24 Jun 2020

Monitoring Dose reduction required in renal impairment ADULT VALACICLOVIR This document should be read in conjunction with this DISCLAIMER Antimicrobial Restriction – Unrestricted There is more experience with aciclovir in pregnancy.

These include cold sores, genital herpes, chickenpox, and shingles.



Minor. 1 g PO q8hr for 7 days (no data on efficacy if started 72 hours after rash)Recurrent episodes: 500 mg PO q12hr for 3 days (no data on efficacy if started >24 hours after lesion onset)Suppressive therapy (immunocompetent patients): 1 g/day POSuppressive therapy (immunocompetent patients with ≤9 recurrences annually): 500 mg/day PO; transmission reduction for source partner, 500 mg/day POSuppressive therapy (HIV-infected patients): 500 mg PO q12hr>2 years: 20 mg/kg PO q8hr for 5 days; not to exceed 1 g PO q8hr Monitor renal function; dosage may have to be adjusted, depending on renal statusThrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) reported in patients with advanced HIV disease and in allogenic bone marrow transplant and renal transplant recipientsAcute renal failure (ARF) may occur, especially in elderly patients or those with underlying renal impairment receiving higher than recommended doses; use with caution in patients with renal impairment, the elderly, and/or patients receiving nephrotoxic drugsTreatment should begin with the earliest symptom (tingling, burning, itching) in cold sores; for genital herpes, it should begin at the first signs and symptoms (within 72 hours of onset of first diagnosis or 24 hours of onset of recurrent episodes); for herpes zoster, it should begin within 72 hours of onset of rash; for chicken pox, it should begin with the earliest sign or symptomCentral nervous system (CNS) effects may occur (eg, agitation, hallucinations, confusion, encephalopathy); risk of CNS adverse effects is higher in elderly patientsAdequately hydrate patient; decreased precipitation in renal tubules may occurClinical data over several decades with valacyclovir and its metabolite, acyclovir, in pregnant women, have not identified a drug associated risk of major birth defects; there are insufficient data on use of valacyclovir regarding miscarriage or adverse maternal or fetal outcomes; there are risks to fetus associated with untreated herpes simplex during pregnancyCo-infection with HSV increases risk of perinatal HIV transmission in women who had a clinical diagnosis of genital herpes during pregnancyAlthough there is no information on presence of drug in human milk, its metabolite, acyclovir, is present in human milk following oral administration of drug; based on published data, a 500-mg maternal dose twice daily would provide a breastfed child with an oral acyclovir dosage of approximately 0.6 mg/kg/day; there is no data on effects of drug on breastfed child or on milk productionConsider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal conditionA: Generally acceptable.



The patients most likely to benefit from treatment are those over 50 years old. During the COVID-19 pandemic, you need to continue to take your usual medicines and stay as healthy as possible.

Following absorption, valaciclovir is rapidly converted to acyclovir.



This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition.

Acyclovir could be made use of by pregnant females, as it's been categorized as FDA pregnancy classification B (not expected to trigger injury to a coming kid). Valacyclovir oral tablet is a prescription medication used to treat or prevent infections caused by the herpes simplex virus.

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