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
ADULTS
Parenteral
- 5–10 mg/kg infused IV over 1 hr, q 8 hr (15 mg/kg/day) for 7–10 days.
Oral
- 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.
PEDIATRIC PATIENTS
Parenteral
- 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.
Oral
- < 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.
Indications
- 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
Contraindications
- Contraindicated with allergy to acyclovir, seizures, CHF, renal disease, lactation.
- Use cautiously with pregnancy.
Nursing considerations
Assessment
- 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
Interventions
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.