Acyclovir IV Injection
Rx
Therapeutic ClassAntiviral
Common Dose5–10 mg/kg
RouteIntravenous
PregnancyCategory B (use if clearly needed)
Indications ▼
Severe herpes simplex virus infections (encephalitis, disseminated)
Varicella-zoster virus infections in immunocompromised patients
Severe cytomegalovirus infections (off-label use)
Mechanism & Pharmacokinetics ▼
Mechanism: Acyclovir is phosphorylated by viral thymidine kinase to active form, which inhibits viral DNA polymerase and prevents viral DNA replication.
Pharmacokinetics: IV administration leads to rapid distribution. Half-life ~2.5–3 hours in adults with normal renal function. Primarily excreted unchanged via kidneys.
Dosage & Administration ▼
| Patient Group | Dose | Frequency / Duration |
|---|---|---|
| Adults | 5–10 mg/kg IV | Every 8 hours, 7–14 days depending on indication |
| Pediatric (≥1 month) | 10 mg/kg IV | Every 8 hours, duration per clinical guidance |
Side Effects ▼
Renal toxicity (crystalluria), nausea, vomiting
Headache, dizziness, rash
Rare: Neurotoxicity (confusion, seizures) in renal impairment
Contraindications ▼
Hypersensitivity to acyclovir or valacyclovir
Severe renal impairment without dose adjustment
Drug Interaction ▼
Coadministration with nephrotoxic drugs (e.g., aminoglycosides, cyclosporine) increases renal risk
Probenecid decreases renal clearance, increasing serum levels
Pregnancy & Lactation ▼
Use during pregnancy only if clearly needed
Safe in breastfeeding at recommended doses (minimal systemic absorption by infant)
Clinical / Research Summary ▼
Therapeutic Role: Acyclovir IV is an antiviral agent used primarily for the treatment of severe herpes simplex virus (HSV) infections, varicella-zoster virus (VZV) infections, and in immunocompromised patients where oral therapy is inadequate.
Mechanism-Based Evidence: Acyclovir is a guanosine analog that inhibits viral DNA polymerase, thereby preventing viral DNA replication. It requires phosphorylation by viral thymidine kinase to become active, which confers selective toxicity toward infected cells.
Clinical Effectiveness: IV acyclovir has demonstrated efficacy in reducing lesion formation, viral shedding, and systemic complications in severe HSV and VZV infections. It is particularly effective in treating encephalitis caused by HSV and disseminated VZV in immunocompromised individuals.
Safety Profile: Common adverse effects include infusion-related reactions (phlebitis), mild renal dysfunction, headache, and nausea. Rarely, neurotoxicity such as confusion or seizures can occur, especially in patients with renal impairment.
Research Directions: Ongoing studies focus on optimizing dosing in special populations (renal impairment, neonates), evaluating combination therapy with other antivirals, and development of resistance management strategies in immunocompromised patients.
Patient Counseling Points ▼
Ensure adequate hydration to prevent crystalluria
Report any neurological symptoms or severe rash
Do not skip doses; complete full treatment course
Storage & Handling ▼
Store at 20–25°C, protect from light
Do not freeze
Keep out of reach of children
Brand Names (Bangladesh & Global) ▼
Bangladesh (Local Brands):
Global / International Brands:
Medical Disclaimer: This clinical summary is for educational purposes only. Always consult a qualified healthcare provider before use.
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