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.

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