Rapid or bolus intravenous and intramuscular or subcutaneous injection of aciclovir must be avoided (see Precautions and Administration as follows). (See Table 1.)
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In patients with renal impairment, aciclovir should be administered with caution since the drug isexcreted by the kidneys.
The following modifications in dosage are suggested: (See Table 2.)
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Dosage in children:
The dose of aciclovir intravenous in children aged 1 to 12 years should be calculated on the basis of body surface area.
Children in this age group with Herpes simplex
infections (except Herpes simplex
encephalitis) or Varicella zoster
infections should be given aciclovir intravenous doses of 250 mg per square metre body surface area (equivalent of 5 mg/kg in adults).
Immunocompromised children in this age group with Varicella zoster
virus infection or with Herpes simplex
encephalitis should be given aciclovir intravenous in doses of 500 mg per square metre of body surface area (equivalent to 10 mg/kg in adults).
Children with impaired renal function require an appropriately modified dose, according to the degree of impairment.
Dosage in the elderly:
No data are available on this age group. However, as creatinine clearance is often low in the elderly, special attention should be given to dosage reduction. It is recommended that the state of hydration and the creatinine clearance should be evaluated before the administration of high dosages of aciclovir, especially in elderly people, who may have reduced renal function despite a normal serum creatinine concentration.
Duration of treatment:
It is recommended that aciclovir intravenous be administered for five to seven days in the treatment of most infections and for at least ten days in the treatment of Herpes simplex encephalitis.
Each dose must be administered by slow intravenous infusion over a period of at least one hour to avoid renal tubular damage (see Precautions).
DBL Aciclovir Intravenous Infusion may be injected directly into a vein over one hour by a controlled rate infusion pump or be diluted for administration by infusion.
For intravenous injection by a controlled rate infusion pump, a solution containing 25 mg aciclovir per mL is used.
For intravenous infusion, each vial of DBL Aciclovir Intravenous Infusion should be added to and mixed with at least 50 mL to 100 mL infusion solution. A maximum of 250 mg of aciclovir may be added to 50 mL of infusion solution and a maximum of 500 mg of aciclovir may be added to 100 mL of infusion solution. After addition of DBL Aciclovir Intravenous Infusion to an infusion solution, the mixture should be shaken to ensure thorough mixing. DBL Aciclovir Intravenous Infusion when diluted in accordance with the above schedule will give an aciclovir concentration not greater than 0.5% w/v (5 mg/mL).
DBL Aciclovir Intravenous Infusion is known to be compatible with the following infusion fluids and stable for up to 24 hours at room temperature (below 25°C) when diluted to concentrations of aciclovir between 2.5 mg/mL and 10 mg/mL: Sodium Chloride Intravenous Infusion (0.9% w/v); Sodium Chloride (0.18% w/v) and Glucose (4% w/v) Intravenous Infusion; Sodium Chloride (0.9% w/v) and Glucose (5% w/v) Intravenous Infusion; Compound Sodium Lactate Intravenous Infusion BP (Lactated Ringers Solution).
DBL Aciclovir Intravenous Infusion is known to be compatible with Glucose Intravenous Infusion BP (5.0% w/v) and stable for up to 24 hours at room temperature (below 25°C) when diluted to concentrations of aciclovir 4.5 mg/mL and 10 mg/mL. When diluted to a concentration of aciclovir 2.5 mg/mL in Glucose Intravenous Infusion BP (5.0% w/v), DBL Aciclovir Intravenous Infusion is stable for up to 6 hours. DBL Aciclovir Intravenous Infusion should not be diluted to an aciclovir concentration less than 2.5 mg/mL in 5% Glucose Intravenous Infusion.
DBL Aciclovir Intravenous Infusion contains no preservative. Dilution should therefore be carried out immediately before use and any unused solution should be discarded. Should visible turbidity or crystallisation appear in the solution before or during infusion, the preparation should be discarded.
THE SOLUTION SHOULD NOT BE REFRIGERATED as this causes precipitation of crystals. These crystals usually do not redissolve when solution temperature is brought to room temperature.