Acyclovir dose
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Here is a comprehensive summary of acyclovir dosing by indication, drawn from Harrison's 22E and Goldman-Cecil Medicine:
Acyclovir Dosing by Indication
Herpes Simplex Virus (HSV)
Immunosuppressed Patients
| Indication | Route | Dose |
|---|---|---|
| Acute symptomatic episode (first or recurrent) | IV | 5 mg/kg q8h × 7–21 days |
| Acute symptomatic episode | PO | 400 mg qid |
| Suppression of reactivation | IV | 5 mg/kg q8h |
| Suppression of reactivation | PO | 400–800 mg 3–5× daily |
Immunocompetent Patients — Genital HSV
| Indication | Route | Dose |
|---|---|---|
| First episode | PO | 200 mg 5×/day or 400 mg tid × 7–14 days |
| First episode (severe / neuro complications) | IV | 5 mg/kg q8h × 5 days |
| Recurrent episode (short-course) | PO | 800 mg tid × 2 days |
| Recurrent episode (5-day) | PO | 200 mg 5×/day × 5 days |
| Suppression | PO | 400–800 mg bid |
Oral-Labial HSV
| Indication | Route | Dose |
|---|---|---|
| First episode | PO | 200 mg 5×/day or 400 mg tid × 5–10 days |
| Recurrent (topical) | Topical | Acyclovir cream (limited benefit) |
Herpes Encephalitis
| Route | Dose |
|---|---|
| IV | 10 mg/kg q8h × 14–21 days (adults) |
Varicella (Chickenpox)
| Population | Route | Dose |
|---|---|---|
| Adolescents/adults (≤24 h onset) | PO | 800 mg 5×/day × 5–7 days |
| Children <12 years (early, ≤24 h) | PO | 20 mg/kg q6h |
| Severe / immunocompromised | IV | 10 mg/kg q8h × 7 days |
Herpes Zoster (Shingles)
| Route | Dose |
|---|---|
| PO | 800 mg 5×/day × 7–10 days |
| IV (severe/immunocompromised) | 10 mg/kg q8h × 7 days |
Note: Valacyclovir and famciclovir are preferred over oral acyclovir for VZV due to better pharmacokinetics and less frequent dosing.
Renal Dose Adjustment
Dose reduction is required in renal impairment. Acyclovir is significantly removed by hemodialysis. Rapid IV bolus should be avoided; maintain adequate hydration to prevent crystalline nephropathy.
Sources: Harrison's Principles of Internal Medicine 22E (2025); Goldman-Cecil Medicine
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