The occurrence rate of birth defects approximates that found in the general population. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. Intravenous infusions must be given over a period of at least 1 hour to reduce the risk of renal tubular damage (see Renal failure, in some cases resulting in death, has been observed with acyclovir therapy (see Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients receiving acyclovir therapy.Precipitation of acyclovir crystals in renal tubules can occur if the maximum solubility of free acyclovir (2.5 mg/mL at 37°C in water) is exceeded or if the drug is administered by bolus injection. Shake the vial well to assure complete dissolution before measuring and transferring each individual dose. The pH has been adjusted with sodium hydroxide and if necessary, hydrochloric acid to fall in the range of 10.7 to 11.7. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the m… Overdosage has been reported following bolus injections or inappropriately high doses, and in patients whose fluid and electrolyte balance was not properly monitored. Dosage reduction may be required in geriatric patients with underlying renal impairment (see Coadministration of probenecid with acyclovir has been shown to increase the mean acyclovir half life and the area under the concentration-time curve. Precipitation of acyclovir in renal tubules may occur when the solubility (2.5 mg/mL) is exceeded in the intratubular fluid. Acyclovir pharmacokinetics were determined in 12 patients ranging in age from birth to 3 months at doses of 5 mg/kg, 10 mg/kg, and 15 mg/kg every 8 hours (Table 3).Acyclovir plasma concentrations are higher in geriatric patients compared to younger adults, in part due to age-related changes in renal function. Concomitant use of other nephrotoxic drugs, pre-existing renal disease, and dehydration make further renal impairment with acyclovir more likely. The peak and trough plasma levels during the 47 hours preceding hemodialysis were 8.5 mcg/mL and 0.7 mcg/mL, respectively.Acyclovir pharmacokinetics were determined in 16 pediatric patients with normal renal function ranging in age from 3 months to 16 years at doses of approximately 10 mg/kg and 20 mg/kg every 8 hours (Table 3). The sodium content is approximately 5.1 mg/mL. Each mL contains acyclovir 25 mg/mL.Acyclovir Injection is supplied as sterile vials, each containing acyclovir sodium equivalent to 1000 mg of acyclovir for intravenous administration in 40 mL of water for injection, tray of 10 (NDC 61703-311-43). Elevation of transaminases occurred in 1% to 2% of patients.The following hematologic abnormalities occurred at a frequency of less than 1%: anemia, neutropenia, thrombocytopenia, thrombocytosis, leukocytosis, and neutrophilia. Plasma drug concentrations in animal studies are expressed as multiples of human exposure to acyclovir at the higher and lower dosing schedules (see Acyclovir was tested in lifetime bioassays in rats and mice at single daily doses of up to 450 mg/kg administered by gavage.
Shake the vial well to assure complete dissolution before measuring and transferring each individual dose. Other reported clinical experience has identified differences in the severity of CNS adverse events between elderly and younger patients (see The adverse reactions listed below have been observed in controlled and uncontrolled clinical trials in approximately 700 patients who received acyclovir at ~5 mg/kg (250 mg/mThe most frequent adverse reactions reported during administration of acyclovir were inflammation or phlebitis at the injection site in approximately 9% of the patients, and transient elevations of serum creatinine or BUN in 5% to 10% (the higher incidence occurred usually following rapid [less than 10 minutes] intravenous infusion). While most of the acyclovir-resistant mutants isolated thus far from such patients have been found to be TK-deficient mutants, other mutants involving the viral TK gene (TK partial and TK altered) and DNA polymerase have been isolated. If your dose is different, do not change it unless your doctor tells you to do so.The amount of medicine that you take depends on the strength of the medicine. Dilution in any appropriate intravenous solution must be performed before infusion (see The chemical name of acyclovir is 9-[(2-Hydroxyethoxy)methyl]guanine sodium. The dose of this medicine will be different for different patients. 20 mg/kg/dose Q8 hr IV infusion by syringe over 1 hour for 21 days for disseminated or CNS infections and for 14 days for localized herpes simplex infections. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, potential causal connection to acyclovir or a combination of these factors.Overdoses involving ingestions of up to 20 g have been reported.
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