Acyclovir (When ATH D06BB03)

When ATH:
D06BB03

Characteristic.

Acyclovir - a white crystalline powder, maximum solubility in water (at 37 °C) 2,5 mg / ml, molecular weight 225,21. Acyclovir natrievaya soly - maksimalynaya solubility in water (at 25 °C) more than 100 mg / ml, molecular weight 247,19; prepared solution of (50 mg / ml) It has a pH of about 11.

Pharmacological action.
Antiviral, antiherpetic.

Application.

For systemic use: primary and recurrent infections of the skin and mucous membranes, HSV (type 1 and 2), including genital herpes, herpetic lesions in patients with immunodeficiency (Treatment and Prevention); shingles, enable vetryanaya.

For outdoor use: herpes simplex skin and mucous membranes, genital herpes (primary and recurrent); Localized shingles (auxiliary treatment).

For topical use in ophthalmology: herpetic keratitis.

Contraindications.

Hypersensitivity to acyclovir or valacyclovir.

Restrictions apply.

The on / in the introduction: degidratatsiya, renal failure (the risk of nephrotoxicity), neurological disorders or neurological reactions to cytotoxic drugs reception, incl. history.

If ingestion: degidratatsiya, renal failure.

Pregnancy and breast-feeding.

Pregnancy. Maybe, if the effect of therapy outweighs the potential risk to the fetus (adequate and well-controlled studies of the safety of use in pregnant women were not conducted). Acyclovir toddler cherez platsentu. Data on the outcome of pregnancy in women, taking acyclovir for systemic effects in the I trimester of pregnancy, showed no increase in the number of birth defects compared to the general population. As the observation was included a small number of women, reliable and definitive conclusions about the safety of acyclovir in pregnancy can not be done.

Lactation. Acyclovir passes into breast milk. Upon receiving acyclovir into, it was determined in human milk in concentrations, the ratio of which to the blood plasma concentration was 0.6-1.4. At such concentrations in breast milk children, are breastfed, may receive a dose of acyclovir 0,3 mg / kg / day. Considering this, Acyclovir should be administered with caution lactating women, only if necessary.

Side effects.

When administered systemically:

From the digestive tract: at / in the introduction - Anorexia, nausea and / or vomiting; ingestion - Nausea and / or vomiting, diarrhea, abdominal pain.

From the nervous system: at / in the introduction - Dizziness, signs of encephalopathy (confusion, hallucinations, convulsions, tremor, coma), delirium, depression or psychosis (neurological disorders are commonly observed in patients with predisposing conditions); ingestion - Malaise, headache, dizziness, ažitaciâ, drowsiness.

Cardio-vascular system and blood: at / in the introduction - Anemia, neutropenia / neutrophilia, Thrombocytopenia / thrombocytosis, leukocytosis, hematuria, DIC, gemoliz, decrease in blood pressure.

With the genitourinary system: at / in the introduction - Transient increase in blood urea nitrogen and creatinine levels in blood serum (It related to the value C_max in a plasma state and the water balance of the patient), acute renal failure (often with fast I / injection).

Other: anaphylactic reactions, allergic skin reactions (itch, rash, Lyell's syndrome, hives, erythema multiforme and others.), blurred vision, fever, leukopenia, lymphadenopathy, peripheral edema, transient increase in liver transaminases and bilirubin; at / in the introduction - Reaction at the site / in the: phlebitis or local inflammation (pain, swelling or redness), necrosis (in contact with the drug under the skin); ingestion - Myalgia, paraesthesia, alopecia.

When applied topically: soreness, burning, itch, skin rash, vulvyt.

When applying eye ointment: burning at the site of application, .Aloe, conjunctivitis, superficial punctate keratopathy.

Cooperation.

Other nephrotoxic drugs increase the risk of nephrotoxicity. In an application with probenecid (blocks tubular secretion) increasing T_1/2 and AUC of acyclovir, reduced renal clearance and slows down, may increase the toxic effect.

Overdose.

Symptoms: headache, neurological disorders, breathlessness, nausea, vomiting, diarrhea, renal failure, lethargy, convulsions, coma.

Treatment: simptomaticheskaya therapy, maintaining vital functions, adequate hydration, hemodialysis (especially in acute renal insufficiency and anuria).

There is no data on overdose when applied topically.

Dosing and Administration.

B / drip, inside, locally. The batch is individually, depending on the indication and the severity of the process. The dosage for children is calculated based on the evidence, age, surface area / body weight. Treatment should begin as soon as possible, at the first signs and symptoms of the disease.

B / drip (administered at a constant rate at least 1 no): when herpes infection, severe herpetic lesions of genital and shingles adults - 5 mg / kg 3 once a day (every 8 no) 5 days; patients with impaired immune systems, in herpetic encephalitis - for 10 mg / kg every 8 h for 10 days. The maximum dose for adults with / in the introduction - 30 mg / kg or 1,5 g / m²/d.

Inside: adults - 0,2 g 5 once a day (excluding night) within 5-10 days. When chicken pox and shingles - on 0,8 g 5 once a day for 7 days.

In the systemic application in the elderly may require adjustments in dosage or the interval between doses, in patients with impaired renal excretory function, reduce the dose based on creatinine clearance.

Outwardly: a cream or ointment is applied to the skin surface 5 once a day for 5-10 days.

Eye ointment: adults and children long strip of ointment 10 mm lay in the lower conjunctival sac 5 once a day (every 4 no) 7-10 days (Treatment should continue for at least 3 days after the full treatment).

Precautions.

In the treatment of acyclovir recommend taking plenty of fluids (to prevent the precipitation of acyclovir in renal tubules).

Caution must be exercised on / in patients with neurological disorders, impaired liver function, electrolyte imbalance, severe hypoxia, as well as with impaired renal function (and with the appointment of the interior). To reduce the risk of kidney damage with a / in the introduction of the drug should be administered slowly, during 1 no. When symptoms of nephropathy drug overturned.

Toxic effect of acyclovir on the CNS are more likely in patients with impaired immunity, in elderly patients, when using high doses of.

When acyclovir therapy in clinical practice and recorded thrombocytopenic purpura / hemolytic uremic syndrome, or, in rare cases with fatal outcome, in patients with symptomatic forms of HIV infection.

Not recommended for use in children for the treatment of chicken pox, if the disease is mild.

In the treatment of eye ointment should not wear contact lenses.

Cooperation