Acyclovir (Aciclovir)

The US label for acyclovir tablets lists the acute treatment of herpes zoster, also called shingles.

It is used for first episodes and for managing repeat episodes of genital herpes.

It is also used for chickenpox (varicella).

The label says treatment should start as early as possible, and no data exist for starting zoster treatment more than 72 hours after the rash begins.

• Shingles (herpes zoster)
• Genital herpes, initial and recurrent
• Chickenpox

Acyclovir is a purine nucleoside analogue active against herpes simplex viruses 1 and 2 and varicella-zoster virus.

A viral enzyme converts it into its active form, which stops herpes viral DNA from copying itself.

For shingles, the US label gives 800 mg every 4 hours, 5 times daily, for 7 to 10 days.

For first genital herpes, it gives 200 mg every 4 hours, 5 times daily, for 10 days. Long-term suppression is described as 400 mg twice daily for up to 12 months, then reviewed.

For chickenpox, adults and children over 40 kg: 800 mg four times daily for 5 days. Younger children use a weight-based dose from the label.

Doses need adjusting in kidney impairment. Keep well hydrated.

Indian pack labels may differ from the US label, and your prescriber's instruction always comes first.

Kidney failure, in some cases fatal, has been observed. Keep well hydrated and use caution with other medicines that harm the kidney.

TTP/HUS has caused deaths in immunocompromised patients.

It is contraindicated if you are allergic to acyclovir or valacyclovir.

The label says acyclovir is not a cure for genital herpes and that no data show it prevents spread to others.

Pregnancy: a registry of first-trimester exposure did not show a pattern of birth defects, but no adequate studies exist. Discuss with your doctor.

Breastfeeding: acyclovir is present in breast milk. Use with caution and only when indicated.

Children: safety is not established in children under 2 years.

Older adults: blood levels are higher because of age-related kidney changes. Dose may need reducing.

• Probenecid
• Other nephrotoxic medicines
• Probenecid raises acyclovir levels and slows its clearance by the kidneys.
• The label describes this with intravenous acyclovir.
• Take care with other medicines that can harm the kidneys, as the risk of kidney or brain effects may rise.

No match in this label text. Ask your pharmacist about any medicine you take.

Overdoses of up to 20 g have been reported. Effects include agitation, coma, seizures and lethargy.

Kidney failure can follow, and haemodialysis may help. Seek emergency help.

The label says to store tablets at 20 to 25 degrees C and protect them from moisture.

Acyclovir is listed in the Drugs Rules 1945 Schedules we checked (Schedule H, serial 9 (rules 65 and 97)).

A Schedule H medicine is sold only against a prescription.

Acyclovir is on the National List of Essential Medicines 2022 in these forms: Tablet 200 mg (page 75); Tablet 400 mg (page 75); Tablet 800 mg (page 75); Powder for Injection 250 mg Powder for (page 75); Injection 500 mg (page 75); Oral liquid 400 mg/5 mL (p) (page 75); Injection 250 mg (page 77); Ointment 3% (page 99).

NPPA ceiling prices exist for scheduled formulations of acyclovir. They are in the table below.

The Jan Aushadhi (PMBJP) list we checked has 2 product rows for acyclovir.

We found no entry for a banned fixed-dose combination that mentions acyclovir in the list we checked.

The NPPA ceiling is the highest price per unit for a scheduled formulation, in the list dated 30.09.2020.

The prices below are per unit. Check the pack and seller, because prices can be revised after that date.

Jan Aushadhi lists the acyclovir products below. We did not capture a price for them, so check the store or the official list.

• Ointment 3%, per 1 gm: ceiling INR 10.38
• Oral Liquid 400 mg/5ml, per 1 ml: ceiling INR 1.26
• Tablet 200 mg, per 1 tablet: ceiling INR 6.75
• Tablet 400 mg, per 1 tablet: ceiling INR 12.27
• Powder for Injection 250 mg, per each pack: ceiling INR 354.27
• Powder for Injection 500 mg, per each pack: ceiling INR 457.58
• Jan Aushadhi: Acyclovir Eye Ointment IP 3% W/W, pack 5 gm (row p23:sno507)
• Jan Aushadhi: Acyclovir Dispersible Tablets IP 200 mg, pack 5's (row p86:sno1868)