Select a medication above to begin.
acyclovir
generic
Adult Dosing .
Dosage forms: CAP: 200 mg; TAB: 400 mg, 800 mg; SUSP: 200 mg per 5 mL; INJ: various
HSV encephalitis
- [10 mg/kg/dose IV q8h x14-21 days]
- Info: give x21 days in immunocompromised pts; use IBW in obese pts
genital HSV, non-pregnant immunocompetent pts
- [1st episode, mild-moderate infection]
- Dose: 400 mg PO tid x7-10 days; Info: may extend tx if not healed after 10 days
- [1st episode, severe infection]
- Dose: 5-10 mg/kg/dose IV q8h for at least 10 days; Info: use IBW in obese pts; may switch to PO antiviral after 2-7 days to complete course; may extend tx if not healed after 10 days
- [recurrence]
- Dose: 800 mg PO tid x2 days; Start: ASAP after sx onset; Alt: 800 mg PO bid x5 days
- [suppression]
- Dose: 400 mg PO bid; Info: reassess tx need at 1y
orolabial HSV, immunocompetent pts
- [1st episode]
- Dose: 400 mg PO tid x7-10 days; Alt: 200 mg PO 5x/day x7-10 days; Info: for infections incl. herpes labialis; may extend tx if not healed after 10 days
- [recurrence]
- Dose: 400 mg PO tid x5 days; Start: ASAP after sx onset; Alt: 200 mg PO 5x/day x5 days; 400 mg PO 5x/day x5 days; Info: for infections incl. herpes labialis; not 1st-line agent
- [suppression]
- Dose: 400 mg PO bid; Info: for infections incl. herpes labialis; reassess tx need at 1y
HSV infection, immunocompromised pts
- [mild-moderate infection, HIV pts]
- Dose: 400 mg PO tid x5-10 days; Start: ASAP after sx onset; Info: for infections incl. herpes labialis; may extend tx if not healed after 10 days
- [severe infection, HIV pts]
- Dose: 5-10 mg/kg/dose IV q8h for at least 10 days; Info: use IBW in obese pts; may switch to PO antiviral after lesions begin to heal; may extend tx if not healed after 10 days
- [suppression, HIV pts]
- Dose: 400-800 mg PO bid-tid; Info: reassess tx need at 1y
- [mucocutaneous disease, non-HIV pts]
- Dose: 400 mg PO tid for at least 5-7 days; Alt: 5 mg/kg/dose IV q8h x7 days; Info: use IBW in obese pts
- [visceral/disseminated disease, non-HIV pts]
- Dose: 10 mg/kg/dose IV q8h x14-21 days; Info: use IBW in obese pts
- [prophylaxis, non-HIV pts (off-label)]
- Dose: 400-800 mg PO bid-tid
varicella (chicken pox)
- [immunocompetent pts]
- Dose: 800 mg PO 4-5x/day x5-7 days; Start: ASAP w/in 24h of rash onset
- [immunocompromised pts]
- Dose: 10 mg/kg/dose IV q8h x7 days; Info: use IBW in obese pts
herpes zoster (shingles)
- [immunocompetent pts]
- Dose: 800 mg PO 5x/day x7 days; Start: ASAP w/in 72h of rash onset, maximum efficacy w/in 48h
- [immunocompromised pts]
- Dose: 10 mg/kg/dose IV q8h x7 days; Info: use IBW in obese pts
herpes zoster ophthalmicus (off-label)
- [800 mg PO 5x/day x7 days]
- Alt: 10 mg/kg/dose IV q8h x7 days; Info: use IBW in obese pts
HSV keratitis (off-label)
- [400 mg PO 5x/day]
- Info: topical tx usually first-line
mucocutaneous HSV, pregnant immunocompetent pts (off-label)
- [1st episode, mild-moderate infection]
- Dose: 400 mg PO tid x7-10 days; Info: may extend tx if not healed after 10 days
- [1st episode, severe infection]
- Dose: 5-10 mg/kg/dose IV q8h for at least 10 days; Info: may switch to PO antiviral after 2-7 days to complete course; may extend tx if not healed after 10 days
- [recurrence]
- Dose: 400 mg PO tid x5 days; Start: ASAP after sx onset
- [suppression]
- Dose: 400 mg PO tid; Start: 36 wk gestation
renal dosing
- [PO route, usual dose 200 mg 5x/day]
- CrCl <10: 200 mg PO q12h
- HD: 200 mg PO q12h, on dialysis days admin. after dialysis; give additional dose as supplement PO after dialysis; PD: not defined
- [PO route, usual dose 400 mg q12h]
- CrCl <10: 200 mg PO q12h
- HD: 200 mg PO q12h, on dialysis days admin. after dialysis; give additional dose as supplement PO after dialysis; PD: not defined
- [PO route, usual dose 800 mg 5x/day]
- CrCl 10-25: 800 mg PO q8h; CrCl <10: 800 mg PO q12h
- HD: 800 mg PO q12h, on dialysis days admin. after dialysis; PD: 600-800 mg PO q24h; no supplement
- [PO route, all other dosing regimens]
- renal impairment: not defined
- HD/PD: not defined
- [IV route]
- CrCl 25-50: give usual dose IV q12h; CrCl 10-24: give usual dose IV q24h; CrCl <10: give 50% usual dose IV q24h
- HD: give 50% usual dose IV q24h, on dialysis days admin. after dialysis; give supplement if next maint. dose not due right after dialysis; PD: give 50% usual dose IV q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: CAP: 200 mg; TAB: 400 mg, 800 mg; SUSP: 200 mg per 5 mL; INJ: various
neonatal HSV infection
- [<3 mo, <35 wk gestation]
- Dose: 40 mg/kg/day IV divided q12h x14-21 days; Info: give x21 days in CNS or disseminated dz
- [<3 mo, 35 wk gestation and older]
- Dose: 60 mg/kg/day IV divided q8h x14-21 days; Info: give x21 days in CNS or disseminated dz
- [suppression, <3 mo]
- Dose: 900 mg/m^2/day PO divided q8h x6mo; Max: 3200 mg/day
HSV encephalitis
- [3 mo-11 yo]
- Dose: 30-45 mg/kg/day IV divided q8h x14-21 days; Info: give x21 days in immunocompromised pts; use IBW in obese pts
- [12 yo and older]
- Dose: 30 mg/kg/day IV divided q8h x14-21 days; Info: give x21 days in immunocompromised pts; use IBW in obese pts
genital HSV, non-pregnant immunocompetent pts
- [1st episode, 2-11 yo (off-label)]
- Dose: 40-80 mg/kg/day PO divided q6-8h x5-10 days
- [1st episode, mild-moderate infection, 12 yo and older]
- Dose: 40-80 mg/kg/day PO divided q6-8h x5-10 days, max 1000 mg/day; Alt: 1200 mg/day PO divided q8h x7-10 days; Info: may extend tx if not healed after 10 days
- [1st episode, severe infection, 12 yo and older]
- Dose: 15-30 mg/kg/day IV divided q8h for at least 10 days; Info: use IBW in obese pts; may switch to PO antiviral after 2-7 days to complete course; may extend tx if not healed after 10 days
- [recurrence, 12 yo and older]
- Dose: 1000 mg/day PO divided 5x/day x5 days; Alt: 1600 mg/day PO divided q12h x5 days; 2400 mg/day PO divided q8h x2 days
- [suppression, 2-11 yo (off-label)]
- Dose: 30 mg/kg/day PO divided q8h for up to 12mo; Max: 1000 mg/day
- [suppression, 12 yo and older]
- Dose: 800 mg/day PO divided q12h for up to 12mo
orolabial HSV, immunocompetent pts
- [1st episode, 2-11 yo (off-label)]
- Dose: 80 mg/kg/day PO divided q6-8h x5-10 days; Alt: 75 mg/kg/day PO divided 5x/day x5-7 days, max 1000 mg/day
- [1st episode, 12 yo and older]
- Dose: 1000 mg/day PO divided 5x/day x7-10 days; Alt: 1200 mg/day PO divided q8h x7-10 days; Info: may extend tx if not healed after 10 days
- [recurrence, 12 yo and older]
- Dose: 1000 mg/day PO divided 5x/day x5 days; Alt: 1600 mg/day PO divided q12h x5 days; 2400 mg/day PO divided q8h x2 days
- [suppression, 12 yo and older]
- Dose: 800 mg/day PO divided q12h for up to 12mo
HSV infection, immunocompromised pts
- [PO route, 2 yo and older]
- Dose: 80 mg/kg/day PO divided qid; Max: 800 mg/dose; Alt: 1000 mg/day PO divided 3-5x/day x7-14 days, max 80 mg/kg/day
- [IV route, 3 mo-12 yo]
- Dose: 30-45 mg/kg/day IV divided q8h x7-14 days; Info: use IBW in obese pts
- [IV route, 12 yo and older]
- Dose: 15-45 mg/kg/day IV divided q8h x7-14 days; Info: use IBW in obese pts
- [prophylaxis, 2 yo and older (off-label)]
- Dose: 600-1000 mg/day PO divided 3-5x/day; Max: 80 mg/kg/day PO (2-11 yo); Alt: 15 mg/kg/day IV divided q8h; Info: give for entire risk period; for IV dosing, use IBW in obese pts
varicella (chicken pox)
- [PO route, immunocompetent pts, 2 yo and older]
- Dose: 80 mg/kg/day PO divided q6h x5 days; Start: ASAP w/in 24h of rash onset; Max: 3200 mg/day
- [IV route, immunocompetent pts, 2 yo and older (off-label)]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days; Start: ASAP w/in 24h of rash onset; Alt: 1500 mg/m^2/day IV divided q8h x7-10 days; Info: use IBW in obese pts
- [IV route, immunocompromised pts, 1-11 mo]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days; Start: ASAP w/in 24h of rash onset; Info: for HIV pts, cont. tx until no new lesions x48h
- [IV route, immunocompromised pts, 1 yo and older]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days; Start: ASAP w/in 24h of rash onset; Alt: 1500 mg/m^2/day IV divided q8h x7-10 days; Info: use IBW in obese pts; for HIV pts, cont. tx until no new lesions x48h
herpes zoster (shingles)
- [PO route, immunocompetent pts, 12 yo and older]
- Dose: 4000 mg/day PO divided 5x/day x5-7 days
- [IV route, immunocompetent pts, 1-11 mo (off-label)]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days
- [IV route, immunocompetent pts, 1 yo and older (off-label)]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days; Alt: 1500 mg/m^2/day IV divided q8h x7-10 days; Info: use IBW in obese pts
- [IV route, immunocompromised pts]
- Dose: 30 mg/kg/day IV divided q8h x7-10 days; Info: use IBW in obese pts
mucocutaneous HSV, pregnant immunocompetent pts (off-label)
- [adolescents]
- see Adult Dosing
renal dosing
- [PO route]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
- [IV route]
- CrCl 25-50: give usual divided dose IV q12h; CrCl 10-24: give usual divided dose IV q24h; CrCl <10: give 50% usual divided dose IV q24h
- HD: give 50% usual divided dose IV q24h, on dialysis days admin. after dialysis; give supplement if next maint. dose not due right after dialysis; PD: give 50% usual divided dose IV q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised