Acyclovir (IV)

Criteria & Principles

Use should be limited to oral therapy unless severity of illness, central nervous system infection, or poor GI function demands parenteral therapy

Indications

Established efficacy for Herpes simplex: 

1. Encephalitis 

2. Severe mucocutaneous disease in immunocompromised host 

3. Prevention of HSV disease in sero+ BMTx pts

Established efficacy for Varicella zoster: 

1. In immunocompromised host 

2. VZV disseminated 

3. Varicella pneumonia or encephalitis

Possible benefit: 

1. Prevention of HSV in sero+ BMTx pts, hematologic malignancy pts, and kidney/liver/pancrease transplant pts 

Adjustment of Dose & Administration

Indication-Specific Adjustment

HSV Dosing (dosing based on IBW unless TBW < IBW)

Indication	CrCl (mL/min)
	>=50	25-49	10-24	<10 / HD	CRRT*
HSV - CNS	10 mg/kg q8h	10 mg/kg q12h	10 mg/kg q24h	5 mg/kg q24h	10 mg/kg q24h
HSV - non-CNS	5 mg/kg q8h	5 mg/kg q12h	5 mg/kg q24h	2.5 mg/kg q24h	5 mg/kg q24h
HSV prophylaxis (unable to take PO)	5 mg/kg q12h (max dose: 400mg)	2.5 mg/kg q12h ​(max dose: 200mg)	2.5 mg/kg q24h ​(max dose: 200mg)	2.5 mg/kg q24h ​(max dose: 200mg)	2.5 mg/kg q24h ​(max dose: 200mg)

 

VZV Dosing (dosing based on IBW unless TBW < IBW)

Indication	CrCl (mL/min)
	>= 50	25-49	10-24	<10 / HD	CRRT*
VZV - complicated (e.g. immunocompromised host, sight-threatening zoster ophthalmicus, CNS, severe disseminated disease)	10 mg/kg q8h	10 mg/kg q12h	10 mg/kg q24h	5 mg/kg q24h	10 mg/kg q24h
VZV - non-CNS	5 mg/kg q8h	5 mg/kg q12h	5 mg/kg q24h	2.5 mg/kg q24h	5 mg/kg q24h

* For CRRT flow rates > 2 L/hr, consider higher dosing or every 12 hour frequency

IBW = ideal body weight

Males: IBW (kg) = 50 + 2.3(# inches over 5 feet)

Females: IBW (kg) = 45 +2.3(# inches over 5 feet)

 

General Notes

1. Up-to-date cost information, click here 
2. IV antimicrobials outpatient (OPAT) dosing, click here
3. Obesity dosing weight recommendations here
4. Helpful drug-drug interaction check website here 
5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.