Acyclovir

Usual Dosing (Adults)

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.

Renal Dosing

Patients with Acute or Chronic Renal Impairment: Refer to dosing info above for recommended doses, and adjust the dosing interval as indicated in the Table below.

Dosage Adjustments for Patients with Renal Impairment:

Creatinine Clearance (mL/min/1.73 m2)	Percent of Recommended Dose	Dosing Interval (hours)
> 50 25 – 50 10 – 25 0 – 10	100% 100% 100% 50%	8 12 24 24

Oral:
Genital herpes therapy:
[>/= 10]: Usual dose
[<10 ml/min]: 200mg q12h

Genital herpes suppression/prophylaxis:
[>/= 10]: Usual dose
[<10 ml/min]: 200mg q12h

Herpes zoster:
[>25 ml/min]: Usual dose
[10-25]: 800mg q8h
[<10 ml/min]: 800mg q12h

IV:
[>50 ml/min]: No change
[30-50]: 5-10mg/kg q12h
[10-30]: 5-10mg/kg q24h
[<10 ml/min]: 2.5 to 5mg/kg q24h

Hemodialysis

Hemodialysis
For patients who require dialysis, the mean plasma half-life of acyclovir during hemodialysis is approximately 5 hours. This results in a 60% decrease in plasma concentrations following a 6 hour dialysis period. Therefore, the patient’s dosing schedule should be adjusted so that an additional dose is administered after each dialysis.Peritoneal Dialysis
No supplemental dose appears to be necessary after adjustment of the dosing interval.

IV: 2.5 - 5 mg/kg IV q24h (give dose after dialysis on dialysis days).
Oral: See above for <10 ml/min.

Reference(s)

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.