Aciclovir: Effective Antiviral Treatment for Herpes Infections
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Aciclovir is a nucleoside analogue antiviral medication specifically designed to manage infections caused by the herpes simplex virus (HSV) and varicella-zoster virus (VZV). As a first-line therapeutic agent, it works by inhibiting viral DNA replication, thereby reducing the severity and duration of outbreaks. This medication is available in multiple formulations—oral tablets, topical cream, and intravenous injection—to suit varying clinical needs and patient circumstances. Its established efficacy and favorable safety profile make it a cornerstone in antiviral therapy for both immunocompetent and immunocompromised individuals.
Features
- Active ingredient: Aciclovir
- Available formulations: 200mg, 400mg, 800mg oral tablets; 5% topical cream; intravenous injection
- Mechanism of action: Selective inhibition of viral DNA polymerase
- Half-life: Approximately 2.5–3.3 hours in adults with normal renal function
- Bioavailability: 10–20% for oral administration; significantly higher with IV formulation
- Excretion: Primarily renal, requiring dosage adjustment in impaired kidney function
Benefits
- Reduces healing time for initial and recurrent herpes outbreaks
- Decreases the frequency of recurrent episodes with prophylactic use
- Lowers risk of viral transmission to partners when used suppressively
- Minimizes complications such as neurologic involvement in herpes zoster
- Helps prevent disseminated infections in immunocompromised patients
- Available in multiple formulations for flexible treatment approaches
Common use
Aciclovir is primarily indicated for the treatment of herpes simplex virus infections, including genital herpes, herpes labialis (cold sores), and herpetic whitlow. It is also effective against varicella-zoster virus infections, presenting as chickenpox or shingles (herpes zoster). In immunocompromised patients, such as those with HIV/AIDS or undergoing chemotherapy, aciclovir serves as prophylaxis against recurrent herpes infections. Off-label uses may include prevention of cytomegalovirus infections in transplant recipients and management of Epstein-Barr virus complications, though these applications require careful medical supervision.
Dosage and direction
Oral tablets: For genital herpes initial episode: 200mg five times daily for 10 days; recurrent episodes: 200mg five times daily for 5 days. Chronic suppression: 400mg twice daily. For herpes zoster: 800mg five times daily for 7–10 days.
Topical cream: Apply sufficient quantity to cover lesions every 4 hours (6 times daily) for 7 days. Begin treatment at earliest sign of outbreak.
Intravenous: 5–10mg/kg every 8 hours for 7–10 days in adults with normal renal function. Dosage must be adjusted for renal impairment.
All formulations should be taken with adequate hydration. Oral doses are preferably administered with food to minimize gastrointestinal discomfort. Treatment should be initiated as early as possible following symptom onset for optimal efficacy.
Precautions
Patients with renal impairment require dosage adjustment based on creatinine clearance. Maintain adequate hydration during treatment to prevent crystal nephropathy. Use with caution in elderly patients due to age-related decline in renal function. Neurological symptoms, including confusion, hallucinations, and seizures, have been reported, particularly in patients with renal impairment or those receiving higher than recommended doses. Monitor complete blood count and renal function during prolonged therapy. Pregnancy category B—use only if potential benefit justifies potential risk to fetus.
Contraindications
Hypersensitivity to aciclovir, valaciclovir, or any component of the formulation. The intravenous formulation is contraindicated in patients with known hypersensitivity to the drug or those with creatinine clearance less than 25 mL/min without appropriate dosage adjustment. Concomitant use with other nephrotoxic drugs should be avoided unless closely monitored.
Possible side effects
Common side effects (≥1%): nausea, vomiting, diarrhea, headache, rash. Less common side effects (0.1–1%): dizziness, fatigue, elevated liver enzymes, photosensitivity reactions. Rare but serious side effects (<0.1%): acute renal failure, neurological symptoms (agitation, confusion, tremor, hallucinations), thrombocytopenia, leukopenia, anaphylaxis. Topical formulation may cause local reactions including burning, stinging, or pruritus at application site. Most side effects are dose-dependent and reversible upon discontinuation.
Drug interaction
Probenecid significantly increases aciclovir plasma concentrations by reducing renal clearance. Concurrent use with other nephrotoxic agents (aminoglycosides, cyclosporine, NSAIDs) may increase risk of renal impairment. Zidovudine may potentiate fatigue and lethargy. The intravenous formulation may interact with solutions containing benzyl alcohol in neonates. Monitor patients closely when administering with medications that compete for renal tubular secretion.
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one. For twice-daily regimens, if remembered within 6 hours of scheduled time, take immediately; if later, skip and resume regular schedule. Maintaining consistent dosing intervals is crucial for therapeutic efficacy, particularly during acute treatment phases.
Overdose
Symptoms of overdose may include nausea, vomiting, headache, neurological manifestations (agitation, confusion, seizures), and renal impairment. Management includes supportive care and adequate hydration to promote renal elimination. Hemodialysis significantly enhances aciclovir removal (approximately 60% reduction in plasma concentrations during a 6-hour session). In cases of massive overdose, continuous renal replacement therapy may be considered. There is no specific antidote for aciclovir overdose.
Storage
Store at room temperature (15–30°C) in original container protected from light and moisture. Do not freeze. Keep all formulations out of reach of children. Oral tablets remain stable for 24 months from manufacturing date. Topical cream should not be stored above 30°C. Intravenous solution should be inspected for particulate matter and discoloration before administration. Reconstituted solutions are stable for 12 hours at room temperature.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Aciclovir is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Dosage and treatment duration must be individualized based on specific diagnosis, renal function, and patient characteristics. Patients should consult their healthcare provider for proper diagnosis and treatment recommendations. Never discontinue or modify prescribed regimens without medical consultation.
Reviews
Clinical studies demonstrate aciclovir’s efficacy in reducing healing time by 1–2 days in recurrent herpes simplex infections and by 1–4 days in herpes zoster. Meta-analyses show suppressive therapy reduces recurrence rates by 70–80% in genital herpes patients. The drug is generally well-tolerated, with most adverse effects being mild and transient. Long-term safety data support its use for chronic suppression for up to 10 years. Healthcare professionals consistently rate aciclovir as a first-line choice for herpes virus management due to its proven efficacy, safety profile, and decades of clinical experience.