Description and indication for use
Aciclovir is an anti-viral agent which is active in-vitro against Herpes Simplex virus (HSV) types 1 and 2 and Varicella Zoster virus (VZV) with Central Nervous System (CNS) and pulmonary involvement.
Intravenous (IV):
Term neonate 20 milligrams (mg)/kilogram (kg)/dose 8 hourly1
| Preterm neonate 20 mg/kg/dose1-3 |
|
| CA
< 30 weeks |
24 hourly2,3
|
| CA 30-32 weeks |
10 hourly2,3
|
| CA > 32 weeks |
12 hourly2 |
Dosage and/or interval may require adjustment in the case of renal impairment.
For HSV infection of the skin, eye or mouth, treat for a minimum of 14 days.
For disseminated or CNS disease, treat for 21 days.2
Reconstitution/Dilution
Preparations:
Injection (Inj.):
250 mg/10 millilitre (mL) (Reconstituted Solution).
250 mg (Powder for Reconstitution).
For IV use: if using
powder for reconstitution
Reconstitute vial with 10 mL water for injection = 25 mg/mL.
Withdraw 5 mL of 25 mg/mL solution from vial and add to 20 mL of sodium chloride 0.9% in a 20 mL syringe = 125 mg in 25 mL = 5 mg/mL.
Withdraw required dose (exact dose) using a 10 mL syringe.
Reconstituted vial is stable for 12 hours in fridge.4
Refrigeration may cause crystallisation. Dissolve by warming to room temperature.
Inspect carefully prior to administration.4
Not for intramuscular (IM) or
subcutaneous (SC) use.4
Route and method of administration
Prime minimum volume extension set with exact dose of Aciclovir (5 mg/mL).
IV:
**Also draw up 3 mL of sodium chloride 0.9% in a 10 mL syringe for a flush.
Following infusion of Aciclovir, infuse 2 mL of sodium chloride 0.9%, via the syringe pump, at the same rate as the Aciclovir to flush the line (Set volume limit of 2 mL on the infusion pump).
Following completion of the Aciclovir and flush, disconnect and discard the syringe and line used for the infusion.
Side effects 5
Local inflammation and phlebitis at IV administration site.
Transient renal dysfunction and crystalluria (reduced by slow infusion rate and adequate hydration).
Hypersensitivity and skin rashes.
Special precautions
Contraindications5
Known hypersensitivity to Acyclovir.
Serious renal, hepatic or electrolyte imbalance.
Hypoxia.
Compatible solutions6-8
Glucose 5%.
Sodium chloride 0.9% and 0.45%.
Glucose/sodium chloride solutions.
Only Aciclovir diluted to 5 mg/mL or weaker is compatible with KCL 20 mmol/L.
Compatible drugs
The following medications are compatible via Y-site administration:
| Cephazolin |
Fluconazole |
Metronidazole |
| Cefotaxime |
Gentamicin |
Ranitidine |
| Ceftriaxone |
Heparin (max. concentration 50 units/mL) |
Vancomycin |
| Dexamethasone |
Hydrocortisone |
|
Incompatibilities
Aciclovir may not be mixed together with the following drugs:
Dobutamine, Dopamine, Morphine, Pantoprazole, Total Parenteral Nutrition (TPN).
Drug interactions
| Aminoglycosides (gentamicin, amikacin etc.) and vancomycin |
Can potentiate nephrotoxicity of aciclovir |
Nursing responsibilities
Observe/measure urine output in case of renal damage. Infant must be well hydrated during course of treatment.
Monitor IV site for phlebitis.
References
1. The Royal Children’s Hospital (RCH), Paediatric Pharmacopoeia, 13th ed. 2002.
2. The Royal Women’s Hospital (RWH), Neonatal Pharmacopoeia, 2nd ed. 2005.
3. Frank Shann, Drug Doses, 15th ed. 2010.
4. RCH Paediatric Injectable Guidelines, 4th ed. 2011 (
http://ww2.rch.org.au/pharmacy/intranet/PIG.pdf - accessed 03/10/2013).
5. Mayne Pharma Limited, Aciclovir Intravenous Infusion (DBL). Manufacturer’s Product Information 08/01/04.
6. Australian Injectables Handbook, The Society of Hospital Pharmacists, Australia (SHPA), 5th ed. 2011.
7. Lawrence Trissel, Handbook on Injectable Drugs, 17th ed. 2013.
8. James King, Guide To Parenteral Admixtures, Issued 2013 (quarterly update).