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Pharmacy and Medications

Maximum Dose of Acyclovir

02/24/2011

Question:

I wonder what the maximum dose of acyclovir is because I notice that many doctors prescrib this medicine for supressive therapy and the patient need to take this medicine everyday up to a year. Is this not too much and can this repeat many years?

Answer:

The general recommendation for chronic suppression therapy using Acyclovir is 400mg twice daily or 200mg three to five times daily for up to 12 months, followed by reevaluation by the prescribing doctor. Some clinicians have also used 1200mg per day in two to three divided doses. Higher doses and longer durations of therapy have generally been used in patients who are immunocompromised, such as organ transplant patients or HIV positive patients. One study conducted in 1993 evaluated the use of Acyclovir for suppressing genital herpes simplex virus for duration of up to 5 years. The dose used in this study was 400mg twice daily. The study showed a decrease in reoccurrence of outbreaks. However, the authors state that the effect could be related to the medication or the decrease in viral burden over time. The main side effects seen with long term acyclovir use include nausea, diarrhea, headache, and rash. These side effects were generally seen within the first year of treatment, but the rates of occurrence continued to decrease over time. Work with your doctor to devise a treatment plan that is best for you.

This response was prepared by Joseph Dunigan, a PharmD candidate at the University of Cincinnati College of Pharmacy.
The general recommendation for chronic suppression therapy using Acyclovir is 400mg twice daily or 200mg three to five times daily for up to 12 months, followed by reevaluation by the prescribing doctor.  Some clinicians have also used 1200mg per day in two to three divided doses.  Higher doses and longer durations of therapy have generally been used in patients who are immunocompromised, such as organ transplant patients or HIV positive patients.  One study conducted in 1993 evaluated the use of Acyclovir for suppressing genital herpes simplex virus for duration of up to 5 years.  The dose used in this study was 400mg twice daily.  The study showed a decrease in reoccurrence of outbreaks. However, the authors state that the effect could be related to the medication or the decrease in viral burden over time.  The main side effects seen with long term acyclovir use include nausea, diarrhea, headache, and rash.  These side effects were generally seen within the first year of treatment, but the rates of occurrence continued to decrease over time.  Work with your doctor to devise a treatment plan that is best for you.   

This response was prepared by Joseph Dunigan, a PharmD candidate at the University of Cincinnati College of Phamracy. 

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati