aciclovir: clinical use

Prescribing considerations

• Check renal function and hydration before systemic treatment, particularly in older people and people with kidney impairment.
• Review concurrent nephrotoxic medicines and medicines cleared by renal tubular secretion.
• Intravenous aciclovir requires adequate hydration, controlled infusion and aseptic preparation; avoid rapid or bolus administration.

Contraindications and cautions

• Hypersensitivity to aciclovir, valaciclovir or a product excipient.
• The selected cold-sore cream is contraindicated in hypersensitivity to propylene glycol and must not be applied to ocular or other mucosal surfaces.

Monitoring

• Renal function during intravenous treatment and when renal risk is increased.
• Hydration status and urine output.
• Neurological toxicity, especially in older people or those with renal impairment.
• Lithium or theophylline concentrations when clinically relevant.

Clinical pharmacology

Aciclovir is selectively activated in herpes-infected cells and inhibits viral DNA polymerase. Systemic aciclovir is eliminated mainly unchanged through glomerular filtration and active renal tubular secretion.

Formulation and product differences

• Some tablets may be swallowed or dispersed in water.
• Oral suspensions require shaking and accurate measurement.
• Cold-sore cream is for external use on the lips and face.
• The intravenous product requires aseptic reconstitution, dilution and slow infusion.

Eye ointment

Route: Ophthalmic

Strengths: 30 mg/g

Oral suspension

Route: Oral

Strengths: 200 mg/5 mL, 400 mg/5 mL

Tablet

Route: Oral

Strengths: 200 mg, 400 mg, 800 mg