Aciclovir: Effective Antiviral Treatment for Herpes Infections
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Aciclovir is a nucleoside analogue antiviral medication primarily indicated for the management of herpesvirus infections, including herpes simplex and varicella-zoster virus. It functions by inhibiting viral DNA replication, thereby reducing the severity and duration of outbreaks. This medication is available in various formulations—oral tablets, topical cream, and intravenous injection—to suit different clinical scenarios and patient needs. Proper usage under medical supervision ensures optimal therapeutic outcomes while minimizing potential adverse effects.
Features
- Active ingredient: Aciclovir
- Available formulations: 200mg, 400mg, 800mg oral tablets; 5% topical cream; intravenous injection
- Mechanism of action: Selective inhibition of viral DNA polymerase
- Half-life: Approximately 2.5–3.3 hours in adults with normal renal function
- Bioavailability: ~15–20% for oral administration
- Pregnancy category: B
Benefits
- Reduces healing time for initial and recurrent herpes outbreaks
- Decreases the frequency of recurrent episodes with prophylactic use
- Lowers risk of viral transmission to susceptible individuals
- Minimizes complications associated with herpes infections in immunocompromised patients
- Provides flexible dosing options for varied clinical presentations
- Demonstrates favorable safety profile with proper monitoring
Common use
Aciclovir is clinically employed for the treatment of herpes simplex virus (HSV) infections, including genital herpes, herpes labialis (cold sores), and herpetic whitlow. It is also indicated for varicella-zoster virus (VZV) infections, such as chickenpox and shingles (herpes zoster). In immunocompromised patients, including those with HIV or undergoing chemotherapy, aciclovir serves as prophylaxis against HSV reactivation. Off-label uses may include prevention of cytomegalovirus (CMV) infection in transplant recipients, though other antivirals are typically preferred for this indication.
Dosage and direction
Oral tablets:
- Genital herpes (initial episode): 200mg every 4 hours while awake (5 times daily) for 10 days
- Genital herpes (recurrent episodes): 200mg every 4 hours while awake (5 times daily) for 5 days
- Chronic suppression: 400mg twice daily or 200mg three times daily
- Herpes zoster: 800mg every 4 hours while awake (5 times daily) for 7–10 days
- Chickenpox (immunocompetent patients): 20mg/kg (max 800mg) four times daily for 5 days
Topical cream:
- Apply sufficient quantity to cover affected area 5 times daily at approximately 4-hour intervals
- Treatment should begin at earliest sign or symptom and continue for at least 4 days
Intravenous:
- 5–10mg/kg every 8 hours infused over at least 1 hour
- Dosage adjustment required for renal impairment
All dosing should be initiated as early as possible following symptom onset for maximum efficacy. Complete the full prescribed course even if symptoms improve earlier.
Precautions
Renal function should be assessed before initiating therapy, particularly in elderly patients or those with pre-existing renal impairment. Maintain adequate hydration during treatment to prevent crystal nephropathy. Use with caution in patients with neurological abnormalities, as neurotoxicity has been reported. Monitor for signs of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) in immunocompromised patients. Topical formulation should not be applied to mucous membranes or eyes. Pregnancy and breastfeeding require careful risk-benefit assessment under medical supervision.
Contraindications
Hypersensitivity to aciclovir, valaciclovir, or any component of the formulation. Severe renal impairment (creatinine clearance <10 mL/min) without appropriate dosage adjustment. Concurrent administration with other nephrotoxic drugs requires extreme caution and close monitoring. Topical formulation is contraindicated for ophthalmic use.
Possible side effect
Common adverse reactions include nausea (2.7–8.1%), vomiting (1.5–4.6%), diarrhea (2–4%), and headache (2.2–13.1%). Dermatological reactions such as rash (1.5–4.1%) and pruritus may occur. Neurological effects including dizziness (1.5–3.1%), fatigue (1.5–4.1%), and confusion (0.3–1.2%) have been reported. Renal impairment may manifest as elevated creatinine (0.7–2.1%) and crystalluria. Intravenous administration may cause inflammation at injection site (8.7–13.7%) and phlebitis. Rare but serious effects include neurotoxicity (lethargy, tremors, seizures), hematological abnormalities, and anaphylaxis.
Drug interaction
Probenecid significantly increases aciclovir plasma concentrations by reducing renal clearance. Concurrent use with other nephrotoxic agents (aminoglycosides, cyclosporine, NSAIDs) may enhance renal toxicity. Zidovudine may potentiate fatigue and lethargy. Cimetidine may slightly increase aciclovir concentrations. The intravenous formulation is incompatible with blood products and protein-containing solutions.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. Maintain regular dosing intervals to ensure consistent antiviral activity. For topical formulation, apply the missed dose when remembered and resume regular schedule.
Overdose
Symptoms may include agitation, coma, seizures, and renal impairment. Elevated BUN and serum creatinine may indicate crystalluria and obstructive nephropathy. Management includes supportive care and adequate hydration to promote drug excretion. Hemodialysis significantly enhances aciclovir elimination (approximately 60% reduction in half-life). Monitor renal function and neurological status closely in suspected overdose cases.
Storage
Store at room temperature (15–30°C) in original container protected from moisture. Keep oral tablets tightly closed and away from light. Topical cream should not be exposed to extreme temperatures. Intravenous solution should be reconstituted and used immediately; discard any unused portion. Keep all medications out of reach of children and pets.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Aciclovir requires prescription and medical supervision. Individual response to therapy may vary. Consult a healthcare professional for proper diagnosis, dosage recommendations, and monitoring. Do not initiate or discontinue treatment without medical guidance. Report any adverse effects to your physician promptly.
Reviews
Clinical studies demonstrate aciclovir reduces healing time by 1–2 days in recurrent genital herpes and by approximately 25% in herpes zoster. Meta-analyses show prophylactic use decreases recurrence rates by 70–80% in immunocompetent patients. Patient satisfaction surveys indicate improved quality of life with reduced outbreak frequency and severity. Long-term safety data support its use for chronic suppression with appropriate monitoring. Comparative studies show superior efficacy to placebo with generally favorable tolerability profile.