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- Brand: Aristopharma
- Product ID: Acyclovir
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Acyvir 250mg IV Infusion — Acyclovir
Generic Name: Acyclovir 250mg (for IV Infusion)
Manufacturer: Beximco Pharmaceuticals Ltd.
Drug Class: Antiviral — Nucleoside Analogue
Dosage Form: Powder/Concentrate for IV Infusion
Prescription Status: Prescription Only (Rx) — Hospital/Specialist Use
Mechanism of Action
Acyclovir is a synthetic nucleoside analogue of guanosine that selectively inhibits herpes virus replication. It is activated by viral thymidine kinase (TK) — present only in virus-infected cells — to acyclovir monophosphate, then further phosphorylated by cellular kinases to acyclovir triphosphate. This active form inhibits viral DNA polymerase and is incorporated into viral DNA, causing chain termination. Because activation requires viral TK, acyclovir has a highly selective antiviral action with minimal toxicity to uninfected host cells.
Relevance to diabetes: Patients with diabetes are at significantly higher risk of severe herpes zoster (shingles), herpes simplex encephalitis, and disseminated HSV infections due to impaired cellular immunity. IV acyclovir provides rapid systemic antiviral concentrations essential for treating severe or life-threatening herpetic infections.
Indications (IV Formulation)
- Herpes simplex encephalitis (HSE) — most critical indication
- Severe herpes zoster (shingles) — including ophthalmic zoster and disseminated disease
- Herpes simplex in immunocompromised patients (including diabetic patients with poor immune function)
- Neonatal herpes simplex
- Varicella (chickenpox) in immunocompromised or high-risk patients
- HSV infections where oral therapy is not possible or adequate
Dosage and Administration
| Indication | Adult Dose | Duration |
|---|---|---|
| Herpes simplex encephalitis | 10mg/kg IV every 8 hours | 14–21 days |
| Severe herpes zoster / immunocompromised HSV | 5–10mg/kg IV every 8 hours | 7–10 days |
| Varicella (immunocompromised) | 10mg/kg IV every 8 hours | 7 days |
| Renal impairment (eGFR 25–50) | Dose every 12 hours | As clinically indicated |
| Renal impairment (eGFR 10–25) | Dose every 24 hours | — |
Administration: Dilute in 0.9% sodium chloride or 5% glucose to a concentration not exceeding 5mg/ml. Infuse slowly over at least 1 hour. Ensure adequate hydration throughout treatment — adequate urinary output must be maintained to prevent renal crystalluria.
Special Considerations in Diabetes
- Diabetic patients have higher risk of severe herpetic infections — early aggressive IV treatment is essential
- Diabetic nephropathy: renal dose adjustment critical — monitor creatinine and urine output closely
- Acyclovir can cause nephrotoxicity (crystalluria) if not adequately hydrated — especially important in patients with pre-existing renal impairment
- Glucose content in IV diluent may affect blood glucose — use 0.9% NaCl where possible and monitor blood glucose during infusion
- Herpes zoster increases risk of post-herpetic neuralgia — early IV treatment reduces this complication
Contraindications
- Hypersensitivity to acyclovir or valacyclovir
- Do not administer as bolus injection — infuse slowly over at least 1 hour
Drug Interactions
| Drug / Class | Effect |
|---|---|
| Probenecid / Cimetidine | Reduce acyclovir renal clearance — increased acyclovir levels |
| Nephrotoxic agents (NSAIDs, aminoglycosides, amphotericin B) | Additive nephrotoxicity — monitor renal function closely |
| Mycophenolate mofetil | Both compete for tubular secretion — increased levels of both |
| Zidovudine | Possible increased neurotoxicity |
Side Effects
| System | Side Effects |
|---|---|
| Renal | Crystalluria, elevated creatinine, acute kidney injury (if dehydrated or rapid infusion) |
| Neurological | Encephalopathy, tremor, confusion (rare; more common in renal impairment) |
| Local (IV site) | Phlebitis, pain, inflammation if extravasation occurs |
| GI | Nausea, vomiting |
| Haematological | Anaemia, leucopenia (uncommon) |
Storage
Store below 25°C. Protect from light. After reconstitution use within 12 hours. Do not refrigerate the reconstituted solution.
Medical Disclaimer
The information provided here is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Acyvir 250mg IV Infusion must only be administered under the supervision of a qualified physician in a clinical setting. Ensure adequate hydration during therapy. DiabetesStore.com.bd does not endorse self-medication.
