Adult: For obese patients, administer the recommended adult dose using ideal body weight.
Systemic herpes simplex virus infections: Usual dosage: 5 mg/kg IV every 8 hours for 7-14 days.
Herpes simplex virus, mucocutaneous: Usual dosage: 5 mg/kg IV every 8 hours for 7 days.
HIV-infected patients: 5 mg/kg/dose IV every 8 hours, followed by oral aciclovir after lesions begin to heal; continue oral therapy until lesions are completely healed.
Herpes simplex encephalitis: 10 mg/kg IV every 8 hours for 10 days.
Herpes simplex virus, genital (severe initial episodes): Usual dosage: 5 mg/kg IV every 8 hours for 5 to 7 days.
Varicella-Zoster infections in immunocompromised patients: Usual dosage: 10 mg/kg IV every 8 hours for 7 days.
Pediatric: Systemic herpes simplex virus infections: Younger than 12 years: 10 mg/kg IV every 8 hours for 7-14 days.
Herpes simplex virus, mucocutaneous: 12 years and older: See Adult as previously mentioned.
Younger than 12 years: 10 mg/kg IV every 8 hours for 7 days.
Herpes simplex encephalitis: 12 years and older: 10 mg/kg IV every 8 hours for 10 days.
Herpes simplex virus, genital (severe initial episodes): 12 years and older: See Adult as previously mentioned.
Herpes simplex virus, neonatal: Birth to 3 months of age: In neonatal herpes simplex infection, doses of 20 mg/kg IV every 8 hours have been used; the safety and efficacy of these doses are not known.
Varicella-Zoster infections in immunocompromised patients: 12 years and older: See Adult as previously mentioned.
Younger than 12 years: Because of increased risk of nephrotoxicity associated with 20 mg/kg/dose, a 10 mg/kg/dose every 8 hours for 7 to 10 days or until no new lesions for 48 hours is recommended by several references.
Renal function impairment: See Table 3.
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Hemodialysis: The patient's dosing schedule should be adjusted so that an additional dose is administered after each dialysis.
Adults receiving continuous renal replacement therapy:
One reference suggests a dosage of 5 to 10 mg/kg IV every 24 hours.
The following alternative recommendations assume ultrafiltration and dialysis flow rates of 1 to 2 L/h. A higher dosage is recommended when treating viral meningoencephalitis and varicella-zoster virus infections.
Continuous venovenous hemofiltration: 5 to 10 mg/kg IV every 24 hours.
Continuous venovenous hemodialysis or continuous venovenous hemodiafiltration: 5 to 10 mg/kg IV every 12 to 24 hours.
Adults receiving intermittent hemodialysis:
2.5 to 5 mg/kg IV every 24 hours administered after the dialysis session. This recommendation assumes the patient is receiving standard intermittent hemodialysis 3 times per week and completes the full dialysis sessions. Patients receiving extended daily dialysis may require increased doses. A higher dosage is recommended when treating viral meningoencephalitis and varicella-zoster virus infections.
Mode of Administration:
Administer by constant infusion over 1 hour. Rapid or bolus IV injection must be avoided. Intramuscular (IM) or subcutaneous injection must also be avoided.
Preparation for administration: Reconstitution: The contents of the vial should be dissolved in sterile water for injection as follows: see Table 4.
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Solution for infusion in each case of Actavir 250 or Actavir 500 are prepared to give a concentration of aciclovir of 25 mg/mL. Shake the vial well to ensure complete dissolution before measuring and transferring each individual dose.
Dilution: This must then be further diluted to a final concentration not greater than about 5 mg/mL (0.5%) and given over 1 hour. Higher concentrations (eg, 10 mg/mL) may produce phlebitis or inflammation at the injection site upon inadvertent extravasation. Once diluted for administration, use each dose within 24 hours.
Admixture compatibilities: When reconstituting the contents of the vial, do not use bacteriostatic water for injection containing benzyl alcohol or parabens. Standard, commercially available electrolyte and glucose solutions are suitable for IV administration, including sodium chloride intravenous infusion (0.45% and 0.9% w/v), sodium chloride (0.18% w/v) and glucose (4% w/v) intravenous infusion, sodium chloride (0.45% w/v) and glucose (2.5% w/v) intravenous infusion, Ringer's lactate solution; biologic or colloidal fluids (eg, blood products, protein solutions) are not recommended.
Storage/Stability: The reconstituted solution should be used within 12 hours. Refrigeration of reconstituted solution may result in the formation of a precipitate that will redissolve at room temperature and diluted solution should be used within 24 hours of preparation.
Parenteral drug should be inspected visually for particle matter and discoloration prior to administration, whenever solution and container permit.