Parenteral Manual

Acyclovir

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): 
Zovirax
Classification: 
Antiviral
Original Date: 
August 2005
Revised Date: 
November 2025
Indications: 
  • 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 for 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.

 

 

Compatibility: 

- 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.

 

 

 

Administration: 

(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
Usual dilution: 5 mg/mL
Infusion time: 1 hour
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

*** Dosage should be based according to ideal body weight ***

Suspected or Confirmed HSV Meningoencephalitis OR HSV disease considered severe or if oral medications are not tolerated    

  • 1 month to less than 4 months of age: 60 mg /kg/day IV divided Q8H
  • 4 months to less than 12 years of age: 45 mg/kg/day IV divided Q8H
  • Greater than or equal to 12 years of age: 30 mg/kg/day divided Q8H

Varicella Zoster Virus (VZV), Chicken Pox

  • Immunocompetent Host: 30 mg/kg/day divided Q8H for 5 days
  • Immunocompromised Host: 
    • < 2 years: 30 mg/kg/day divided Q8H for 7-10 days
    • > 2 years: 30 mg/kg/day OR 1500 mg/m2 Q8h for 7-10 days

Zoster (VZV reactivation)

  • Immunocompetent Host: 30 mg/kg/day OR 1500 mg/m2 divided Q8H for 7-10 days
  • Immunocompromised Host: 30 mg/kg/day divided Q8H for 7-10 days

Dosing adjustment in renal impairment:

  • CrCl 25-50 mL/min: Administer usual dose every 12 hours
  • CrCl 10-25 mL/min: Administer usual dose every 24 hours
  • CrCl < 10 mL/min: Administer 50% of usual dose every 24 hours
Potential hazards of parenteral administration: 
  • Acyclovir can precipitate in the kidneys if infused too rapidly (less than 1 hour), at high concentrations, or in dehydrated patients. Rapid administration increases the risk of renal tubule damage. Infuse acyclovir over a minimum of 1 hour.
  • To minimize nephrotoxicity, ensure that the patient is adequately hydrated and has an appropriate urine output, especially within the first 2 hours post-infusion as this is when the urine drug concentration peaks. The target urine output is ≥500 mL per gram of drug infused, calculated over 24 hours.
  • 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.
Notes: 
  • Adjust dose in patients with renal failure.
  • Measure baseline serum creatinine. Monitor urinalysis, BUN, serum creatinine, liver enzymes, CBC, accurate ins and outs.
References: 
  1. Abbott Laboratories, Limited. Product Monograph: Acyclovir Sodium for Injection (Acyclovir Sodium Sterile Powder).
  2. Pediatric and Neonatal Lexi-Drugs
  3. Trissel's 2 Clinical Pharmaceutics Database

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