Oral Genital herpes, Herpes simplex infections of skin and mucous membranes
Adult: Immunocompetent patients: 500 mg bid for 3-5 days for recurrent episodes or for up to 10 days for initial episodes. Immunocompromised patients: 1,000 mg bid for at least 5 days for recurrent episodes or for up to 10 days for initial episodes. Treatment duration is based on severity of clinical condition and immunological status. Child: ≥12 years Same as adult dose.
Adult: Immunocompetent patients: 1,000 mg tid for 7 days. Immunocompromised patients: 1,000 mg tid for at least 7 days and for 2 days after crusting of lesions.
Oral Herpes labialis
Adult: 2,000 mg 12 hourly for 1 day. Child: ≥12 years Same as adult dose.
Oral Prophylaxis of cytomegaloviral infections in immunocompromised patients
Adult: Patient following solid organ transplantation: 2,000 mg 4 times daily, usually for 90 days according to patient response. Child: ≥12 years Same as adult dose.
Oral Suppression of recurrent herpes simplex
Adult: Immunocompetent patients: 500 mg once daily. Patient with ≥10 relapses a year: 250 mg bid. Immunocompromised patients: 500 mg bid. Re-evaluate treatment after 6-12 months of therapy. Child: ≥12 years Same as adult dose.
Herpes zoster (shingles); Herpes zoster ophthalmicus Patient on haemodialysis: Lowest recommended dose after the dialysis session.
Immunocompetent and immunocompromised patients: 1,000 mg bid.
Immunocompetent and immunocompromised patients: 1,000 mg once daily.
Immunocompetent and immunocompromised patients: 500 mg once daily.
Herpes simplex infections of skin and mucous membranes; Genital herpes Patient on haemodialysis: Lowest recommended dose after the dialysis session.
This drug does not reduce your risk of passing genital herpes through sexual contact, if symptoms are present, avoid sexual intercourse or use safer sex practices.
Monitor LFTs, CBC, BUN, serum creatinine and urinalysis regularly during treatment. Assess for signs of CNS changes.
Symptoms: Acute renal failure, nausea, vomiting, confusion, agitation, hallucinations, decreased consciousness, and coma. Management: May consider haemodialysis to enhance removal of aciclovir from the blood.
Increased risk of renal impairment with nephrotoxic drugs (e.g. aminoglycosides, organoplatinum compounds, iodinated contrast media, methotrexate, pentamidine, foscarnet, ciclosporin, tacrolimus). Probenecid and cimetidine may reduce renal clearance of aciclovir.
Description: Valaciclovir is rapidly and almost completely converted via hepatic and intestinal metabolism to aciclovir, then converted to aciclovir monophosphate by virus-specific thymidine kinase, then further converted to aciclovir triphosphate by other cellular enzymes. Aciclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Bioavailability: Approx 54% (aciclovir). Time to peak plasma concentration: Approx 1-2 hours. Distribution: Widely distributed into body organs, muscle, uterus, vagina and CSF. Enters breast milk (aciclovir). Plasma protein binding: Approx 14-18%. Metabolism: Converted to aciclovir and L-valine via first-pass intestinal and/or hepatic metabolism. Aciclovir is converted to a small extent by aldehyde oxidase and by alcohol and aldehyde dehydroxegenase to its inactive metabolites. Excretion: Mainly via urine (89% as aciclovir; <1% as unchanged drug); faeces (46% as non-absorbed drug). Elimination half-life: Approx 30 minutes (valaciclovir); 2.5-3.3 hours (aciclovir). End-stage renal disease: 14-20 hours (aciclovir); During hemodialysis: 4 hours.
J05AB11 - valaciclovir ; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. Used in the systemic treatment of viral infections.
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