Traditional medicine

What is the best acyclovir ointment? Acyclovir ointment for herpes

Acyclovir is a modern drug for the treatment of herpes, as well as some other viral diseases. Acyclovir has a direct antiviral effect, which means that it acts directly on the viruses themselves, preventing them from multiplying.

Operating principle

The mechanism of the antiviral effect of the drug is that the active substance contained in the drug penetrates cells infected with the virus. Once in cells, the virus begins to multiply in them, using nucleotides present in the cell to synthesize the viral genome.

The structure of acyclovir is similar to the structure of guanine present in cells. Viral enzymes modify acyclovir to acyclovir triphosphate, which is structurally similar to deoxyguanosine triphosphate, which is normally part of the viral DNA sequence. The “unsuspecting” viral enzyme essentially inserts a “Trojan horse” into its DNA chain. And in vain, since acyclovir triphosphate makes it impossible for the virus to replicate. This stops its reproduction and makes it much easier for the body’s immune forces to fight viral particles.

It should be noted that the active substance of the drug has no effect on the genetic apparatus of the cell itself and does not contribute to the occurrence of mutations. This can be confirmed based on the results of both numerous tests on animals and the practice of using the drug in humans. Therefore, in this regard, the drug is completely safe.

The described method of fighting viruses was at one time a novelty in the world of medicine, and the developers of the drug were awarded the Nobel Prize. And to this day, Acyclovir remains the most effective remedy for herpes viruses, despite the emergence of new antiviral drugs.

What viruses does the drug protect against? Unfortunately, the scope of action of the medicine is limited only to a certain class of viruses, namely the herpesvirus family. These include herpes simplex viruses types 1 and 2, Varicella Zoster virus, cytomegalovirus, which causes cytomegalovirus infection, and Epstein-Barr virus, which causes some tumors and blood diseases. Therefore, you should not listen to the opinion of those who suggest treatment with Acyclovir for any viral infections, such as influenza and even AIDS.

The strength of the drug’s effect on different viruses of the family is not the same. The drug is most dangerous for herpes simplex viruses, it has a slightly weaker effect on the chickenpox virus and even worse on cytomegalovirus and Epstein-Barr virus.

Indications for use

First of all, the drug treats diseases caused by the herpes simplex virus. This is a herpes that occurs on the face, primarily around the lips, and on the mucous membranes, including the mucous membranes of the eyes, as well as in the area of the anus and genitals.

Diseases caused by the Varicella zoster virus include chickenpox and shingles. Diseases caused by cytomegalovirus and Epstein-Barr virus can also be treated with the drug. However, their therapy requires larger doses than the treatment of herpes simplex.

Herpes is one of the most common infectious diseases. Its main symptoms are rashes on the lips, face and eyes. Sometimes rashes appear in the genital area. As a rule, the rashes are very itchy and painful.

Statistics show that more than 90% of the world's population is infected with the herpes simplex virus. However, not everyone has symptoms of herpes. What is this connected with? The fact is that immunity in healthy people usually inhibits the spread of the virus. However, in some cases, the immune system may be weakened, and then we encounter manifestations of herpes.

What can reduce antiherpes immunity:

infectious diseases (acute respiratory infections, influenza)
hypothermia
stress
old age
changes in hormonal levels (for example, during pregnancy)

If these reasons lead to the activation of the virus, then antiviral therapy with the drug is prescribed.

There are often cases when the drug is used for other purposes, for example, for the treatment of boils, acne, other rashes and dermatitis not associated with herpes viruses. Needless to say, this will not benefit the body at all. Therefore, before starting treatment, you should clarify the diagnosis - herpes or herpes zoster - from a specialist. It should also be remembered that the use of antibiotics for herpes is also meaningless.

Description of the drug

The drug is available in various dosage forms:

Acyclovir tablets, 200 or 400 mg
eye ointment
creams
solutions for parenteral administration

The question may arise, which dosage form is optimal to use? This should be decided by the attending physician. However, it should be noted that when it comes to skin rashes, it is best to use a cream or ointment, from which the active substance enters directly into the places where the virus multiplies. If you use Acyclovir in tablets, then due to the low bioavailability of the drug, only a small amount enters the bloodstream. This means that the effectiveness of the product will be lower.

Acyclovir is an inexpensive, but quite serious drug. Therefore, Acyclovir tablets are sold in pharmacies only with a prescription. The only exceptions are creams and ointments.

The drug has several analogues. The most famous of them is Zovirax. In fact, this is a drug that has the same composition. However, it is of imported origin, and therefore its price is slightly higher.

Side effects

The drug has few side effects. Allergic reactions to the components of the drug, headache, dizziness, gastrointestinal disturbances - nausea, diarrhea, vomiting - may occur.

Under no circumstances should you combine taking the drug with drinking alcohol. The fact is that the drug is metabolized in the liver using the same enzymes as alcohol. Therefore, if you take Acyclovir and alcohol at the same time, this will lead to both substances accumulating in the blood and, as a result, to poisoning.

Contraindications

Acyclovir has several contraindications. First of all, the drug penetrates the placental and blood-brain barriers and enters breast milk. Therefore, it is not recommended for use during pregnancy. When prescribing the drug to pregnant and nursing mothers, the doctor must weigh the pros and cons. It is also not recommended to give tablets to children under 3 years of age.

Instructions for use and dosage

When taking Acyclovir tablets, you should use the instructions for use that come with the drug or the instructions of your doctor.

Typically, Acyclovir 200 mg in tablet form must be taken for herpes simplex 5 times a day. Between doses there should be a break of 4 hours (at night - 8 hours). For chickenpox and herpes zoster, the dose is increased 4 times - up to 800 mg.

Children are prescribed the drug based on their weight - 20 mg/kg. In this case, the drug is taken 4 times a day for 5 days.

The usual course of treatment is 5 days; for genital herpes, the period increases to 10 days. Prevention of herpes is carried out by taking 400 mg of the drug every 12 hours.

The maximum permissible daily dose is 2 g. The absorption of the substance into the blood does not depend on food. Therefore, Acyclovir tablets can be taken both before and after meals.

The body’s ability to remove the active substance from the blood is limited, so the dosage must be strictly observed to avoid poisoning.

When using a cream or ointment, the medicine is spread in a thin layer on the affected area. It should be remembered that a thick layer of ointment will not increase the therapeutic effect, but will only lead to wasted use of the drug.

Tamiflu

Cycloferon

Acyclovir is a very popular means of combating herpes viruses. Is this drug prescribed to children, can it be used for acute respiratory infections and colds, and how to give Acyclovir tablets correctly?

Release form

Acyclovir is produced in several forms:

Pills. They are white in color, have a flat surface and have a ridge. Each tablet contains 200 mg or 400 mg of active ingredient. They are packaged in blisters of 5-20 pieces, and one pack contains from 10 to 100 tablets.
Cream for external treatment. It is represented by a homogeneous white mass. The percentage of active substance in this Acyclovir is 5%. One tube can hold 2 g, 5 g or 10 g of cream. Also, the drug can be packaged in jars, from 5 to 50 g of cream in one package.
Ointment for external treatment. It has a viscous consistency and a white or yellowish-white color. The concentration of the active component in this form of Acyclovir is also 5%. The drug is placed in aluminum tubes or glass jars, and the weight of the drug in one package ranges from 2 g to 30 g.
Eye ointment. It is a yellow or white mass. The concentration of the active substance in this dosage form is 3%. One tube of ointment includes 3 or 5 g of the drug.
Powder, from which a solution is prepared for injection into a vein. One bottle may contain 0.25 g, 0.5 g or 1 g of active substance. The number of bottles in one package is 1, 5 or 10.

Such forms of medicine as syrup, suppositories or suspension are not produced.

Compound

The main component of any form of medication that ensures its therapeutic effect is acyclovir. Additional substances differ in different types of the drug:

In the cream they are represented by petroleum jelly, cetyl alcohol, macrolog, propylene glycol, water and other chemicals.
In Acyclovir ointment, the auxiliary ingredients are propylene glycol, water, emulsifiers, nipazole and other compounds.
Microcrystalline cellulose, starch, Mg stearate, crosscarmellose Na and other substances are added to the tablets.
There are no additional chemical compounds in the injection form.

A practicing dermatovenerologist: Vyacheslav Vasilievich Makarchuk talks about the benefits, principle of action and possible side effects of the drug Acyclovir in the following video.

Operating principle

Acyclovir is an antiviral drug effective on:

Herpesviruses types 1 and 2.
Varicella Zoster viruses.
Epstein-Barr viruses.
Cytomegaloviruses.

The drug directly affects the DNA in viral cells, as a result of which the pathogen stops reproducing. Having penetrated the virus cells, the drug breaks the DNA chains and interferes with its replication. At the same time, Acyclovir has almost no effect on the cells of the patient’s body.

The use of such an antiviral medicine prevents the spread of the rash, accelerates the healing of the affected skin, and in case of herpes zoster, reduces pain. Acyclovir also has an immunostimulating effect.

Indications

The use of Acyclovir is indicated:

For herpes infection. The medicine is used topically for herpes on the lips, as well as on the genitals. The drug is indicated for herpes sore throat, dermatitis, stomatitis and conjunctivitis caused by the herpes simplex virus.
For severe or moderate chickenpox. Acyclovir is recommended to be used for chickenpox in infants up to one year old (for example, at 10 months), since in the first year of life this infectious disease is characterized by a predominantly severe course. The drug is also used for congenital chickenpox.
For herpes zoster. This disease, caused by the same virus as chickenpox, most often occurs in old age.
For preventive purposes, if the child has an immunodeficiency and there is a high risk of infection with pathogens sensitive to Acyclovir.

In addition, the use of Acyclovir is in demand for infectious mononucleosis. For influenza and acute respiratory viral infections, this medicine is often not used, since it has no effect on their pathogens, but can be prescribed for prophylactic purposes if there is a high risk of herpes infection.

At what age is it allowed to take it?

It is permissible to treat a child’s skin with Acyclovir cream or ointment from birth. When indicated, the drug in the form of intravenous injections can be used at any age, including infants. As for tablets, this Acyclovir is given from 1 year of age.

Contraindications

If you have hypersensitivity to any component of the drug.
With a mild form of chickenpox.
For bacterial infections, for example, streptoderma.

In case of dehydration, neurological problems or renal pathologies, Acyclovir should be used with caution. 5% ointment or cream should not be lubricated on mucous membranes.

You may be interested in watching the episode of the program of the famous children's doctor Evgeniy Komarovsky, dedicated to the herpes virus in children:

Side effects

Acyclovir has the ability to influence the central nervous system. Taking this medicine may lead to dizziness, weakness, fatigue, drowsiness, tremors of the limbs, and headaches. Occasionally, a young patient may experience hallucinations.
The child’s digestive system may respond to treatment with Acyclovir with diarrhea, nausea, liver dysfunction, abdominal pain, and vomiting. Many mothers are interested in how to support the liver while taking Acyclovir, but if this organ is healthy in the child, additional medications are not required to support it. If the doctor has detected liver disease, he will also prescribe hepatoprotective medications along with Acyclovir.
Taking Acyclovir may cause a decrease in the level of red and white blood cells in the blood, as well as changes in the number of platelets.
External use of the drug sometimes causes skin irritation or peeling. Also, an allergy in the form of a rash may occur at the site of lubrication.
If the medicine is given intravenously, serious side effects such as kidney failure or seizures may occur. In rare cases, such use of Acyclovir leads to psychosis or coma.
Phlebitis may occur at the site of injection of the drug into a vein, and if Acyclovir accidentally gets under the skin, necrosis is possible.
Eye ointment can cause conjunctivitis, blepharitis, keratopathy or severe burning when applied to the mucous membrane.

Instructions for use and dosage

Pills

To treat infections caused by herpes simplex viruses, 1/2 tablet is often prescribed as a single dose for children 1-2 years old, and a whole tablet for children over two years old. The drug is taken four or five times a day. It is recommended to take the tablet with plenty of water.. The average duration of therapy with Acyclovir is 5 days, but if indicated, tablets can be taken for up to 10 days.

For chickenpox, a single dosage of Acyclovir tablets is often selected individually, since for effective treatment a small child needs to calculate the dose by weight. It is 20 mg of active substance per kilogram of baby’s weight. The calculated dose is given 4 times a day for 5 days.

For example, a 1.5-year-old child weighs 11 kilograms and, according to calculations, a single dosage will be 220 mg, so he is given 1 tablet containing 200 mg of acyclovir. And at 7 years old with a weight of 21 kg, 420 mg of the active substance is required per dose, so the child can be given either 2 tablets with 200 mg of acyclovir, or 1 tablet containing 400 mg of the drug. The maximum single dose is 800 mg of acyclovir.

For prevention, Acyclovir is prescribed in tablets if there is a high risk of herpes infection and low immune defense. The dosage of the medicine is 2 tablets per 1 dose, if the drug is taken every 12 hours, or 1 tablet four times a day.

External means

Acyclovir ointment carefully treat the affected areas of the skin, trying not to smear the drug on clean skin, since the medicine forms a dense film on the surface. The dosage of the ointment is determined by the doctor, taking into account the baby’s weight and the area of his skin. Treatment of the rash begins from the very first days of its appearance, but the medicine is not applied to the skin at night. Treatment often lasts 5 days.

Acyclovir cream Apply with a clean hand or a cotton swab to the affected skin up to 5 times a day. The amount of medicine in this form is determined individually. Skin treatment is prescribed for a period of 5 to 10 days.

Eye ointment apply 5 times a day with pauses between placements in the lower conjunctival sac for about 4 hours. A strip of ointment for 1 application is approximately 1 cm long. After recovery, treatment is continued for at least another three days.

Injections

Acyclovir dosage for intravenous injections is calculated based on body weight(in newborns) or by body surface area(in children over 3 months). The drug is administered at intervals of 8 hours, monitoring kidney function. If tests reveal changes in creatinine levels, the dosage is adjusted.

Injections are often given over five days, but depending on the disease and the patient’s body’s response to treatment, injections may be prescribed for a longer period. For example, for herpetic encephalitis, Acyclovir is administered for 10 days.

Acyclovir injection is a slow infusion over one hour or longer(the medicine is administered by drip). To give an injection, water for injection or sodium chloride solution is added to the powder. Acyclovir can also be combined with glucose solutions.

Overdose

There have been no cases of overdose with topical use of Acyclovir. If you take many tablets of this drug orally, it will lead to neurological disorders, nausea, headaches, shortness of breath, loose stools or vomiting. In severe cases, exceeding the dosage causes renal failure, seizures and coma. Treatment involves symptomatic therapy and measures aimed at maintaining vital functions.

Interaction with other drugs

If you take Acyclovir along with other drugs that have a toxic effect on the kidneys, this will increase the nephrotoxic effect of the treatment.

Terms of sale

To purchase any dosage form of Acyclovir, you do not need to present a prescription from a doctor.

Storage conditions and shelf life

The storage location for Acyclovir should be dry, protected from direct sunlight and inaccessible to children. The optimal temperature range for storing cream is +12+15°C, and ointment or tablets is +15+25°C.

After the release date of the tablet form, it can be stored for up to 3 years. The shelf life of the cream is 2 years. An opened tube of eye ointment should be used within 1 month.

The drug under this name is better known as an external remedy for the treatment of herpes. However, there is also a tablet form of the drug intended for systemic treatment of viral infections. Medicines should be used strictly according to medical prescription, since there are a number of contraindications and restrictions on use.

Is Acyclovir ® an antibiotic or not?

Pharmacological group

The tableted drug is classified as an antiviral drug intended for the treatment of herpes infections.

Composition of Acyclovir ® tablet

Like any tablet dosage form, this drug consists of main and auxiliary components. The active ingredient, in the form of sodium salt, has the chemical name 2-Amino-1,9-dihydro-9-[(2-hydroxyethoxy)methyl]-6H-purine-6-OH. To put it simply, the active substance Acyclovir ® is acyclovir, a synthetic analogue of the structural elements of DNA (purine nucleosides).

Once in the body, it undergoes a number of specific transformations. After entering a virus-infected cell through phosphorylation by thymidine kinase, acyclovir takes the form of monophosphate, then diphosphate, and finally turns into triphosphate. It is the final compound that has antiviral activity: it is integrated into the DNA of the pathogen and stops the replication process.

Taking Acyclovir ® tablets is indicated when the body is affected by the following viruses:

Herpes simplex – causes herpes, has several varieties; The spectrum of activity of the drug includes two of them - HSV types 1 and 2.
Varicella zoster is the causative agent of the well-known chickenpox, which most people contract in childhood and receive lifelong immunity.
The Epstein-Barr virus is the cause of many pathologies, which include various cancers, hepatitis and other dangerous diseases.
Cytomegalovirus is a common subtype of herpetic viruses that is extremely dangerous for people with immunodeficiency conditions and newborns.

In children, Epstein-Barr viruses and ciomegalovirus often cause

Release form Acyclovir ®

Based on the active substance, several dosage forms are produced, which are used externally, used for intravenous administration, and also for oral administration. In the latter case, these are tablets, regular and extended release, containing 200 and 400 mg of the active ingredient, respectively.

Photo of the packaging of Acyclovir ® in the form of 400 mg tablets

Under the original name Acyclovir ®, the antiviral drug is produced by the Belarusian manufacturer Belmedpreparaty ® and the domestic company OZON. The tablets contain 200 mg of active ingredient, as well as calcium, milk sugar, potato starch, polyvinylpyrrolidone and aerosil. They are packaged in 20 pieces in blisters and cardboard packs, sold at a price of about 32 rubles. Acyclovir ® has a shelf life of 3 years from the date of manufacture.

In addition, the drug for oral use is produced by many Russian and foreign pharmaceutical enterprises with the addition of branded postfixes to the main name: Acyclovir-akrikhin ®, Acyclovir-sandoz ®, Acyclovir-akos ®, etc. Long-acting tablets at a dosage of 400 mg are called Acyclovir-forte ®.

What do Acyclovir ® tablets help with?

The drug in tablet form is intended for systemic treatment of diseases caused by several types of herpeviruses. For example, tablets, especially in combination with external ointment, are good for rashes on the lips and genital herpes. They are also prescribed for herpes zoster and chickenpox. Treatment of chickenpox with acyclovir ® is especially important for adults: children tolerate it relatively easily, but at an older age the disease is severe and can cause complications.

Acyclovir ® recipe in Latin

You can take tablets only as prescribed by a doctor, since there are certain contraindications for systemic treatment of viral infections. When filling out a prescription form, the specialist briefly indicates basic information about the patient (age and full name) and makes a note in Latin intended for the pharmacist with the prescription in Russian:

Rp.: Tab. Aciclovir 0.2

D.t. d. No. 20

S. 1 tablet 5 times a day.

Acyclovir ® – indications for use

Tablets are prescribed for the purpose of systemic treatment of infections of the skin and mucous membranes caused by susceptible viruses:

Herpes simplex, both primary and in case of relapses.
Genital herpes, affecting the genitals.
Severe infectious course.
Chickenpox in adults and children, starting from the first day after the onset of a characteristic vesicular rash.
Shingles (this disease is a consequence of previous chickenpox and the presence of the virus in the body).

The drug is also indicated for patients with immunodeficiency (who have undergone organ transplantation, undergoing chemotherapy) for the prevention and treatment of herpetic eruptions.

Contraindications for use of Acyclovir ®

The only strict contraindication is considered to be individual hypersensitivity to acyclovir ® itself and its predecessor valacyclovir ® . However, there are cases when you should be careful when using the tablets. These include conditions associated with kidney failure and dehydration. The possibility of using the drug for the treatment of pregnant and lactating women is discussed in the corresponding section.

Dosage and method of use Acyclovir ® tablets

When taken orally, the active substance is partially absorbed, its bioavailability does not exceed 30%. The presence of food in the stomach and intestines does not affect the rate of absorption, so you can take the tablets at any time.

Herpes simplex

For the treatment of primary and recurrent herpes caused by Herpes simplex, it is recommended to observe a 4-hour interval during the day and an 8-hour interval at night:

Children over 2 years of age and adults with normal immune status are prescribed a 5-day course, during which they need to take 200 mg of the drug 5 times daily. For preventive purposes - the same single dose, but every 6 hours.
In the presence of HIV infection, after transplantations and during chemotherapy, the single dose is 400 mg, and the treatment and prevention regimens are similar.
For the treatment of children under two years of age, the dosage is halved (that is, 100 m for each of 5 doses).

Chicken pox

The treatment period for chickenpox is from 7 to 10 days, while adults and children whose body weight is above 40 kg are recommended to take 800 mg of the drug 5 times a day. For a younger child, the amount of active substance should be calculated by weight. Recommended treatment regimen: 5-day course, 20 mg of acyclovir per kilogram of body weight every 6 hours.

Shingles

The drug is prescribed according to age:

children under 2 years old – 200 mg per dose;
from two to six – 400 milligrams;
over 6 and adults – 800 each.

Tablets should be taken four times a day at equal intervals, the full course of treatment is 5 days.

Acyclovir ® – side effects, effects and overdose

Any negative reactions of the body to taking the drug are observed quite rarely.

On the part of the digestive organs, dyspeptic disorders and diarrhea are most likely. In isolated cases, increased transient activity of ALaT and ACaT, liver enzymes, is noted.

Side effects from the nervous system associated with the use of Acyclovir ® tablets are as follows:

general weakness,
drowsiness or agitation,
dizziness or headache.

More severe conditions are possible only with intravenous administration or overdose. Oral administration of the drug usually does not affect the hematopoietic system. Allergy to Acyclovir as a side effect is manifested by urticaria and skin itching.

More serious body reactions occur when the recommended dose is exceeded, especially when the drug is administered parenterally. When ingested, the following symptoms of overdose are mentioned: headache, shortness of breath, fever, neurological disorders, diarrhea and vomiting. In especially severe cases - convulsive syndrome, coma and lethargy (observed after a single dose of 20 grams of the active substance).

Acyclovir ® during pregnancy and breastfeeding

There have been no large-scale clinical studies on the effects of the drug on the fetus. Based on the available information about women and their children who took the drug during pregnancy, it can be concluded that there is no teratogenic effect. That is, Acyclovir can be prescribed during pregnancy from the 1st to the 3rd trimester, but taking into account possible risks, it still penetrates the placenta.

The active substance is also excreted into breast milk in fairly large quantities. Therefore, the use of Acyclovir ® during breastfeeding is not recommended. It is advisable to avoid breastfeeding during the treatment of a viral infection, replacing feeding with a special formula.

Acyclovir ® and alcohol – compatibility

It is known about the potential nephrotoxic effect of the antiviral agent on the kidneys due to its accumulation in the tubules. This is why it is recommended to drink more fluids during treatment and avoid taking other drugs that are harmful to the kidneys. Can I drink alcohol while taking acyclovir ®?

There is no direct prohibition on the combined use of alcohol with these tablets in the instructions from the manufacturers, however, it is necessary to take into account the general negative impact of ethanol on an organism weakened by the disease. In addition, alcohol always increases the likelihood of side effects, especially from the nervous and digestive systems.

Analogues of Acyclovir ® tablets

As already mentioned at the beginning of the article, quite a lot of antiviral drugs based on acyclovir are produced. Pharmacy chains offer the following structural substitutes for the original:

Acyclovir-AKOS ®
Zovirax ®
Acyclovir-Acri ®
Acyclovir-Belupo ®
Virolex ®
Ciclovir ®
Acyclovir-Sandoz ®
Acyclovir-Akrikhin ®
Cyclovax ®
Acyclostad ®
Vivorax ®
Supraviran ®
Gerperax ®
Provirsan ®
Lizavir ®
Cycloviral-SEDICO ®
Citivir ®

In the case of Acyclovir ®, it is simply impractical to look for cheaper analogues. It is the original domestic drug that is the most affordable in pharmacies, while imported substitutes can cost several times more.

Zovirax ® or Acyclovir ®, which is better?

Cost of 25 tablets produced by GlaxoSmithKline Pharmaceuticals S.A. ® today is almost 15 times higher than the price of the domestic drug. At the same time, there is no fundamental difference in the composition of the medicines, since the dose of the active substance is the same. Therefore, there are no differences in the list of indications, contraindications, and possible side effects.

Thus, the difference between Zovirax ® and Acyclovir ® is only in cost, manufacturer and external design. No differences in the therapeutic effect were clinically identified or confirmed.

Which is better, Acyclovir ® or Famvir ®?

The active ingredient in Swiss-made tablets is another antiviral compound – famciclovir.

Photo of Famvir ® 250 mg 21 film-coated tablets

It is active against the same viruses, but is characterized by higher bioavailability. In addition, acyclovir ® -resistant strains of Herpes simplex are susceptible to it. Due to the longer half-life, Famvir ® is also more convenient to use (no more than 3 times a day). The only negative is the cost from 1500 rubles for a pack of 3 tablets.

What is the difference between valacyclovir ® and acyclovir ®

Valacyclovir ® , on the basis of which various antiviral drugs are also produced, is the precursor of acyclovir ® - the hydrochloride salt of its L-valyl ester. In infected cells it undergoes the same transformations and acts similarly.

However, there is a difference between acyclovir ® and valacyclovir ®, which determines the higher effectiveness of drugs based on the latter (for example, Valtrex ®, popular in America). In the form of a prodrug, the antiviral agent is absorbed much better and to the fullest extent possible.

In this article you can read the instructions for use of the drug Acyclovir. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Acyclovir in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Acyclovir in the presence of existing structural analogues. Use for the treatment of oral and genital herpes in adults, children, as well as during pregnancy and lactation. Brand names of various versions of acyclovir: Acri, HEXAL, AKOS.

Acyclovir- an antiviral drug, a synthetic analogue of thymidine nucleoside, which has a highly selective effect on herpes viruses. Inside virus-infected cells, under the influence of viral thymidine kinase, a series of sequential reactions of transformation of acyclovir into mono-, di- and triphosphate of acyclovir takes place. Acyclovir triphosphate is integrated into the viral DNA chain and blocks its synthesis through competitive inhibition of viral DNA polymerase.

The specificity and very high selectivity of action are also due to its predominant accumulation in cells affected by the herpes virus. Highly active against Herpes simplex virus types 1 and 2; the virus that causes chickenpox and herpes zoster (Varicella zoster); Epstein-Barr virus (types of viruses are listed in increasing order of the minimum inhibitory concentration of acyclovir). Moderately active against cytomegalovirus.

In case of herpes, it prevents the formation of new rash elements, reduces the likelihood of skin dissemination and visceral complications, accelerates the formation of crusts, and reduces pain in the acute phase of herpes zoster.

Pharmacokinetics

After oral administration, the bioavailability is 15-30%, creating dose-dependent concentrations sufficient for the effective treatment of viral diseases. Food does not have a significant effect on the absorption of acyclovir. Acyclovir penetrates well into many organs, tissues and body fluids. Acyclovir penetrates the blood-brain and placental barriers and accumulates in breast milk. About 84% is excreted unchanged by the kidneys, 14% in the form of a metabolite. Less than 2% of acyclovir is excreted from the body through the intestines.

Indications

treatment of infections of the skin and mucous membranes caused by Herpes simplex viruses types 1 and 2 (genital and oral herpes), both primary and secondary, including genital herpes;
prevention of exacerbations of recurrent infections caused by Herpes simplex types 1 and 2 in patients with normal immune status;
prevention of primary and recurrent infections caused by Herpes simplex viruses types 1 and 2 in patients with immunodeficiency;
as part of complex therapy for patients with severe immunodeficiency: with HIV infection (stage AIDS, early clinical manifestations and detailed clinical picture) and in patients who have undergone bone marrow transplantation;
treatment of primary and recurrent infections caused by the Varicella zoster virus (chickenpox, as well as herpes zoster).

Release forms

Tablets 200 mg.

Ointment for external use 5%.

Cream for external use 5%.

Eye ointment 3%.

Lyophilisate for preparing a solution for infusion (in injections).

Instructions for use and dosage

Acyclovir is taken during or immediately after a meal and washed down with plenty of water. The dosage regimen is set individually depending on the severity of the disease.

Treatment of skin and mucous membrane infections caused by Herpes simplex types 1 and 2

Adults

Acyclovir is prescribed 200 mg 5 times a day for 5 days at 4-hour intervals during the day and at 8-hour intervals at night. In more severe cases of the disease, the course of treatment can be extended as prescribed by a doctor to 10 days. As part of complex therapy for severe immunodeficiency, incl. with a detailed clinical picture of HIV infection, including early clinical manifestations of HIV infection and the stage of AIDS; after bone marrow transplantation or if absorption from the intestine is impaired, 400 mg is prescribed 5 times a day.

Treatment should begin as soon as possible after infection occurs; for relapses, acyclovir is prescribed in the prodromal period or when the first elements of the rash appear.

Prevention of recurrence of infections caused by Herpes simplex types 1 and 2 in patients with normal immune status

The recommended dose is 200 mg 4 times a day (every 6 hours) or 400 mg 2 times a day (every 12 hours). In some cases, lower doses are effective - 200 mg 3 times a day (every 8 hours) or 2 times a day (every 12 hours).

Prevention of infections caused by Herpes simplex types 1 and 2 in patients with immunodeficiency.

The recommended dose is 200 mg 4 times a day (every 6 hours). In case of severe immunodeficiency (for example, after bone marrow transplantation) or in case of impaired absorption from the intestine, the dose is increased to 400 mg 5 times a day. The duration of the preventive course of therapy is determined by the duration of the period of existence of the risk of infection.

Treatment of infections caused by the Varicella zoster virus (chickenpox)

Adults

Prescribe 800 mg 5 times a day every 4 hours during the day and at 8-hour intervals at night. The duration of treatment is 7-10 days.

Children

Prescribed 20 mg/kg 4 times a day for 5 days (maximum single dose 800 mg), children from 3 to 6 years old: 400 mg 4 times a day, over 6 years old: 800 mg 4 times a day within 5 days.

Treatment should begin at the earliest signs or symptoms of chickenpox.

Treatment of infections caused by the Herpes zoster virus (shingles)

Adults

Prescribe 800 mg 4 times a day every 6 hours for 5 days. For children over 3 years of age, the drug is prescribed in the same dose as for adults.

Treatment and prevention of infections caused by Herpes simplex types 1 and 2 in pediatric patients with immunodeficiency and normal immune status.

Children from 3 years to 6 years - 400 mg; over 6 years old - 800 mg 4 times a day. A more precise dose is determined at the rate of 20 mg/kg body weight, but not more than 800 mg. The course of treatment is 5 days. There are no data on the prevention of recurrence of infections caused by the herpes simplex virus and the treatment of herpes zoster in children with normal immunity.

For treatment children over 3 years of age, 800 mg of acyclovir is prescribed 4 times a day every 6 hours (as for the treatment of adults with immunodeficiency).

In old age, there is a decrease in the clearance of acyclovir in the body in parallel with a decrease in creatinine clearance. Those taking large doses of the drug orally should receive sufficient fluids. In case of renal failure, it is necessary to decide on reducing the dose of the drug.

Side effect

nausea, vomiting, diarrhea;
abdominal pain;
a slight increase in the concentration of urea and creatinine;
leukopenia, erythropenia, anemia, thrombocytopenia;
headache;
dizziness;
agitation, confusion, drowsiness;
tremor;
hallucinations;
convulsions;
dyspnea;
anaphylactic reactions;
skin rash, itching, urticaria;
fatigue;
fever;
myalgia.

Contraindications

lactation period;
children under 3 years of age (for this dosage form).

Use during pregnancy and breastfeeding

Acyclovir crosses the placental barrier and accumulates in breast milk. The use of the drug during pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus. If it is necessary to take acyclovir during lactation, interruption of breastfeeding is required.

Special instructions

Acyclovir is used strictly as prescribed by a doctor to avoid complications in adults and children over 3 years of age.

Long-term or repeated treatment with acyclovir in patients with reduced immunity may lead to the emergence of strains of viruses that are insensitive to its action. Most identified strains of viruses that are insensitive to acyclovir show a relative lack of viral thymidine kinase; strains with altered thymidine kinase or with altered DNA polymerase were isolated. In vitro, the effect of acyclovir on isolated strains of the Herpes simplex virus may cause the emergence of less sensitive strains.

The drug is prescribed with caution to patients with impaired renal function and elderly patients due to an increase in the half-life of acyclovir.

When using the drug, it is necessary to ensure the supply of a sufficient amount of fluid.

When taking the drug, kidney function should be monitored (blood urea and plasma creatinine concentrations). Acyclovir does not prevent the sexual transmission of herpes, so during the treatment period it is necessary to abstain from sexual intercourse, even in the absence of clinical manifestations. It is necessary to inform patients about the possibility of transmission of the genital herpes virus during the period of rash, as well as about cases of asymptomatic virus carriage.

Impact on the ability to drive vehicles and operate machinery

No data available. However, it should be taken into account that dizziness may develop during treatment with acyclovir, so care must be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug interactions

An increase in the effect of acyclovir is observed with the simultaneous administration of immunostimulants.

When taken simultaneously with nephrotoxic drugs, the risk of developing renal dysfunction increases.

Analogues of the drug Acyclovir

Structural analogues of the active substance:

Acigerpin;
Acyclovir Belupo;
Acyclovir HEXAL;
Acyclovir Sandoz;
Acyclovir forte;
Acyclovir-AKOS;
Acyclovir-Acri;
Acyclovir-Ferein;
Acyclostad;
Vero-Acyclovir;
Vivorax;
Virolex;
Gervirax;
Gerpevir;
Herperax;
Herpesin;
Zovirax;
Lisavir;
Medovir;
Provirsan;
Supraviran;
Cyclovax;
Cyclovir;
Citivir.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

Active ingredient

Aciclovir

Release form, composition and packaging

10 pcs. - contour cell packaging (2) - cardboard packs.

Pharmacological action

The antiviral drug is a synthetic analogue of an acyclic purine nucleoside, which has a highly selective effect on herpes viruses. In virus-infected cells, under the influence of viral thymidine kinase, phosphorylation and further sequential transformation into mono-, di- and triphosphate occur. Acyclovir triphosphate is incorporated into the viral DNA chain and blocks its synthesis through competitive inhibition of viral DNA polymerase.

In vitro, acyclovir is effective against the herpes simplex virus - Herpes simplex types 1 and 2; against the Varicella zoster virus, which causes chickenpox and; higher concentrations are required to inhibit Epstein-Barr virus. Moderately active against cytomegalovirus.

In vivo, acyclovir is therapeutically and prophylactically effective, primarily against viral infections caused by the Herpes simplex virus types 1 and 2. Prevents the formation of new rash elements, reduces the likelihood of skin dissemination and visceral complications, accelerates the formation of crusts, and reduces pain in the acute phase of herpes zoster.

Pharmacokinetics

After oral administration, the bioavailability is 15-30%, creating dose-dependent concentrations sufficient for the effective treatment of viral diseases. Food does not have a significant effect on the absorption of acyclovir. Acyclovir penetrates well into many organs, tissues and body fluids. Protein binding is 9-33% and is independent of its plasma concentration. The concentration in the cerebrospinal fluid is about 50% of its concentration in plasma. Acyclovir penetrates the blood-brain and placental barriers and accumulates in breast milk. After oral administration of 1 g/day, the concentration of acyclovir in breast milk is 60-410% of its concentration in plasma (acyclovir enters the baby’s body with mother’s milk at a dose of 0.3 mg/kg/day).

C max of the drug in blood plasma after oral administration of 200 mg 5 times a day is 0.7 μg/ml, C min is 0.4 μg/ml; time to reach C max in plasma is 1.5-2 hours. Metabolized in the liver to form the pharmacologically inactive compound 9-carboxymethoxymethylguanine. It is excreted by the kidneys by glomerular filtration and tubular secretion: about 84% is excreted by the kidneys unchanged, 14% in the form of a metabolite. The renal clearance of acyclovir is 75-80% of the total plasma clearance. T1/2 in adults with normal renal function is 2-3 hours. In patients with severe T1/2 - 20 hours, with hemodialysis - 5.7 hours, in this case, the concentration of acyclovir in plasma decreases to 60% of the initial value. Less than 2% of acyclovir is excreted from the body through the intestines.

Indications

- treatment of infections of the skin and mucous membranes caused by Herpes simplex viruses types 1 and 2, both primary and secondary, including;

- prevention of exacerbations of recurrent infections caused by Herpes simplex types 1 and 2 in patients with normal immune status;

- prevention of primary and recurrent infections caused by Herpes simplex viruses types 1 and 2 in patients with immunodeficiency;

— as part of complex therapy for patients with severe immunodeficiency: with HIV infection (stage AIDS, early clinical manifestations and detailed clinical picture) and in patients who have undergone bone marrow transplantation;

- treatment of primary and recurrent infections caused by the Varicella zoster virus (chickenpox, as well as herpes zoster).

Contraindications

- lactation period;

- children under 3 years of age (for this dosage form).

WITH caution: pregnancy; elderly people and patients taking large doses of acyclovir, especially against the background of dehydration; renal dysfunction; neurological disorders or neurological reactions to taking cytotoxic drugs (including in history).

Dosage

Acyclovir is taken during or immediately after a meal and washed down with plenty of water. The dosage regimen is set individually depending on the severity of the disease.

Treatment of skin and mucous membrane infections caused by Herpes simplex types 1 and 2

Adults

Treatment should begin as soon as possible after infection occurs; for relapses, acyclovir is prescribed in the prodromal period or when the first elements of the rash appear.

Prevention of recurrence of infections caused by Herpes simplex types 1 and 2 at patients with normal immune status

The recommended dose is 200 mg 4 times/day (every 6 hours) or 400 mg 2 times/day (every 12 hours). In some cases, lower doses are effective - 200 mg 3 times a day (every 8 hours) or 2 times a day (every 12 hours).

Prevention of infections caused by Herpes simplex types 1 and 2, y patients with immunodeficiency.

Treatment infections caused by the Varicella zoster virus (chickenpox)

Adults

Prescribe 800 mg 5 times a day every 4 hours during the day and at 8-hour intervals at night. The duration of treatment is 7-10 days.

Children

Prescribed 20 mg/kg 4 times/day for 5 days (maximum single dose 800 mg), children from 3 to 6 years old: 400 mg 4 times/day, over 6 years old: 800 mg 4 times/day for 5 days.

Treatment should begin at the earliest signs or symptoms of chickenpox.

Treatment of infections caused by the Herpes zoster virus (shingles)

Adults

Prescribe 800 mg 4 times a day every 6 hours for 5 days. Children over 3 years of age the drug is prescribed in the same dose as for adults.

Treatment and prevention of infections caused by Herpes simplex types 1 and 2, pediatric patients with immunodeficiency and normal immune status.

Children from 3 years to 6 years- 400 mg times/day; over 6 years old- 800 mg 4 times/day. A more accurate dose is determined at the rate of 20 mg/kg body weight, but not more than 800 mg times/day. The course of treatment is 5 days. There are no data on the prevention of recurrence of infections caused by the herpes simplex virus and the treatment of herpes zoster in children with normal immunity.

For treatment children over 3 years old prescribe 800 mg of acyclovir 4 times a day every 6 hours (as for treatment adults with immunodeficiency).

IN old age there is a decrease in the clearance of acyclovir in the body in parallel with a decrease in creatinine clearance. Those taking large doses of the drug orally should receive sufficient fluids. In case of renal failure, it is necessary to decide on reducing the dose of the drug.

Caution must be exercised when prescribing acyclovir patients with renal failure. In such patients, taking the drug orally in recommended doses for the treatment and prevention of infections caused by the herpes simplex virus does not lead to the accumulation of the drug to concentrations exceeding established safe levels. However,

At , as well as during treatment

—

Side effects

The drug is usually well tolerated.

The following classification of adverse reactions was used depending on the frequency of occurrence: very often (>1/10), often (>1/10,<1/100), иногда (>1/1000, <1/100), редко (>1/10 000, <1/1000), очень редко (<1/10 000).

From the digestive system: often - nausea, vomiting, diarrhea; very rarely - hepatitis, jaundice, in isolated cases - abdominal pain.

From the hematopoietic system: rarely - a transient slight increase in the activity of liver enzymes, a slight increase in the concentration of urea and creatinine, hyperbilirubinemia; very rarely - leukopenia, erythropenia, anemia, thrombocytopenia.

From the side of the central nervous system: often - dizziness; very rarely - agitation, confusion, tremor, ataxia, dysarthria, hallucinations, psychotic symptoms, convulsions, drowsiness, encephalopathy, coma.

Typically, these side effects were observed in patients with renal failure or in the presence of other precipitating factors, and were mainly reversible.

From the respiratory system: rarely - shortness of breath.

Allergic reactions: anaphylactic reactions, skin rash, itching, urticaria, Lyell's syndrome, Stevens-Johnson syndrome.

From the skin and subcutaneous tissue: often - itching, urticaria, rash, including sensitization, rarely - alopecia, rapid diffuse hair loss (since this type of alopecia is observed in various diseases and during therapy with many drugs, its connection with taking acyclovir has not been established); very rarely Lyell's syndrome, Stevens-Johnson syndrome.

Others: often - fatigue, fever; rarely - peripheral edema, blurred vision, lymphadenopathy, myalgia, malaise.

Overdose

There have been no reported cases of overdose with oral administration of acyclovir. Ingestion of 20 g of acyclovir has been reported. Symptoms: agitation, coma, convulsions, lethargy. Precipitation of acyclovir in the renal tubules is possible if its concentration exceeds the solubility in the renal tubules (2.5 mg/ml).

Treatment: symptomatic.

Drug interactions

Simultaneous use with probenecid leads to an increase in the average half-life and a decrease in the clearance of acyclovir.

An increase in the effect of acyclovir is observed with the simultaneous administration of immunostimulants.

When taken simultaneously with nephrotoxic drugs, the risk of developing renal dysfunction increases.

Special instructions

Acyclovir is used strictly as prescribed by a doctor to avoid complications in adults and children over 3 years of age.

Long-term or repeated treatment with acyclovir in patients with reduced immunity can lead to the emergence of strains of viruses that are insensitive to its action. Most identified virus strains that are insensitive to acyclovir show a relative lack of viral thymidine kinase; strains with altered thymidine kinase or with altered DNA polymerase were isolated. In vitro, the effect of acyclovir on isolated strains of the Herpes simplex virus may cause the emergence of less sensitive strains.

The drug is prescribed with caution to patients with impaired renal function and elderly patients due to an increase in the half-life of acyclovir.

When using the drug, it is necessary to ensure the supply of a sufficient amount of fluid.

Impact on the ability to drive vehicles and operate machinery

Patients with renal failure. In such patients, taking the drug orally in recommended doses for the treatment and prevention of infections caused by the herpes simplex virus does not lead to the accumulation of the drug to concentrations exceeding established safe levels. However, patients with severe renal failure (creatinine clearance less than 10 ml/min) the dose of acyclovir should be reduced to 200 mg 2 times a day at 12-hour intervals.

At treatment of infections caused by the Varicella zoster virus, Herpes zoster, as well as during treatment patients with severe immunodeficiency recommended doses are:

— end-stage renal failure (creatinine clearance less than 10 ml/min)- 800 mg 2 times a day every 12 hours;

—severe renal failure (creatinine clearance 10-25 ml/min)- 800 mg 3 times/day every 8 hours.

Use in old age

IN old age There is a decrease in the clearance of acyclovir in the body in parallel with a decrease in creatinine clearance. Those taking large doses of the drug orally should receive sufficient fluids. In case of renal failure, it is necessary to decide on reducing the dose of the drug.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

Store the drug in a dry place, protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children. Shelf life - 2 years. Do not use after expiration date.