Whether it is possible to smear acyclovir. Acyclovir: instructions, indications, contraindications

Acyclovir is a modern drug for the treatment of herpes, as well as some other viral diseases. Acyclovir has a direct antiviral effect, which means that it acts directly on the viruses themselves, preventing them from multiplying.

Operating principle

The mechanism of the antiviral effect of the drug is that the active substance contained in the drug penetrates into virus-infected cells. Once in the cells, the virus begins to multiply in them, using the nucleotides present in the cell to synthesize the viral genome.

The structure of acyclovir is similar to the structure of guanine present in cells. Viral enzymes modify acyclovir to acyclovir triphosphate, which is structurally similar to deoxyguanosine triphosphate, and is normally included in the viral DNA sequence. The “unsuspecting” viral enzyme essentially inserts a “Trojan horse” into its DNA chain. And in vain, since acyclovir triphosphate makes it impossible for the virus to replicate. This stops its reproduction and greatly facilitates the body's immune forces in the fight against viral particles.

It should be noted that the active substance of the drug has absolutely no effect on the genetic apparatus of the cell itself and does not contribute to the occurrence of mutations. This can be confirmed by the results of both numerous tests on animals and the practice of using the drug in humans. Therefore, in this regard, the drug is completely safe.

The described method of fighting viruses was once a novelty in the world of medicine, and the developers of the drug were awarded the Nobel Prize. And until now, Acyclovir remains the most effective remedy for herpes viruses, despite the emergence of new antiviral drugs.

What viruses does the drug protect against? Unfortunately, the scope of the drug is limited only to a certain class of viruses, namely the herpesvirus family. These include herpes simplex viruses type 1 and 2, the virus (Varicella Zoster), cytomegalovirus that causes cytomegalovirus infection, and the Epstein-Barr virus that causes some tumors and blood diseases. Therefore, one should not listen to the opinion of those who propose to be treated with Acyclovir for any viral infections, such as influenza and even AIDS.

The effect of the drug on different viruses of the family is not the same. The drug is most terrible for herpes simplex viruses, it has a slightly weaker effect on the varicella-zoster virus and even worse on cytomegalovirus and Epstein-Barr virus.

Indications for use

First of all, the drug treats diseases caused by the herpes simplex virus. This is a herpes that occurs on the face, primarily around the lips, and on the mucous membranes, including the mucous membranes of the eyes, as well as in the anus and genitals.

Diseases caused by the Varicella zoster virus include chicken pox and shingles. Diseases caused by cytomegalovirus and Epstein-Barr virus can also be treated with the drug. However, their therapy requires larger doses than the treatment of herpes simplex.

Herpes is one of the most common infectious diseases. Its main symptoms are rashes in the lips, face and eyes. Sometimes rashes appear in the genital area. As a rule, the rash is very itchy and painful.

According to statistics, more than 90% of the world's population is infected with the herpes simplex virus. However, not everyone has symptoms of herpes. What is it connected with? The fact is that immunity in healthy people usually restrains the spread of the virus. However, in some cases, immunity can be weakened, and then we meet with manifestations of herpes.

What can reduce antiherpes immunity:

• infectious diseases (ARI, influenza)
• hypothermia
• stress
• elderly age
• hormonal changes (for example, during pregnancy)

If these reasons led to the activation of the virus, then antiviral therapy is prescribed with the help of the drug.

Often there are cases when the drug is used for other purposes, for example, for the treatment of boils, acne, other rashes and dermatitis not associated with herpes viruses. Needless to say, there will be no benefit to the body in doing so. Therefore, before starting treatment, you should clarify the diagnosis - herpes or herpes zoster, with a specialist. It should also be remembered that the use of antibiotics for herpes is also meaningless.

Description of the drug

The drug is available in various dosage forms:

• Acyclovir tablets, 200 or 400 mg
• eye ointment
• creams
• solutions for parenteral administration

The question may arise, which dosage form is optimal? This should be decided by the attending physician. However, it should be noted that in the event that we are talking about skin rashes, it is best to use a cream or ointment, from which the active substance enters the virus breeding sites directly. If you use Acyclovir in tablets, then due to the low bioavailability of the drug, only a small amount enters the bloodstream. And this means that the effectiveness of the tool will be lower.

Acyclovir - although inexpensive, but quite a serious drug. Therefore, Acyclovir tablets are sold in pharmacies only by prescription. The only exceptions are creams and ointments.

The drug has several analogues. The most famous of them is Zovirax. In fact, this is a drug that has the same composition. However, it is of imported origin, and therefore its price is somewhat higher.

Side effects

The drug has few side effects. There may be allergic reactions to the components of the drug, headache, dizziness, gastrointestinal disturbances - nausea, diarrhea, vomiting.

In no case should you combine taking the drug with alcohol. The fact is that the drug is metabolized in the liver using the same enzymes as alcohol. Therefore, if you take Acyclovir and alcohol at the same time, this will lead to the fact that both substances will accumulate in the blood and, as a result, poisoning.

Contraindications

Acyclovir has several contraindications. First of all, the drug penetrates the placental and blood-brain barriers, enters breast milk. Therefore, it is not recommended for use during pregnancy. When prescribing the drug to pregnant and lactating mothers, the doctor must weigh the pros and cons. It is also not recommended to give tablets to children under 3 years of age.

Instructions for use and dosage

When taking Acyclovir tablets, you should follow the instructions for use that the drug is supplied with, or the instructions of your doctor.

Usually, Acyclovir 200 mg tablets should be taken for herpes simplex 5 times a day. Between doses, a break of 4 hours should be observed (at night - 8 hours). With chickenpox and herpes zoster, the dose is increased by 4 times - up to 800 mg.

Children are prescribed the drug based on their weight - 20 mg / kg. In this case, the drug is taken 4 times a day for 5 days.

The usual course of treatment is 5 days, with genital herpes, the period increases to 10 days. Prevention of herpes is carried out by taking 400 mg of the drug every 12 hours.

The maximum allowable daily dose is 2 g. The absorption of a substance into the blood does not depend on food. Therefore, Acyclovir tablets can be taken before and after meals.

The body's ability to remove the active substance from the blood is limited, so the dosage must be strictly observed so as not to be poisoned.

When using a cream or ointment, the medicine is smeared with a thin layer on the affected area. It should be remembered that a thick layer of ointment will not increase the therapeutic effect, but will only lead to the waste of the drug.

Many colds strike people in the winter. Flu, colds and SARS are common among them. In most cases, we are talking about a viral infection that provoked the disease. Therefore, the use of Acyclovir against colds or flu is normal. The main thing to remember about contraindications.

This may come as a surprise to many, since such diseases may not be indicated in the instructions. Acyclovir is prescribed by doctors, so the reason for their use should be found out from them.

Doctors take into account the condition of the patient who is being diagnosed. That is why Acyclovir is used. Depending on the severity and cause of the disease, a certain complex of drugs is prescribed.

The antiviral drug acts in this way on the body: it penetrates the DNA of the virus, changing its structure, due to which it is destroyed. In this case, human cells remain intact.

Application of Acyclovir

Doctors say that Acyclovir is ineffective for flu and colds. This can be understood by what viruses it affects when it is used:

• herpes zoster.
• Cytomegalovirus.
• Herpes simplex.
• Epstein-Barr virus.

It is obvious that Acyclovir is effective in the fight against herpes, which mainly manifests itself in skin rashes. The drug is available in tablets, solutions, ointments, creams, which allows it to be used externally for skin diseases. If relapses are observed, then Acyclovir is also drunk in the form of tablets. If herpes zoster is detected, an injectable form of the drug and a drip injection are used.

Acyclovir is actively used in such diseases:

1. Shingles.
2. herpetic infection.
3. An immunodeficiency condition, such as HIV or a consequence of a bone marrow transplant.
4. Chickenpox.

The active substance acyclovir affects the structure of the virus and can be used both as a treatment and as a prophylaxis for herpetic skin diseases and lesions of the mucous membranes.

The question arises: for what purposes do doctors prescribe Acyclovir for ARVI, a cold, or if this drug affects the herpes virus? It is with these diseases that herpes can reappear, especially if a person has previously had it. In this case, Acyclovir is used as a prophylactic agent, which should predict the development of a herpetic disease. It is also prescribed for a significant decrease in immunity, since it is in this case that the herpes virus easily infects the body.

When using Acyclovir, you should follow the dosage indicated in the instructions. However, if the doctor prescribes the drug, then you should adhere to its dosages. The course of treatment and dosage may be changed by the doctor and differ from the instructions. Children should strictly observe the dosage, since negative consequences are possible after the use of Acyclovir.

What dosage does the doctor prescribe? It all depends on the form of the disease and the severity of the course:

• Treatment of herpetic infection of the skin and mucous membranes involves the appointment of children and adults 200 mg of the drug 5 times a day with an interval of 4 hours, which is interrupted by sleep (8 hours). The duration of therapy is 5 days. If Acyclovir is used as a prophylaxis for influenza or SARS, then it is used 4 times a day, 200 mg every 6 hours.
• As a complex therapy for severe immunodeficiency, the drug is taken 400 mg 5 times a day.
• Treatment of chickenpox in children and adults whose body weight exceeds 40 kg involves taking the medicine 800 mg 5 times a day. Children over 2 years of age with a body weight below 40 kg take the drug at a rate of 20 mg per kilogram of weight. They take the drug 4 times a day for 5 days.
• Treatment of shingles involves taking Acyclovir in children over 6 years of age and adults at 800 mg every 6 hours for 5 days. Children from 2 to 6 years old take the medicine 400 mg 4 times a day, and children under 2 years old receive it 4 times a day, 200 mg.

Thus, Acyclovir is used in such cases:

1. Skin diseases of an infectious nature in the primary lesion with herpes.
2. Suppression of relapses of the occurrence of infectious diseases with reduced immunity.
3. Therapy of keratitis, which develop against the background of infection.
4. Therapy for lichen and chickenpox.
5. For the prevention of flu and colds. Although this drug is ineffective in the fight against viruses that cause respiratory diseases, it is prescribed for prevention. It is quite useful for mild colds.

Contraindications

In the instructions, you can note the many side effects that occur if the drug is used incorrectly. This leads to a list of contraindications for which the medicine should not be used:

• Persons with kidney pathologies, since Acyclovir leads to renal failure, especially with rapid intravenous infusion.
• Persons with pathologies in the nervous system, since the drug can contribute to the development of encephalitis and even coma.
• Pregnant and breastfeeding women, unless the harm done to the child is less than the positive effect on the mother. During lactation, the drug passes into breast milk, so at the time of taking the drug, the child is transferred to artificial feeding.
• Elderly people to avoid the development of renal failure.
• When dehydrated.

You should also take into account such contraindications - high sensitivity to Acyclovir and other substances of the drug.

If Acyclovir is used correctly, then there will be no side effects. Otherwise, you can read the instructions for a list of side effects, which include:

1. Fever.
2. Nausea.
3. Skin rash.
4. Headache.
5. Vomit.
6. Drowsiness.
7. Weakness.
8. Diarrhea.
9. Dizziness.
10. Abdominal pain, etc.

Since the drug adversely affects the functioning of the kidneys, it should be taken along with drinking plenty of fluids.

As for the use of medicine for influenza or SARS, it is rarely prescribed. In most cases, it is unnecessary because it does not affect the viruses that provoke influenza or SARS. In the worst case, it provokes the development of various side effects.

However, Acyclovir can be used as a prophylactic agent that prevents the development of herpetic diseases. Immunity with or SARS falls, so herpes will make attempts to hit an already sick person.

The drug should be used only when needed. Otherwise, addiction to the drug will occur, which will be accompanied by strain resistance. However, the timely and short-term use of the drug allows you to effectively deal with herpes viruses, which today are very numerous and quite common.

Should Acyclovir be used for a cold or flu?

Since some doctors may prescribe, and some of the patients will want to use the drug, the question arises: should Acyclovir be used for colds or flu?

You should be attentive to your body. If after 5-6 days the symptoms do not leave the patient and even various complications arise, then taking Acyclovir becomes useful. Until then, it should not be used as it does not fight respiratory disease viruses. The body is trying to fight off the infection on its own.

With a cold, Acyclovir should be used as a prophylaxis. However, it is strictly necessary to follow the instructions. Only severe cases of the common cold suggest the use of Acyclovir. Until that time, it is not prescribed as a therapy.

If the child has a cold, then you should use more gentle methods that help in the cure:

1. Keep him away from other people, especially children. This will help not to become a carrier of infection and give peace to a sick child.
2. Leave the child at home for at least 4-5 days. The children's body is not yet able to endure "on its feet" even mild illnesses.
3. Protect from hypothermia. It is necessary to ventilate the air in the room of a sick child, but this should be done in the absence of a baby.
4. Hasten the cure with plenty of fluids and rest.
5. Give vitamin complexes, fresh fruits and vegetables. The child's immune system is not only weak, but also fights infection. She needs help every day.
6. Contact your pediatrician. If home treatments do not help, then it's time to see a doctor.
7. Bring down the heat. It is considered normal up to 38 degrees.
8. Spare your child the lessons. We remember the peace that is disturbed if a child is forced to study during an illness.

With a virus herpes Everyone in his life faced at least once, and many more than once. It is he who is the causative agent of chicken pox, shingles and, of course, annoying many herpes that appears on the lips, under the nose, on the mucous membranes of the oral cavity or genital organs. Perhaps one of the most popular drugs that are used to combat this virus is acyclovir. But how effective is this drug, how do they speak about it, and can it be harmful to health?

There are several varieties herpes virus that cause the diseases listed above. Most often you have to deal with the herpes simplex virus type 1. Once in the body, it remains there forever, that is, it is extremely difficult, if not impossible, to expel the virus. So why don't we walk around with a rash on our lips all year round?

The fact is that the immune system does not allow the virus switch to active form, but as soon as the immune system weakens, right there. That is why a "cold" on the lips or mucous membranes often occurs together with the flu, or after other past illnesses, accompanied by a decrease in the protective functions of the body. In other words, herpes simplex is an indicator of weak protection, a signal of the need to strengthen the immune system. If your protection is complete, then you will not remember herpes all year round. Well, the frequency of its appearance and severity depend on how reduced immunity is.

Acyclovir is antiviral drug. It disrupts the division and reproduction of viral particles, but does not affect immunity in any way. That is, to some extent, using it, a person fights not so much with the cause - weakened immunity, but with the consequence - the active herpes virus and the result of its "work".

On the other hand, while sick will lead order your immunity, herpes on the lips will cause a lot of inconvenience. Children have special problems, whose protection is not yet complete and, moreover, is subjected to serious attacks. This is where acyclovir comes to the rescue, as it fights the symptoms of herpes - itching, burning, pain, swelling, that is, makes it less pronounced. Therefore, after the use of acyclovir, herpes is usually tolerated more easily and passes faster. But remember that using this medicine, you do not protect yourself from subsequent multiple relapses of herpes, but by systematically strengthening the immune system, you significantly reduce the chances of the virus becoming more active in the future.

It must be admitted that reviews are sometimes very diverse. Someone is saved from the herpes that has appeared only to them, and someone, having tried it once, swore to use it. What is it connected with?

First, the effectiveness largely depends on how early you start to treat them. Remember carefully the sensations that arise before the bubbles appear on the lips. Usually, in the place of a future “cold”, a slight tingling or itching is felt, and if you look closely, one or two bubbles have already appeared. Those who start using acyclovir at this stage have every chance of getting rid of herpes within 24-48 hours, sometimes even preventing its occurrence. So, the basic rule is that the sooner you use acyclovir, the more sense you will get from it. By the way, the frequency of applying the ointment to the affected area is also of great importance.

Secondly, some of people who face a recurrent course of herpes, the virus has spread too "deep", so they need not only local treatment, but systemic therapy. Without knowing about it, the sick people regularly smear the sore with acyclovir, in the hope that it will disappear, but this does not happen.

Finally, there are those who have hypersensitivity to the active substance. In this case, the course can only worsen against the background of an inadequate response of the body to acyclovir. Itching and burning intensify, swelling increases and redness of the skin area increases.

Of the advantages, of course, the low cost can be noted, in contrast to the popular analogue of Zovirax, which is based on the same active substance acyclovir, which means that it does not differ in effectiveness. It is also worth recognizing that in the early stages of the onset of herpes, acyclovir is often effective, and with recurrent herpes after a course of taking pills, it is sometimes possible to forget about rashes. The use of the ointment helps to reduce the discomfort from herpes.

As for the forms release, then there are several of them and they are suitable for the treatment of various herpetic diseases. Ointment for external use is applied in a thin layer to the affected area (except for the mucous membranes of the mouth, eyes and genitals) 5 times a day until the rash disappears. Tablets should be taken orally, adults and children from two years of age, 200-400 mg 3 to 5 times a day. For children under two years old, 100-200 mg per day is enough. The duration of the course of such treatment should not be less than 5 days, but not more than 10 days.

Particular care with pills should be people with kidney failure, and indeed with kidney disease, since acyclovir is still somewhat harmful to this organ. Therefore, such patients require dosage adjustment, and it is desirable to take tablets under the supervision of a physician, periodically taking blood and urine tests.

pregnant women without doctor's advice It is better not to take acyclovir tablets. Also, they should not be drunk by lactating women, since the active substance is excreted in milk.

Side effects from the use are observed less often, mainly in people with hypersensitivity to the active substance. They can manifest as itching, redness, swelling, nausea and dizziness. In any case, if you feel unwell, stop using acyclovir and consult a doctor.

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Antiviral drugs occupy a relatively small niche in the drug market. Among the most popular of them is Acyclovir tablets.

Description and features of the drug, properties

In medical practice, Acyclovir Akos tablets are actively used to treat primary and secondary infectious lesions and their manifestations on the skin, lips and mucous membranes. The drug has a pronounced antiviral effect, reduces pain, prevents the development of neuralgia after a herpetic lesion.

The basis of the drug is the substance acyclovir. With herpes, it suppresses the progression of the infection and prevents the appearance and spread of new plaques on the body.

Kidney disease reduces the rate of elimination of the drug, and also affects its processing for further excretion.

There is also an acceleration of tissue healing and strengthening of immunity.

The bioavailability of tablets is up to 30%. At the same time, after processing, up to 84% of the total amount of the active substance is excreted through the kidneys. In relatively healthy individuals, the half-life is about two to three hours.

Indications and dosing regimen

Most often, Acyclovir Akrikhin is used for the so-called colds on the lips and spine (herpes). But for adults and children, this is not the only indication for use. Acyclovir tablets also help against viral pathologies:

The drug is used for prophylactic purposes after surgery. Acyclovir Belmed (and other species) is effective in the treatment of primary and secondary viral infections. The standard dosage for treatment is determined as follows:

In the presence of other pathologies, renal failure, digestive diseases, it is necessary to inform the doctor about this, since in this case the dosages are adjusted.

At the discretion of the physician, the dose may be increased or decreased. The course of treatment is also set by the attending physician based on the individual characteristics of the patient and the overall clinical picture.

Contraindications and restrictions on use

In the form of tablets, an antiviral drug is not used to treat a child under three years of age. Also, it should not be drunk by women at the stage of lactation. Acyclovir during pregnancy 1 trimester is allowed to be taken, but only under the supervision of the attending physician.

Supervision is also required in the treatment of the elderly and children under 18 years of age. In the presence of concomitant diseases, it is necessary to record the results of the therapy.

Negative Side Effects

With intolerance to the components of Acyclovir Forte, severe allergic reactions, anaphylactic shock are possible. Other side effects:

Side effects with the correct use of the drug are relatively rare. The likelihood of their manifestation increases with the establishment of large dosages of the drug. With a significant increase in the recommended dosages, it is possible:

In case of an overdose, it is necessary to monitor and monitor the patient's condition and conduct symptomatic therapy. The use of the drug must be suspended.

Medicine analogs

Acyclovir Akri (and others) is produced by several pharmaceutical companies and sold through pharmacy chains by prescription. If necessary, another drug with similar properties can be prescribed instead.

Name of medication	Main active ingredient	Brief description, properties	Cost in pharmacies (rubles per pack)
Valaciclovir	Alacyclovir hydrochloride	An antiviral agent used in medical practice to eliminate herpes	250-350
Zovirax	Acyclovir	Antiviral agent, available in the form of tablets, cream, ointment and powder for injection	150-200 (tablets)
Virolex	Acyclovir	Complex antiviral medication (tablets, powder, cream, ophthalmic ointment)	200-250
Atsik	Acyclovir	Complete analogue of the drug. Available in the form of tablets of 200 and 400 milligrams, cream	200-250

Many patients self-medicate and independently select analogues for the medication. Often they are interested in which of the remedies (Zovirax, Acyclovir or Valaciclovir) helps better with the formation of herpetic vesicles on the lips and mucous membranes. But it is not recommended to carry out the selection on your own, since each of the drugs has its own characteristics, composition and limitations in use.

Replacement of the drug with an analogue is most often required with insufficient effectiveness or the manifestation of significant side effects.

Analogues are also used as part of complex therapy or separately. Each medication affects a specific group of viruses, has its own side effects and contraindications.

6 analogues of Acyclovir in tablets for herpes

Usually, topical medications are used in the treatment of herpes. However, for the treatment of some forms of the disease, it is not enough to use only creams and ointments. In severe pathology, systemic drugs are prescribed. Pharmacy chains offer a range of medicines in the form of helping to stop the development of the disease and speed up recovery. The following are analogues of acyclovir in tablets. The choice of drug depends on the patient's condition and the type of herpes virus that has affected the body.

Isoprinosine (Groprinosine)

This drug belongs to the class of immunomodulators and in parallel has a powerful antiviral effect. The medicine helps to activate the body's own defenses and directs them to fight the herpes virus. Against the background of treatment, it is possible to increase the synthesis of G antibodies, as well as interferons and leukins - substances that contribute to the formation of immunity.

Isoprinosine is available in tablets for oral use. The drug is not prescribed for small patients from birth to a year. For babies whose body weight is less than 20 kg, the daily dosage is selected at the rate of 1 Isoprinosine tablet per 10 kg of weight. For older children and adults, the dose per day is selected at the rate of 50 mg of the active ingredient per kilogram of weight. The resulting number of tablets is divided into 3-4 doses. Maximum per day, you can take no more than 4 grams of Isoprinosine.

Tablets Valvir

The active ingredient in this drug is valaciclovir. The drug is available in tablets for oral administration. The drug is used to treat several types of herpes, lichen, and also as a prophylactic to protect the body from the effects of cytomegalovirus and herpes.

Depending on the type of disease and the severity of its course, patients are prescribed 1-2 grams of the active substance per day, divided into several doses.

For the prevention of herpetic eruptions drink 500 mg. The effect of therapy is observed from the first days of application. Reduces itching, swelling, rash and pain.

Immunomodulator Cycloferon

The drug has a versatile effect on the body, therefore it shows a fairly high therapeutic effect. The medicine effectively fights not only with all manifestations of herpes, but also with other viruses. Among other things, the drug has a powerful immunomodulatory effect, activating the human body's own defenses.

For the treatment of herpes, Cycloferon is taken according to a special scheme. In the first week, the tablets are taken every other day, in the second and third - in two. Even if a positive effect of therapy is observed in the first days of treatment, in order to avoid relapse, it is necessary to drink the full course.

Valtrex (Valacyclovir)

The active substance of the drug is valaciclovir. This is another form of acyclovir that is much better absorbed by the body. The drug is available in the form of tablets of 500 mg. Indications for use are the herpes virus, lichen.

Take the drug twice a day, 500 mg, regardless of food intake. For the prevention of the herpes virus, one tablet per day is enough. A stable effect of therapy is recorded after 4-5 days from the start of treatment.

Zovirax tablets

The active ingredient in Zovirax is Acyclovir. It integrates directly into the DNA of the herpes virus and stops its reproduction. The drug is effective in many varieties of this disease, and is also prescribed for eye diseases such as keratitis. Can be used in infancy.

The minimum course of therapy for any form of herpes is 5 days. If necessary, the duration of the course of treatment can be increased up to 10 days. The average daily dosage does not exceed 1000 mg, divided into 5 doses. With shingles, chickenpox and some other types of the virus in adults, a single dose should be 800 mg, and the daily dose should not exceed 3.2 grams.

Immunomodulator Amiksin

The drug activates the immune system, and also has a powerful antiviral effect. May be used to treat certain types of herpes. The drug effectively suppresses the activity of pathogenic microorganisms and promotes the production of antibodies to viruses.

The disadvantage of the drug is the impossibility of prescribing it in children under 7 years of age. It is often prescribed in the complex therapy of herpes together with Acyclovir, Panavir, topical agents, as well as hormonal drugs. Combination treatment is better than monotherapy. With this therapeutic approach, relapses occur much less frequently.

Conclusion

As part of complex therapy for the relief and elimination of viral infections, Acyclovir is often used. The main component of the drug is often included in the composition of other (similar in action) drugs as the most effective and reliable. Antiviral tablets act quickly, have relatively few contraindications and have a wide spectrum of action.

0 Acyclovir belongs to the group antiviral drugs. The effectiveness of this medication has been repeatedly proven in large medical studies, along with the study of its mechanism of action and the determination of side effects. Despite the fact that the drug was invented more than 20 years ago, it remains a relevant and effective tool for combating both herpes simplex and herpes zoster viruses, chicken pox ( chickenpox), Epstein-Barr and cytomegalovirus.

A wide range of forms of release of this drug allows you to use it both systemically and locally. In addition, the therapeutic window ( range of acceptable therapeutic doses that do not cause side effects) of acyclovir is large enough to safely use it on an outpatient basis ( at home).

With a sufficiently high degree of confidence, it can be assumed that acyclovir does not have a carcinogenic effect when used systemically, that is, it does not cause the appearance of malignant tumors, which cannot be said about a number of other antiviral drugs. However, the effect of external forms of acyclovir on the skin and mucous membranes has not been thoroughly studied.

Teratogenic effect ( influence on the appearance of developmental anomalies) of this drug was also not observed in animal studies, even when using excessively high doses. There was no decrease in testicular function and sperm activity after the use of acyclovir in men.

For pregnant women, this drug is indicated only in cases where the benefits of its use outweigh the potential harm to the fetus. According to studies, women who took acyclovir during pregnancy did not show an increase in the frequency of having children with developmental anomalies, which indicates its relative safety.

However, despite all the advantages of this drug, it also has significant disadvantages. One of them is the need for frequent administration due to low bioavailability ( the amount of the drug that is completely distributed throughout the body in relation to the amount of the drug absorbed by the patient) and short half-life ( the time it takes for half of the administered dose of the drug to be eliminated from the body).

Another disadvantage is the potential nephrotoxic ( kidney damaging) the action of acyclovir. Passing through the renal tubules, the drug can cause inflammation and blockage. However, this happens only when the concentration of the drug in the primary urine reaches a high level. High concentrations may result from an excessive initial dose, rapid entry of the active substance into the body, or dehydration. Thus, to prevent acute renal failure, it is necessary to take the drug only according to the instructions and drink plenty of fluids during the entire period of treatment.

The last, but not the least, disadvantage of acyclovir is the frequent development of tolerance to it. In other words, the viruses targeted by the effect of the drug develop certain defense mechanisms against it ( To date, at least three mechanisms are known by which the herpes simplex virus is protected from the action of acyclovir.). As a result, with repeated use, the effectiveness of the drug decreases from time to time, forcing the patient and his doctor to resort to second- and third-line drugs.

Types of medication, commercial names of analogues, release forms

Acyclovir is available in the following dosage forms:

• pills;
• lyophilizate for preparation of solution for intravenous drip injection;
• ointment and cream for external use;
• eye ointment.

The use of acyclovir does not imply any age restrictions. The choice of dosage form is based on the severity of a particular case. For outpatient treatment, you can use the tablet form of the drug, as well as a cream for external use and an eye ointment. The use of a lyophilisate for the preparation of perfusion solutions imposes some precautions, so it is preferable to use this dosage form exclusively in a hospital under the supervision of medical personnel.

Acyclovir is found in pharmacies under the following commercial names:

• Cycloviral;
• Cyclovir;
• Cyclovax;
• Supraviran;
• Provirsan;
• Medovir;
• Lizavir;
• Zovirax;
• Herpes;
• Herperax;
• Gerpevir;
• Gervirax;
• Virolex;
• Vivorax;
• Acyclostad;
• Acigerpin and others.

Manufacturers of acyclovir

Firm manufacturer		Commercial name drug	Producing country	Release form	Dosage
Stada Arzneimittel AG		Acyclostad	Germany	Pills (800 mg).	The dosage of the drug depends on the type of disease, associated complications and the age of the patient. With the herpes simplex virus, 200 mg is prescribed 5 times a day, except at night. With chicken pox and shingles - 800 mg 5 times a day. Children older than 2 years are prescribed the same doses as adult patients. Children under 2 years of age are given half the dose with the same frequency of administration ( 5 times a day). The last tablet should be taken at least 2 to 3 hours before going to bed. The duration of treatment on average takes from 5 to 10 days.
Ozone LLC		Acyclovir	Russia	Pills (400 mg).
Obolenskoye - pharmaceutical company		Acyclovir forte	Russia
BELUPO d.d.		Aciclovir Belupo	Republic of Croatia
NIZHFARM		Acyclovir	Russia	Pills (200 mg).
Salutas Pharma		Aciclovir Sandoz	Germany
Stada Arzneimittel AG		Acyclostad	Germany
KRKA		Virolex	Slovenia
Glaxo Wellcome		Zovirax	Spain
Belmedpreparaty RUE		Acyclovir	Republic of Belarus
Cadila Pharmaceuticals		Vivorax	India
PRO.MED.CS Praha a.s.		Provirsan	Czech Republic
GlaxoSmithKline Manufacturing S.p.A.		Zovirax	Italy	(250 mg).	The lyophilizate is used in severe cases of herpes simplex and genital herpes, with severe pain caused by herpes zoster, etc. The perfusion solution is made immediately before use by mixing the powder from the vial with the amount of saline indicated in the instructions ( different salts of acyclovir have different solubility in saline). On average, adults are prescribed 5 mg of the drug per 1 kg of the patient's body weight 3 times a day. In severe complications of the disease, such as meningoencephalitis and viral pneumonia, 10 mg / kg is prescribed 3 times a day. The maximum dose for intravenous administration is 30 mg / kg / day, and for children under 2 years old, half as much. The introduction of the drug should be carried out exclusively drip and slowly ( at least 1 - 2 hours) to avoid acute renal failure.
KRKA		Virolex	Slovenia
North China Pharmaceutical Corporation		Acyclovir	China
Anfarm Hellas		Medovir	Greece
Belmedpreparaty RUE		Acyclovir	Republic of Belarus	Lyophilisate for preparation of perfusion solution (250 mg, 500 mg, 1 g).
VERTEX		Acyclovir	Russia	(5% - 2, 5, 10 mg).	A cream or ointment is applied to the affected areas of the skin at the first signs of the disease, on average 4-5 times a day. The duration of treatment varies from 5 to 10 days.
Salutas Pharma		Aciclovir GEKSAL	Germany
BELUPO d.d.		Aciclovir Belupo	Republic of Croatia
Glaxo Wellcome Operations		Zovirax	United Kingdom
KRKA		Virolex	Slovenia
Agio Pharmaceuticals		Acigerpin	India
Synthesis JSC		Acyclovir	Russia	Eye ointment (3% - 4.5, 5 mg).	A strip of ointment 0.5 - 1 cm long is placed behind the lower eyelid. Next, the eye is closed for a few minutes in order for the substance to spread through the cornea and be absorbed into it. Apply the ointment 5 times a day for 5 to 10 days.
KRKA		Virolex	Slovenia
Draxis Pharma Inc.		Zovirax	Canada

Mechanism of therapeutic action of acyclovir

Once in the gastrointestinal tract, this medicine is absorbed into the blood only in a small amount ( approximately one fifth). With an increase in the dose that enters the body, an increase in the concentration of the drug in the blood does not occur, no matter how paradoxical it may sound. The explanation lies in the fact that acyclovir is able to penetrate the mucous membrane of the initial sections of the digestive system with a limited speed. Moreover, with an increase in the dose, there is a slight decrease in the absorption of the drug due to overload of the transport systems of the cells of the mucous membrane of the stomach and duodenum. Eating food together with taking acyclovir does not change the rate of its absorption in any way.

Once in the blood, the drug only partially binds to plasma proteins ( 9 - 33% ). For this reason, the bulk of the active substance circulates freely in the blood and is rapidly metabolized and excreted from the body. Nevertheless, with the timely intake of the next dose of the drug in the blood, its constant concentration is maintained, which ensures its penetration into all tissues of the body without exception. Thus, acyclovir freely penetrates the blood-brain and hematoplacental barrier, is found in high concentrations in the tissues of the kidneys, liver, lungs, eyes, in the secretions of the lacrimal, salivary and sex glands. In the cerebrospinal fluid, the concentration of the drug is equal to half of its concentration in the blood plasma. Absorption of the drug from the surface of the skin is moderate, and from the surface of the mucous membranes - pronounced.

It is important to note that acyclovir has a selective effect on the target virus and does not damage healthy body cells. Once in a healthy cell, it does not produce any changes in the metabolism of its substances, it is excreted unchanged and neutralized in the liver. However, when the drug enters an infected cell, it is first converted from the original acyclovir molecule to acyclovir monophosphate by a viral enzyme called thymidine kinase. Further, with the help of some enzymes of the cell itself, the drug is converted into acyclovir triphosphate, the most active form of this drug substance. Acyclovir triphosphate acts on the virus in two ways. The first way involves interaction with the DNA polymerase of the virus ( an enzyme that makes copies of the virus) and slowing down the pace of its work. This leads to the isolation of the virus and the impossibility of its spread along the nerve fibers. The second route involves the insertion of acyclovir into the DNA chain ( deoxyribonucleic acid - a carrier of genetic information) of the virus instead of purine bases ( building blocks that make up DNA). In this case, the genome of the virus becomes unstable and disintegrates.

The neutralization of this drug occurs in the liver with the help of two enzymes - alcohol dehydrogenase and aldehyde dehydrogenase. These enzymes, as you can easily guess from the name, inactivate alcohol consumed from the outside. Accordingly, the use of alcohol in parallel with treatment with acyclovir is fraught with a slowdown in the neutralization of alcohol and an excessive accumulation of the medicinal substance itself. This, in turn, leads to severe intoxication even from a small dose of alcohol and a pronounced hangover syndrome, as well as to an overdose of the drug, the outcome of which is often acute renal failure.

Excretion of the drug is carried out mainly by the kidneys. At the same time, its main part is excreted in the form of inactive metabolites and only a small part ( no more than 14% when taken orally) is active. With intravenous administration, the proportion of the active substance in the urine can reach 79%. With a low glomerular filtration rate and tubular secretion occurring during dehydration and at night, acyclovir and its metabolites tend to settle in the renal tubules and cause acute renal failure. The same side effect can develop with rapid intravenous administration of the drug, when one single dose is poured in less than one hour.

For what pathologies is it prescribed?

Acyclovir has the most pronounced directed action in relation to the herpes simplex virus of the first and second types. In addition, this drug is used to combat herpes zoster, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus, but its therapeutic effect in these cases is somewhat less pronounced.

The use of acyclovir

Name of the disease	Mechanism of therapeutic action	Dosage of the drug
Herpes simplex virus 1 and 2 (genital)type	The drug penetrates into the infected cell and turns into an active form - acyclovir triphosphate with the help of a number of enzymes of both the cell and the virus itself. Further, this substance is integrated into the DNA molecule of the virus, causing a chain break and blocking the replication process ( breeding) of its genome.	With a moderate course of the disease, adults and children are recommended to combine the systemic use of the drug with local forms. Children under 2 years of age are prescribed 100 mg 5 times a day. The last dose of the drug should be carried out at least 2 to 3 hours before bedtime. Outwardly, 5% ointment or cream is used 4-5 times a day, applying it in a thin layer, without rubbing it into the affected skin. With a more severe course of the disease, treatment begins with the appointment of the drug intravenously in the form of droppers 3 times a day, 5-10 mg / kg or 0.5 g / m 2 in one dropper for both adults and children. Drip prescription of the drug involves being under the constant supervision of medical personnel. In addition, it is important to monitor hourly diuresis ( excretion of urine) in order to determine the possible first signs of acute renal failure in time. The rate of administration of the drug should be slow, not more than 250 ml of a standard solution in 1 hour. After the patient's condition improves and a clear positive dynamics is determined, the patient is transferred to the tablet form of the drug. With concomitant herpetic keratitis, 3% eye ointments are used. They are laid behind the lower eyelid with a strip 0.5 - 1 cm long 5 times a day for 5 - 10 days.
Shingles (herpes zoster)		Since this member of the herpes virus family is less responsive to treatment with this drug, increased doses of the drug are used to improve the therapeutic effect. The optimal oral dose for adults and children over 2 years of age is 800 mg 5 times a day. For children under 2 years of age, 400 mg 5 times a day is indicated. The course of treatment takes from 7 to 15 days, and in some cases even up to one month. Drip and externally, the drug is prescribed in the same way as with the herpes simplex virus.
Chickenpox (chickenpox)		Doses in the treatment of chickenpox are identical to those for herpes zoster and are 800 mg and 400 mg for adults and for children under 2 years of age, respectively, 5 times a day. However, due to the fact that chickenpox is more often more severe in adults, treatment with the drug is indicated for this particular age group. Treatment of chickenpox in children with this drug is not recommended for two reasons. Firstly, chickenpox goes away on its own with traditional treatment with brilliant green and paracetamol. Secondly, with the use of this drug, a weaker immunity against this infection is developed, which contributes to its relapse ( re-aggravation) throughout life.
Cytomegalovirus		With these diseases, treatment is prescribed by a doctor on an individual basis, depending on the goals ( prevention or cure) and comorbidities of the patient.
Epstein-Barr virus

How to apply the medication?

Acyclovir is released to the pharmaceutical market in the form of four dosage forms:

• pills;
• powder for solution for intravenous drip infusion;
• cream / ointment for external use;
• eye ointment.

Each of these forms is available in various dosages, and also has some application features.

Pills

Tablets are available in standard doses of 200, 400 and 800 mg. Acyclovir should be taken 5 times a day only during the daytime, when the drug is not deposited in the kidneys and does not cause side effects from the genitourinary system. Food intake does not affect the absorption of acyclovir in the gastrointestinal tract, therefore, when scheduling the daily intake of this drug, one should not focus on daily meals.

The systemic use of this medicine involves some precautions. First, it is necessary to consume an increased volume of fluid during the entire period of treatment. This reduces the concentration of the drug in the urine and prevents the development of kidney disorders. Secondly, it is important to adhere to the rule - to use the last dose of the drug at least 2 - 3 hours before going to bed. Thus, at night, when the physical activity of a person is minimal, the concentration of the drug in the urine decreases. This leads to a decrease in the likelihood of acyclovir sedimentation in the renal tubules and the prevention of acute renal failure. Thirdly, it is not recommended to drink alcohol during treatment with acyclovir. These substances are neutralized in the liver by one enzyme system. When used together, the rate of neutralization of each of them decreases, which leads to two effects - severe alcohol intoxication after drinking small doses of alcohol with a severe hangover and an overdose of acyclovir. The latter effect, similar to the previous one, is dangerous for the development of acute renal failure.

With herpes simplex virus type 1 and 2, acyclovir is prescribed for adults and children over 2 years old, 200 mg 5 times a day. Children under 2 years of age are shown 100 mg 5 times a day. With the herpes virus Zoster ( shingles) adults and children over 2 years old take 800 mg of the drug 5 times a day. Children under 2 years old - 400 mg 5 times a day. With the varicella-zoster virus, the dosages are the same as for herpes zoster, but this treatment is recommended only for adults, since children tolerate this infection much more easily. Treatment with acyclovir of cytomegalovirus and Epstein-Barr virus is variable and depends on many factors, so the dose is set by the attending physician individually in each case.

Powder for solution for intravenous drip infusion

This drug is available as a lyophilisate, packaged in 250 mg, 500 mg and 1 g in 15 ml and 20 ml vials. A solution for intravenous administration is prepared as follows. First, the amount of saline required according to the instructions is added to the vial with the drug. The resulting suspension is shaken until a clear concentrated solution is formed. The resulting solution is then added to a large dropper bottle ( not less than 250 ml) after which it is stirred again until the final solution is obtained.

Before the first intravenous administration, it is mandatory to conduct a skin prick test to exclude the patient from an allergy to acyclovir. To do this, a shallow scratch is made on the palmar surface of the forearm with a scarifier or a needle point, onto which a drop of the test substance is applied ( in this case, acyclovir solution). The test is considered positive if, 5-10 minutes after the application of the substance, a pronounced area of ​​​​inflammation appears around the scratch. In this case, administering the drug intravenously is strictly contraindicated. If inflammation is not observed, then you can safely proceed to the introduction of the drug.

An important feature of the parenteral administration of acyclovir is that its concentration in the body should not increase sharply. According to numerous studies, this leads to acute renal failure. In order to avoid this complication, it is necessary that a single dose of the drug is administered for at least one hour, and preferably even more than one hour.

Doses of acyclovir for intravenous administration are approximately the same for all diseases of the herpes family. For adults and children, it is calculated based on the patient's body weight. On average, the drug is prescribed at 5 mg / kg 3 times a day. In herpetic encephalitis, the dose is doubled to 10 mg/kg 3 times a day. Thus, the maximum daily dose is 30 mg/kg. In addition, it is possible to dose the drug based on the surface area of ​​the patient's skin. This technique is more often used in the treatment of pediatric patients. According to her, acyclovir should be prescribed at a maximum dose of 1.5 g per 1 m 2 of skin surface per day, divided into 3 doses. The duration of the course of treatment depends on the severity of the disease and the tolerance of the treatment by the patient due to possible adverse reactions.

Cream / ointment for external use

Acyclovir in the form of a cream or ointment is available in aluminum tubes of 2, 5 and 10 g, in which the content of acyclovir is 5%. The drug is applied to the skin, practically without rubbing into the affected area, 5 times a day. Treatment should be started at the first signs of the disease ( local itching, mild soreness, first bullae, etc.) The duration of the drug is on average from 5 to 10 days. Acyclovir helps to reduce the growth rate of the area of ​​the affected skin, as well as the faster formation of a crust and healing of the defect. It is recommended to stop using this drug after 2-3 days after the disappearance of the focus of inflammation.

If itching, redness, swelling or other manifestations of an allergic reaction occur at the site of application of the ointment or cream, the drug should be immediately washed off the skin surface and not used in the future. In addition, you should consult a doctor to replace acyclovir with another drug that does not cause allergies.

During treatment with acyclovir, it is not recommended to independently remove the crusts that form on the surface of the vesicles. This slows down the healing process and contributes to the infection of people in contact with the sick. It is also important not to apply a topical cream or ointment to mucous membranes. This increases the likelihood of developing a local inflammatory process.

It is important to consider that acyclovir does not prevent the transmission of viruses during sexual intercourse, therefore, in order to protect both partners, it is recommended to use condoms. However, there is one feature associated with them. Vaseline, which is part of the ointment, interacts with the latex that makes up the condom, and weakens its mechanical properties. In other words, when using acyclovir ointments, the risk of condom rupture increases.

Eye ointment

Eye ointment is produced at a concentration of 3% or 30 mg / g and is found in aluminum tubes with a volume of 4.5 and 5 g. The ointment is placed behind the lower eyelid in the form of a strip 0.5 - 1 cm long. in order for the drug to spread along the cornea and be absorbed into the surrounding tissues. The ointment is applied 5 times a day. The duration of the course of treatment is from 5 to 10 days. If there are signs of allergic conjunctivitis, the use of the ointment should be discontinued and a doctor should be consulted to replace the drug.

Possible side effects

Acyclovir causes the most pronounced side effects when used systemically. When using a skin ointment, cream or eye ointment, adverse reactions are only local inflammatory-allergic in nature.

The systemic use of acyclovir is fraught with the development of disorders from:

• digestive tract;
• nervous system;
• hematopoietic systems;
• of cardio-vascular system;
• urinary system, etc.

Gastrointestinal disorders:

• liquid stool, etc.

Nervous system disorders:

• dizziness;
• excitation;
• confusion;
• delirium, etc.

Disorders of the hematopoietic system:

• hemolytic anemia ( a decrease in the number of red blood cells and / or hemoglobin due to their destruction);
• DIC ( disseminated intravascular coagulation syndrome);
• leukopenia/leukocytosis ( decrease / increase in the number of white blood cells) and etc.

Cardiovascular disorders:

• strong heartbeat;
• tachycardia ( increase in heart rate);
• functional heart murmurs;
• chest pain;
• cardiac arrhythmias, etc.

Urinary system disorders:

• acute renal failure with rapid intravenous administration;
• increase in urea and creatinine in blood serum.

If a scarification allergic test for acyclovir perfusion solution is not performed in a patient with an increased allergic background, the likelihood of developing anaphylactic shock is high.

Approximate cost of medication

The cost of acyclovir varies greatly depending on factors such as the form of release, dose, manufacturer, etc. In addition, there are also transportation costs, registration fees and mark-ups of various pharmacy chains, which can significantly change the price of the drug.

The average cost of acyclovir in various regions of the Russian Federation

City	Price
	Pills (200 mg - 20 pcs.)	Powder for solution for intravenous drip (250 mg - 1 pc.)	Ointment / cream for external use (5% - 5 g)	Eye ointment (3% - 5 g)
Moscow	29 rubles	17 rubles	17 rubles	69 rubles
Kazan	32 rubles	17 rubles	19 rubles	63 rubles
Tyumen	20 rubles	16 rubles	19 rubles	62 rubles
Krasnoyarsk	24 rubles	12 rubles	18 rubles	59 rubles
Samara	20 rubles	16 rubles	18 rubles	64 rubles
Chelyabinsk	28 rubles	15 rubles	17 rubles	61 ruble

Reviews

Can acyclovir be used in children?

Acyclovir is approved for use by children of all ages.

Despite the fact that there are certain differences between the physiology of a child and an adult, the drug manufacturers do not limit its use to patients under the age of 18 years.

Acyclovir in the form of an ointment or cream for external use is prescribed for children in the same way as for adults - 5 times a day, applied to the foci of rashes on the skin. There are also no differences in the use of eye ointment. A strip of ointment 0.5 - 1 cm long is placed in the space between the eye and the lower eyelid. Then the eye is closed for a few minutes, so that the medicine spreads over the surface of the cornea and is absorbed. Such procedures are carried out 5 times a day. The duration of treatment is from 5 to 10 days. During treatment with eye ointment, it is recommended to refrain from using contact lenses in order to avoid reactive inflammation and damage to the lenses themselves.

Acyclovir tablets are prescribed for children over 2 years of age in the same dosage as for adult patients. For children under 2 years of age, acyclovir is indicated at a half dose with the same frequency of administration. Thus, with herpes types 1 and 2, children over 2 years old are shown 200 mg 5 times a day, and children under 2 years old - 100 mg 5 times a day. With herpes zoster, children over 2 years old are prescribed 800 mg 5 times a day, and children under 2 years old - 400 mg 5 times a day. The same principle applies to cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus.

When using acyclovir in the form of a lyophilisate for the preparation of a solution for intravenous administration, the dose is calculated based on the patient's body weight or skin surface area in both adults and children of all ages. Thus, the optimal dose for drip administration of acyclovir is 5-10 mg/kg every 8 hours. The maximum daily dose is 30 mg/kg or 1.5 g/m 2 divided into 3 doses. The drug should be administered slowly at least 1 hour) under the supervision of medical personnel and under the control of endogenous creatinine clearance ( a laboratory indicator that evaluates kidney function).

Can aciclovir be used by pregnant and breastfeeding women?

Acyclovir is not contraindicated during pregnancy and lactation, however, its use is recommended only when the expected benefit outweighs the potential harm to the mother and the growing fetus.

This drug has a pronounced purposeful action. In other words, it affects only cells in which DNA is present ( deoxyribonucleic acid is a large molecule in which the gene is encoded) virus. Healthy body cells are absolutely not damaged by acyclovir. Thus, this antiviral agent does not cause developmental anomalies or retardation in mental and physical development in newborns. This fact was confirmed in the study of teratogenic ( causing developmental anomalies) the effect of acyclovir on rats treated with high doses of the drug for a long time. As a result of the study, it turned out that even after exorbitant doses, offspring were born without bodily defects.

On humans, such experiments have not been carried out, since they are inhumane. However, observational studies show that the percentage of children born with developmental anomalies in women who took acyclovir in the first trimester of pregnancy does not differ from those who did not take this drug. In view of the foregoing, we can conclude that this drug is safe for pregnant women, but there are some clarifications.

The first clarification is the fact that an insufficient number of women participated in the described study, which casts doubt on the correctness of the original conclusions. Secondly, among other things, acyclovir has a number of side effects that occur not only in pregnant women, but also in ordinary patients. Thus, it can cause disorders in the gastrointestinal tract, nervous system, genitourinary system, etc., which can significantly affect the course of pregnancy.

However, if there is still a need to resort to the use of this medication, then it is advisable to use only local forms, that is, ointments and creams. They do not create high concentrations of the active substance in the blood, therefore they are less dangerous in terms of side effects. The use of tablets and especially solutions for intravenous drip infusion should be avoided.

However, in exceptional cases, when there are vital indications for the use of acyclovir, the systemic forms of the drug are preferred, but under the strict supervision of medical personnel.

Is it possible to smear with acyclovir in the mouth?

Acyclovir should not be smeared in the mouth, as this may cause a local mucosal inflammatory reaction or more severe complications.

Each form of medicinal substance is intended exclusively for strictly defined routes of administration. In other words, tablets administered orally should be swallowed and only in the stomach begin to act. Powders for the preparation of solutions for intravenous drip can only be administered parenterally, since when taken orally, they will, at best, have no effect. Similarly, ophthalmic ointment and topical creams should only be used as directed.

Such restrictions are determined by the properties of the active substance. In particular, acyclovir is a rather strong irritant for the oral mucosa and in most cases causes local inflammation at the site of contact. In addition, in addition to the active substance, the cream or ointment contains many ballast substances that are not intended to be swallowed. They are most likely to cause gastrointestinal disturbances such as nausea, vomiting, epigastric pain, diarrhea, etc.

The outcome of using an ointment or cream of acyclovir in the oral cavity in a patient who does not know that he is allergic to this substance can be much more deplorable. Such cases, unfortunately, are not uncommon. The speed and severity of an allergic reaction often depends on the way the allergen enters the body. Thus, skin contact with an allergen is more likely to cause hives or allergic dermatitis. Tablets and intravenous agents are more likely to cause shock in a patient who is allergic to the injected substance. If the urticaria disappears after using several suprastin tablets, then anaphylactic shock requires urgent measures to save the patient's life, which can only be provided by medical personnel who have the necessary medicines at their disposal.

Considering that the rate of absorption of substances from the oral cavity is equivalent to intramuscular injection, with good reason one should be wary of the development of severe allergic complications in patients with an increased allergic background. These complications include angioedema (angioneurotic edema). angioedema) and anaphylactic shock. The first is manifested by progressive swelling of the soft tissues of the face with spread to the neck and upper chest. The greatest danger is the transition of edema to the glottis, leading to its closure. The second complication is anaphylactic shock, which is manifested by a sharp drop in blood pressure and loss of consciousness.

Is it possible to combine acyclovir with alcohol?

The use of alcoholic beverages during treatment with acyclovir is strongly discouraged by drug manufacturers and physicians. However, an amendment should be made that we are talking only about the use of this drug systemically, that is, in the form of tablets and droppers. Skin creams and ointments, as well as eye ointments, do not create high concentrations of the active substance in the blood, so this prohibition does not apply to them.

The reason for the incompatibility lies in the fact that both acyclovir and ethyl alcohol are neutralized in the liver using a single enzyme system. As a result, each of the substances slows down the neutralization of a competitor, leading to its accumulation in the body.

Slow excretion of ethyl alcohol leads to the fact that the patient's resistance to alcoholic beverages is significantly reduced. In other words, when drinking even a small dose of alcohol, a person quickly gets drunk and slowly sobers up. The consequence is an increase in the toxic effect of alcohol and its metabolites ( more toxic than ethyl alcohol itself) on the central nervous system and internal organs. In addition to all of the above, the next morning the patient will experience a severe hangover.

Slow elimination of acyclovir from the body leads to its accumulation and, ultimately, to an overdose with all the ensuing side effects. The most severe of these is acute renal failure, requiring the patient to prescribe extracorporeal methods for removing creatinine, urea and other protein breakdown products. In the absence of these funds ( simple or peritoneal dialysis) the patient runs the risk of entering a uremic coma. Even with assistance at this stage, there is a high probability of serious brain damage. In the absence of assistance and in the future, the patient dies in less than 1 week.

Which of the analogues of acyclovir is more effective?

To date, the vast majority of acyclovir analogues are drugs of the same high quality level. However, in rare cases, you can buy, frankly, a fake, although recently there have been fewer and fewer such cases.

Medicines are divided into 2 groups - originals and generics. Original drugs are those that were released for the first time by one of the pharmaceutical companies that spent certain resources on its development. Such companies issue a patent for an invention, according to which other competing companies do not have the right to produce the same drug for an average of 5 to 10 years. After this time, the inventing company must disclose the formula of the drug and methods of its manufacture so that other companies can release it on the market at a lower target, which would make the drug more accessible to the masses. This copy of the drug is called a generic.

However, in practice things are different. The company-inventor announces the formula and the main points of the process of obtaining the drug, keeping many secrets in secret in order to maintain market leadership for some time. Competing companies take on average another 5 to 10 years to bring the quality of their drug to the level of the original.

The result is the following picture. The first 5 - 10 years the original drug is unique in its kind. In the next 5 - 10 years, its numerous analogues appear, which are actually inferior to it in quality. In total, from 10 to 20 years after the invention of the drug, the originals are superior in quality to generics. Further, analogues are equalized with the original, which is certainly beneficial for the patient who purchases a quality product at a lower price.

Acyclovir was invented over 25 years ago. Based on the foregoing, one can easily conclude that all self-respecting pharmaceutical concerns have been producing a drug that is not inferior in quality to the original for at least 5 years. Thus, we can conclude that all generics of acyclovir are equally good for treatment.

Nevertheless, there remains, albeit small, but the chance that some unscrupulous company produces a fake product. In order to reduce the likelihood of its acquisition, it is recommended to buy medicines in large pharmacies. Such pharmacies often work with trusted suppliers who guarantee a quality product.

Will acyclovir help with herpes?

Acyclovir is highly likely to help with the herpes simplex virus. However, there are also acyclovir-resistant strains of the virus that need treatment with other drugs.

The mechanism of action of acyclovir causes the suppression of activity and the destruction of the herpes simplex virus, thereby justifying its effectiveness. According to clinical guidelines, acyclovir and similar drugs are prescribed primarily in the treatment of herpetic viral infections, regardless of the severity of the viral process. The most successful therapeutic results are noted with the early appointment of this drug.

The therapeutic effects of this drug are:

• a significant reduction in the duration of the acute period of the disease ( the period of appearance of new rashes);
• early formation of crusts on the surface of the rash;
• suppression of the spread of herpetic eruptions;
• reduction of pain intensity and general intoxication syndrome;
• reduction in the frequency of relapses;
• reduction in the frequency and severity of complications, etc.

The effectiveness of the treatment of the herpes virus in the acute period of the disease increases with the simultaneous use of two drug forms of the drug - oral ( pills) and local ( ointments and creams). This ensures the suppression of viral activity both in the patient's blood and directly in the affected area. This combination is acceptable for mild and moderate forms of infection.

For the treatment of severe common forms of herpes with simultaneous damage to the eyes, skin, mucous membranes and internal organs, acyclovir is prescribed in the form of intravenous drip infusions. In parallel with this, local forms are also applied.

Acyclovir has a positive antiherpetic effect, regardless of the presence and degree of immune suppression. For this reason, it is successfully used for the prevention of herpesvirus infections in patients with severe immunodeficiency of various etiologies.

Treatment of herpes simplex virus types 1 and 2 with acyclovir is carried out in different ways, depending on the severity of the course of the disease. Based on this, various drug forms of the drug are used.

Treatment of herpes simplex with acyclovir

Pharmaceutical form	Indications for use	Patient's age
		Adults and children over 2 years old	Children under 2 years old
Ointment or cream for external use (5% - 2, 5, 10 g)	For the first time or recurrent herpetic eruptions on the skin of the face.	Ointment or cream is applied directly to the rash, covering their entire area 5 times a day. The duration of the course of treatment is 5-10 days. If skin cream / ointment gets on the oral mucosa, rinse it with plenty of water.
Eye ointment (3% - 4.5.5 g)	Herpetic keratitis ( needs to consult an ophthalmologist).	The ointment is applied to the lower eyelid in the form of a strip 0.5 - 1 cm long. Then the eyelid is lowered and the eye is closed for several minutes in order for the drug to spread and be absorbed into the cornea. The ointment is applied 5 times a day for 5 to 10 days. During treatment, it is recommended not to use contact lenses.
Pills (200 mg)	The appearance of rashes on the genitals ( needs a consultation with a urologist or gynecologist). It is preferable to use tablets and cream in parallel.	Acyclovir is taken 200 mg 5 times a day for 5 to 10 days. Tablets should be taken only during the daytime, regardless of the meal. The last dose should be taken 2 to 3 hours before bedtime.	For children under 2 years of age, acyclovir is indicated at 100 mg 5 times a day for 5 to 10 days. Recommendations for use are the same as for adults.
Powder for solution for intravenous drip (250 mg)	Severe herpetic lesions of the eyes, skin, brain and internal organs.	The dose is calculated based on the patient's body weight or the area of ​​his skin. On average, 5-10 mg / kg or 500 mg / m 2 are prescribed 3 times a day. Intravenous drip administration of a single dose should last at least 1 hour. Before starting the procedure, it is necessary to conduct a scarification test to determine an allergy to the drug. It is necessary to constantly monitor the patient's condition by medical personnel.	For children under 2 years old, the dose is 2 times less than in adults with the same frequency of administration. Recommendations for use are the same as for adults.

Do I need a prescription to buy acyclovir?

To date, all forms of release of acyclovir can be purchased at almost any pharmacy. However, according to the requirements and standards of the Ministry of Health, it is only possible to purchase ointments containing acyclovir as an active ingredient without a doctor's prescription. To buy tablets and solutions of this drug, you need a prescription from your doctor. This is due to the fact that acyclovir in the wrong dosages can cause serious side effects.

The most common of these are a local allergic reaction, fever, soreness at the site of application of the ointment, burning, itching, etc.

Influencing the gastrointestinal tract(gastrointestinal tract)this drug may cause:

• nausea;
• vomiting;
• diarrhea
• abdominal pain, etc.

In addition, acyclovir can adversely affect the hematopoietic system.

The most common side effects that this drug has on blood cells are:

• hemolytic anemia ( decrease in the concentration of hemoglobin and / or erythrocytes in peripheral blood due to their premature destruction);
• leukocytosis/leukopenia ( leukocytes in peripheral blood);
• thrombocytosis/thrombocytopenia ( increase or decrease in the number of platelets in peripheral blood);
• DIC ( syndrome of disseminated intravascular coagulation due to a sharp decrease in the number of platelets and clotting factors) and etc.

When taking the tablet form, crystalline forms of the drug settle in the renal tubules. In order to prevent this from happening, throughout the course of treatment, it is necessary to drink the tablets with plenty of liquid. It is also recommended to take the last dose of the drug at least 2 to 3 hours before bedtime, in order to reduce the concentration of the drug at night and also prevent precipitation of the drug in the kidneys. With intravenous drip, it is necessary that the rate of penetration of the drug into the blood is such that one single dose ( on average 250 - 500 mg) was administered for at least one hour.

If these conditions are not observed, the following side effects from the urinary system may occur:

• hematuria ( the presence of blood in the urine);
• acute renal failure with rapid intravenous administration ( a sharp decrease in the excretory function of the kidneys, accompanied by the accumulation of urea and residual nitrogen in the blood).

Aciclovir should be used with caution in patients with psychiatric disorders, as its use may lead to an aggravation of the mental state.
From the side of the nervous system, the appearance of:

• dizziness;
• hallucinations;
• confusion of consciousness;
• delirium, etc.

When breastfeeding, acyclovir passes into breast milk at approximately the same concentration as in the blood of the mother ( 0,6-1,4 ). This makes it necessary to prescribe this drug to nursing mothers with great caution, only in isolated cases and according to strict indications.

What is aciclovir used for?

Acyclovir is a fairly effective antiviral agent, the most active against many viruses, which are based on a DNA molecule ( deoxyribonucleic acid - a large molecule that carries information about the genome of the virus).

However, the main field of application of this drug is the fight against herpes family viruses. This family includes 8 types of viruses, and the degree of antiviral action of acyclovir on them is different. The most pronounced effect is manifested in relation to the herpes simplex virus 1( facial) and 2 ( genital) type. Followed by herpes zoster ( shingles), varicella-zoster virus ( chickenpox), Epstein-Barr virus and cytomegalovirus. In the case of the last two representatives of this family, the antiviral effect is the least pronounced.

The action of the drug is directed exclusively to cells affected by the virus. Their distinctive feature is the presence of a special enzyme - viral thymidine kinase. This enzyme starts a chain of biochemical reactions by which acyclovir is converted from an inactive form to an active one - acyclovir triphosphate. This substance significantly slows down replication ( reproduction) of the virus, is embedded in its structure and leads to its instability and decay.

However, even when acyclovir is used against herpes simplex virus, for which it is the first-line drug, treatment failures occur. This is due to the fact that a fairly significant percentage of virus strains with resistance to this drug circulates in the population. Such a virus is called acyclovir-resistant and requires the appointment of more specific and narrowly targeted drugs, that is, drugs of the second and third line of treatment.

Which is better, acyclovir ointment or tablets?

When answering this question, it should be noted that it in itself is not entirely correct, since the ointment and tablets are dosage forms of the same substance. This means that their choice is based, rather, on the severity and manifestations of a particular disease, rather than on the subjective preferences of the patient.

Ointments and creams based on acyclovir have a local effect. Moreover, given the fact that they are perfectly absorbed into the skin and mucous membranes, their use in point manifestations of the disease is considered the most justified. Tablets have a systemic effect and are indicated for more severe forms of the disease with damage to internal organs and important nervous structures ( brain and spinal cord).

From the foregoing, one might get the impression that acyclovir in tablet form exhibits a more pronounced effect than in local form. However, in fact, the effect is equally strong in both cases, but the scope is different.

In addition, do not forget about the side effects of the drug, the severity of which increases several times when using tablets compared to ointments and creams for external use. In other words, if you treat, for example, small rashes around the lips for the first time with acyclovir tablets for 5 to 10 days at an average dose for an adult - 1 g per day, then the severity of side effects may outweigh the effect of treatment.

Fields of application of external and systemic dosage forms of acyclovir

local forms (ointment and cream)	System forms (tablets and droppers)
Local cutaneous forms of herpes simplex virus type 1 (new-onset or recurrent rarely)	Local forms of herpes simplex virus type 1 (often recurrent or with unusual localization (cheeks, forehead, chin, etc.))
Local, minor manifestations of the herpes virus type 2 (genital)	Abundant local or frequently recurrent manifestations of herpes simplex virus type 2
	Herpetic stomatitis, pharyngitis, or tonsillitis
	Chickenpox (chickenpox)
	Shingles
	Epstein-Barr virus
	Cytomegalovirus
	Unspecified immunodeficiency (for the treatment and prevention of a wide range of viruses)

Often, in severe viral infections involving both internal organs and skin, they resort to the parallel use of local and systemic dosage forms of acyclovir. Such treatment is recognized as more effective, but before starting it, it is imperative to consult with an infectious disease specialist or dermatologist.