Composition, indications and contraindications
Cream and ointment for topical use containing the active ingredient acyclovir. Additional ingredients are presented:
- poloxamer 407;
- cetostearyl alcohol;
- sodium lauryl sulfate;
- white soft and liquid paraffin;
- dimethicone 20;
- propylene glycol;
- purified water;
- arlacelom 165.
The white or almost white mass has no lumps, grains, impurities of foreign substances or signs of separation.
The drug is used to treat infectious lesions of the face and lips caused by recurrent labial herpes. If you have a weakened immune system, the medicine is not prescribed; a doctor is consulted before therapy.
The medication is contraindicated in patients with registered allergies:
- to acyclovir;
- valacyclovir;
- propylene glycol;
- any excipient included in the ointment.
Before starting procedures, it is necessary to conduct a test for the development of a spontaneous allergic reaction. A small amount of the drug is applied to the inner surface of the elbow. If after 20 minutes there is no redness, blistering or itching on the skin, then the cream can be applied.
Adverse reactions
When taking tablets or injecting Zovirax, unusual body responses may occur. The list of common deviations includes:
- attacks of nausea, vomiting, diarrhea, pain in the abdominal area;
- anemic conditions, decreased levels of leukocytes and platelets;
- dermatological rashes, obsessive itching, fever;
- shortness of breath, nettle rash;
- increased sensitivity to ultraviolet radiation;
- inflammation at the point of injection of the solution;
- anaphylactic shock and Quincke's edema;
- increased concentration of urea and creatinine in the blood;
- renal failure;
- increased levels of bilirubin and liver enzymes;
- symptoms of jaundice or hepatitis.
The reception can also affect the nervous system, manifesting itself:
- confusion, psychosis;
- tremor, nervous excitement;
- drowsiness, hallucinations;
- attacks of headache or coma.
During treatment, active hair loss and increased fatigue were recorded.
Eye ointment therapy came with its own list of side effects:
- allergic reactions, up to Quincke's edema;
- burning sensation in the area of application;
- symptoms of blepharitis, conjunctivitis;
- punctate keratopathy - signs go away on their own and do not require changes in the treatment regimen.
The use of the cream provokes temporary reactions: burning sensation, obsessive itching, tingling, peeling of the skin. May cause the development of angioedema or dermatitis.
Dosages and methods of application
The medicine is used only externally:
- Adult patients - applied every 4 hours, up to 5 times a day. Treatment should be carried out with the first appearance of symptoms of the pathology, with redness of the skin. Therapy is also allowed if papules and vesicles appear on the dermis. The duration cannot exceed 4 days; in difficult cases, an increase to 10 days is allowed.
- Children - the lack of comprehensive research does not allow use by minors under 12 years of age. Therapeutic manipulations are carried out according to a standard algorithm.
To prevent transmission of infection, the patient should wash their hands with soap before applying the ointment and after treatment. Patients with renal or hepatic insufficiency do not require special dosage adjustments - the drug has insignificant systemic absorption.
Use for pregnant women is justified if the benefit to the mother exceeds the potential risk to the fetus. Studies have shown that taking acyclovir in different dosage forms did not cause congenital anomalies in children.
Restrictions on therapy are indicated only for nursing women, when using systemic agents with an active component. The choice of medication is decided by the doctor. Self-medication during pregnancy and breastfeeding is unacceptable due to the risk of allergic reactions to any medications, even previously used ones.
Zovirax, 5 pcs., 250 mg, lyophilisate for solution for infusion
Inside
during meals, with a full glass of water.
For adults
Treatment of infections caused by the herpes simplex virus:
The recommended dose of Zovirax is 200 mg 5 times a day every 4 hours, with the exception of the period of night sleep. Usually the course of treatment is 5 days, but can be extended for severe primary infections.
In case of severe immunodeficiency (for example, after bone marrow transplantation) or in case of impaired absorption from the intestine, the oral dose of Zovirax can be increased to 400 mg 5 times a day. Treatment should begin as soon as possible after infection occurs; in case of relapses, it is recommended to prescribe the drug already in the prodromal period or when the first elements of the rash appear.
Prevention of recurrence of infections caused by the herpes simplex virus.
In patients with normal immune status, the recommended dose of Zovirax is 200 mg 4 times a day (every 6 hours). For many patients, a more convenient treatment regimen is suitable - 400 mg 2 times a day (every 12 hours). In some cases, lower doses of Zovirax are effective - 200 mg 3 times a day (every 8 hours) or 2 times a day (every 12 hours). In some patients, interruption of the infection may occur when taking a total daily dose of 800 mg.
Treatment with Zovirax should be periodically interrupted for 6–12 months to identify possible changes in the course of the disease.
Prevention of infections caused by the herpes simplex virus
. In patients with immunodeficiency, the recommended dose of Zovirax is 200 mg 4 times a day (every 6 hours). In case of severe immunodeficiency (for example, after bone marrow transplantation) or in case of impaired absorption from the intestine, the oral dose of Zovirax can be increased to 400 mg 5 times a day. The duration of the preventive course of therapy is determined by the length of the period when there is a risk of infection.
Treatment of chickenpox and herpes zoster:
The recommended dose of Zovirax is 800 mg 5 times a day; The drug is taken every 4 hours, with the exception of the period of night sleep. The course of treatment is 7 days. The drug should be prescribed as soon as possible after the onset of infection, because in this case, treatment is more effective.
Treatment of patients with severe immunodeficiency:
The recommended dose of Zovirax is 800 mg 4 times a day (every 6 hours). For patients who have undergone a bone marrow transplant, it is usually recommended to undergo a course of IV therapy with Zovirax for 1 month before prescribing Zovirax for oral administration. In clinical studies, the maximum duration of treatment for bone marrow transplant recipients was 6 months (from the 1st to the 7th month after transplantation). In patients with an advanced clinical picture of HIV infection, the course of treatment with Zovirax was 12 months, but there is reason to believe that longer courses of therapy may be effective in such patients.
For children
Treatment and prevention of infections caused by the herpes simplex virus in children with immunodeficiency:
from 2 years and older - the same doses as for adults;
under 2 years of age - half the dose for adults.
Treatment of chickenpox:
over 6 years old - 800 mg 4 times a day;
from 2 to 6 years - 400 mg 4 times a day;
under 2 years - 200 mg 4 times a day.
More precisely, the dose can be determined at the rate of 20 mg/kg body weight (but not more than 800 mg) 4 times a day. The course of treatment is 5 days.
There are no data on the prevention of recurrence of infections caused by the herpes simplex virus and on the treatment of herpes zoster in children with normal immunity. According to the very limited information available, the same doses of Zovirax can be used to treat children over 2 years of age with severe immunodeficiency as for the treatment of adults.
Elderly patients.
In old age, there is a decrease in the clearance of acyclovir in the body in parallel with a decrease in creatinine clearance.
Elderly patients should receive a sufficient amount of fluid while taking high doses of Zovirax orally; if they have renal failure, it is necessary to consider reducing the dose of Zovirax.
Patients with renal failure.
In patients with renal failure, oral administration of acyclovir at recommended doses for the treatment and prevention of infections caused by the herpes simplex virus does not lead to accumulation of the drug to concentrations exceeding established safe levels. However, in patients with severe renal failure (Cl creatinine <10 ml/min), the dose of Zovirax is recommended to be reduced to 200 mg 2 times a day (every 12 hours).
When treating chickenpox, herpes zoster, as well as when treating patients with severe immunodeficiency, the recommended doses of Zovirax are:
severe renal failure (Cl creatinine <10 ml/min): 800 mg 2 times a day every 12 hours;
moderate renal failure (Cl creatinine 10–25 ml/min) 800 mg 3 times a day every 8 hours.
IV, adults
. In obese patients, dosages are recommended as in adults with normal body weight.
Treatment of infections caused by HSV (except herpetic encephalitis) and FOG
— IV infusion at a dose of 5 mg/kg every 8 hours.
Treatment of FOG infections and herpetic encephalitis in immunocompromised patients
- IV infusion at a dose of 10 mg/kg every 8 hours with normal renal function.
Prevention of CMV infection during bone marrow transplantation
— IV 500 mg/m2 3 times a day with an interval of 8 hours. Duration of treatment from 5 days before transplantation and up to 30 days after transplantation.
For children
Doses for IV infusions in children aged 3 months to 12 years are calculated depending on body surface area. In newborns, doses are calculated depending on body weight. For infections caused by HSV, a dose of 10 mg/kg every 8 hours is recommended.
Treatment of infections caused by HSV (except herpetic encephalitis) and FOG
— IV infusion at a dose of 250 mg/m2 every 8 hours.
Treatment of herpes encephalitis and FOG infections in immunocompromised children
- IV infusion at a dose of 500 mg/m2 every 8 hours with normal renal function.
Prevention of CMV infection in children over 2 years of age
. Limited data suggest that children over 2 years of age who have undergone bone marrow transplantation may be given the adult dosage of Zovirax IV. In children with reduced renal function, dose adjustment is required according to the degree of renal failure.
In elderly patients
the clearance of acyclovir in the body decreases in parallel with a decrease in creatinine clearance. Particular attention should be paid to reducing doses of Zovirax in the elderly with reduced creatinine clearance.
In patients with renal failure
IV infusions of Zovirax should be administered with caution. The dose is adjusted depending on the degree of decrease in creatinine clearance:
with creatinine Cl 25–50 ml/min, the dose is 5–10 mg/kg or 500 mg/m2 every 12 hours;
with creatinine Cl 10–25 ml/min, the dose is 5–10 mg/kg or 500 mg/m2 every 24 hours;
with creatinine Cl 0 (anuria) - 10 ml/min: with continuous ambulatory peritoneal dialysis, the dose is 2.5–5 mg/kg or 250 mg/m2 every 24 hours; for hemodialysis - 2.5–5 mg/kg or 250 mg/m2 every 24 hours and after dialysis.
The course of treatment with Zovirax by intravenous infusion is usually 5 days, but may vary depending on the patient's condition and response to therapy. The duration of treatment for herpetic encephalitis and HSV infections in newborns is usually 10 days. The duration of prophylactic use of Zovirax for intravenous infusion is determined by the duration of the period when there is a risk of infection.
Preparation of solution and method of administration
The recommended dose of Zovirax should be administered as a slow IV infusion over 1 hour.
To prepare a Zovirax solution with an acyclovir concentration of 25 mg/ml, add 10 ml of water for injection or sodium chloride solution for injection (0.9%) to the ampoule with Zovirax powder and shake gently until the contents of the ampoule are completely dissolved. After dilution, the Zovirax solution can be administered as an intravenous infusion using a special infusion pump that regulates the rate of drug administration.
Another method of infusion administration is possible, when the prepared Zovirax solution is diluted further to obtain an acyclovir concentration not exceeding 5 mg/ml (0.5%). To do this, you need to add the prepared solution to the selected infusion solution (see below)
and shake well to completely mix the solutions. For children and newborns in whom minimum infusion volumes must be observed, it is recommended to add 4 ml of prepared Zovirax solution (100 mg acyclovir) to 20 ml of infusion solution.
For adults, it is recommended to use infusion solutions in 100 ml packs, even if this will give an acyclovir concentration significantly lower than 0.5%. Thus, one 100 ml infusion solution can be used for any dose of acyclovir between 250 and 500 mg (10 and 20 ml diluted solution). For doses between 500 and 1000 mg of acyclovir, a second infusion of that volume should be used.
Zovirax for IV infusion is compatible with the following infusion solutions and, when diluted with them, remains stable for 12 hours at room temperature (15 to 25 °C):
sodium chloride for intravenous infusion (0.45% and 0.9%);
sodium chloride (0.18%) and glucose (4%) for intravenous infusion;
sodium chloride (0.45%) and glucose (2.5%) for intravenous infusion;
Hartmann's solution.
Since no antibacterial preservative is included in the solutions, dissolution and dilution must be carried out completely under aseptic conditions immediately before administration of the drug, and the unused solution is destroyed.
If the solution becomes cloudy or crystals fall out, it should be destroyed.
Eye ointment:
For adults and children, a strip of ointment 10 mm long is placed in the lower conjunctival sac 5 times a day with an interval of about 4 hours. Treatment must be continued for at least 3 days after recovery.
Directions and overdose
The drug is intended for the treatment of herpes, which manifests itself on the skin of the face and lips. It is not used to treat the mucous membranes of the mouth or eyes, or genital herpes. The exception is Zovirax eye ointment.
The manufacturer recommends handling with extreme caution and avoiding contact of the composition with the organs of vision. Severe symptoms of a herpetic infection on the lips require additional consultation with a local doctor.
If an opening of the lesion is present, the patient must follow precautions to prevent accidental infection of bystanders. The patient should use separate care items, and do not forget to wash their hands before and after each manipulation.
Cetyl alcohol included in the composition can provoke the occurrence of local skin reactions - contact dermatitis, etc. The propylene glycol present becomes a source of local irritation on the skin.
The drug has no significant interactions with other medications. The medicine does not affect the speed of reactions and can be used when working with moving mechanisms and when driving a car.
No pronounced consequences of an overdose of ointment have been identified. Accidental ingestion or application of large volumes of medication did not cause serious complications. The appearance of non-standard reactions to the drug requires consultation with a doctor and replacement of the previously recommended therapy regimen.
