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Anti-Herpetic Agents

Infectious Disease -ALL Agents (INDEX)

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Acyclovir ( zovirax ® ) 

Mucocutaneous herpes simplex: IV: 5 mg/kg/dose every 8 hours x 5-10 days.
Encephalitis: 10mg/kg/dose IV every 8 hours.
Primary HSV infection-genital (Oral therapy): 200mg every 4 hours while awake (5 times/day) or 400mg orally three times daily for 10 days.
Recurrent genital: 400mg orally three times daily for 5 days.
Herpes Zoster: 800mg orally every 4 hours while awake (5 times/ day) for 7 days. If severe give 10-12 mg/kg IV every 8 hours x 7-14 days.
Chronic suppression (genital herpes): 400mg orally twice daily.

Zovirax ointment: apply ½" every 3 hours (6 times/day).

Renal dosing: 50 - 90/ 5 to 12.4 mg/kg q8h || 10-50 / 5-12.4 mg/kg q12-24h || <10 / 2.5 to 6 mg/kg q24h. Alternatively: (Oral): 10-25 / dose q8h || <10 / dose q12h. (IV): 25-50/ 5-10mg/kg q12h || 10-25/ 5-10mg/kg q24h || <10/ 2.5 to 5mg/kg IV q24h. || HD: dose after dialysis || CAPD: see < 10.

Drug UPDATES:  SITAVIG (acyclovir) buccal tablets 50mg
[Drug information  /  PDF]  
Dosing:  Click (+) next to Dosage and Administration section (drug info link)

Initial U.S. Approval:  2013

Mechanism of Action: Acyclovir is a synthetic purine nucleoside that is phosphorylated intracellularly by the viral encoded thymidine kinase (TK) of HSV into acyclovir monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. In a biochemical reaction, acyclovir triphosphate inhibits replication of herpes viral DNA by competing with nucleotides for binding to the viral DNA polymerase and by incorporation into and termination of the growing viral DNA chain. The cellular thymidine kinase of normal, uninfected cells does not use acyclovir effectively as a substrate, hence toxicity to mammalian host cells is low.

INDICATIONS AND USAGE:  SITAVIG (acyclovir) buccal tablets 50mgSITAVIG is indicated for the treatment of recurrent herpes labialis (cold sores) in immunocompetent adults
Application of one SITAVIG 50 mg buccal tablet as a single dose to the upper gum (canine fossa) region.
SITAVIG should be applied within one hour after the onset of prodromal symptoms and before the appearance of any signs of herpes labailis.
Do not crush, chew, suck or swallow tablets .

HOW SUPPLIED:  50 mg buccal tablets

Famciclovir ( famvir ®) 

First episode genital: 250 mg orally three times daily for 7-10 days.
Recurrent herpes simplex (genital): 125 mg orally twice daily for 5 days.
Prophylaxis (Chronic suppression): 250mg orally twice daily.
Recurrent (HIV patient): 500mg orally twice daily for 7 days.
Zoster: 500mg orally three times daily for 7 days.

Supplied: [125,250, 500 mg tabs]

Renal dosing: >60/ no change || 40-59/ 500mg q12h || 11-39/ 500mg q24h || <10/ 250 mg q48h || HD: 250mg after dialysis.

Valacyclovir  ( valtrex ®)  

First episode genital: 1000mg orally twice daily for 10 days. Recurrent: 500mg orally twice daily for 5 days. Prophylaxis: 500-1000mg orally once daily.
Zoster: 1000 mg orally three times daily for 7 days.
Herpes labialis (cold sores) 2 gm q12h x 1 day.

Supplied: [500,1000mg tabs]

Renal Dosing:
[CRCL >50]: No changes.

[30-49]: Zoster: 1 gram q12h. H. Labialis: 1 gram q12h x 2 doses. Initial episode GH: 1 gram q12h. Recurrent: 500mg q12h. Suppressive: 0.5 – 1 gm qd.

[10-29]: Zoster: 1 gram q24h. H. Labialis (lip): 500mg q12h x 2 doses. Initial episode G. Herpes: 1 gram q24h. Recurrent: 500mg q24h. Suppressive: 500mg q24-48h.

[<10]: Zoster: 500mg q24h. H. Labialis: 500mg x 1.
Initial episode G. Herpes: 500mg q24h. Recurrent: 500mg q24h. Suppressive: 500mg q24-48h. Hemo: 500 mg PO q24h (on dialysis days give dose after dialysis)

Acyclovir  ( zovirax ®)

Apply every 3 hours (6 times / day) for 7 days.
Supplied: [5% ointment]

Docosanol ( abreva ®)

Abreva Cream (Docosanol 10%):
: Treats cold sore/fever blisters on the face or lips. Shortens healing time and duration of symptoms: tingling, pain, burning, and/or itching.
: adults and children 12 years or over: wash hands before and after applying cream. Apply to affected area on face or lips at the first sign of cold sore/fever blister (tingle). Early treatment ensures the best results. Rub in gently but completely. Use 5 times a day until healed.

Penciclovir (denavir ®)

 Herpes labialis: apply 1% cream every 2 hours while awake for 4 days.


National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Anti-Herpetic Agents