acyclovir Nursing Considerations & Management

 Drug  Name

Generic Name :  acyclovir (acycloguanosine)

Brand Name:  Alti-Acyclovir (CAN), Avirax (CAN), Zovirax

Classification: Antiviral, Purine nucleoside analogue
Pregnancy Category B

Dosages & Route



  • 5–10 mg/kg infused IV over 1 hr, q 8 hr (15 mg/kg/day) for 7–10 days.


  • Initial genital herpes: 200 mg q 4 hr (1,000 mg/day) for 10 days.
  • Long-term suppressive therapy: 400 mg bid for up to 12 mo.
  • Acute herpes zoster: 800 mg q 4 hr five times daily for 7–10 days.
  • Chickenpox: 800 mg qid for 5 days.



  • HSV infections < 12 yr: 10 mg/kg infused IV over 1 hr q 8 hr for 7 days.
  • Shingles, HSV encephalitis: 20 mg/kg IV over 1 hr q 8 hr for 10 days.
  • Neonatal HSV: 10 mg/kg infused over 1 hr q 8 hr for 10 days.


  • < 2 yr: Safety not established.
  • 2 yr and < 40 kg: 20 mg/kg per dose qid (80 mg/kg/day) for 5 days.
  • 40 kg: Use adult dosage.
  • 12 yr: Use adult dosage.
Therapeutic actions
  • Antiviral activity; inhibits viral DNA replication.
  • Initial and recurrent mucosal and cutaneous HSV-1 and HSV-2 and varicella zoster infections in immunocompromised patients
  • Severe initial and recurrent genital herpes infections in selected patients
  • Herpes simplex encephalitis
  • Treatment of neonatal herpes simplex virus infections
  • Acute treatment of herpes zoster (shingles) and chickenpox
  • Ointment: Initial HSV genital infections; limited mucocutaneous HSV infections in immunocompromised patients
  • Cream: Recurrent herpes labialis (cold sores) in patients > 12 yr
  • Unlabeled uses: Cytomegalovirus and HSV infection following transplant, herpes simplex infections, varicella pneumonia, disseminated primary eczema herpeticum
Adverse effects

Systemic administration

  • CNS: Headache, vertigo, depression, tremors, encephalopathic changes
  • Dermatologic: Inflammation or phlebitis at injection sites, rash, hair loss
  • GI: Nausea, vomiting, diarrhea, anorexia
  • GU: Crystalluria with rapid IV administration, hematuria

Topical administration

  • Dermatologic: Transient burning at site of application
  • Contraindicated with allergy to acyclovir, seizures, CHF, renal disease, lactation.
  • Use cautiously with pregnancy.
Nursing considerations
  • History: Allergy to acyclovir, seizures, CHF, renal disease, lactation, pregnancy
  • Physical: Skin color, lesions; orientation; BP, P, auscultation, perfusion, edema; R, adventitious sounds; urinary output; BUN, creatinine clearance

Systemic administration
  • Ensure that the patient is well hydrated.

Topical administration

  • Start treatment as soon as possible after onset of signs and symptoms.
  • Wear a rubber glove or finger cot when applying drug.
Teaching points
Systemic administration

  • Complete the full course of oral therapy, and do not exceed the prescribed dose.
  • Oral acyclovir is not a cure for your disease but should make you feel better.
  • Avoid sexual intercourse while visible lesions are present.
  • You may experience these side effects: Nausea, vomiting, loss of appetite, diarrhea; headache, dizziness.
  • Report difficulty urinating, rash, increased severity or frequency of recurrences.

Topical administration

  • Wear rubber gloves or finger cots when applying the drug to prevent autoinoculation of other sites and transmission to others.
  • This drug does not cure the disease; application during symptom-free periods will not prevent recurrences.
  • Avoid sexual intercourse while visible lesions are present.
  • This drug may cause burning, stinging, itching, rash; notify your physician if these are pronounced.