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What is acyclovir?Acyclovir is an antiviral drug. It slows the growth and spread of the herpes virus so that the body can fight off the infection. Acyclovir will not cure herpes, but it can lessen the symptoms of the infection. Acyclovir is used to treat infections caused by herpes viruses. Illnesses caused by herpes viruses include genital herpes, cold sores, shingles, and chicken pox. Acyclovir may also be used for purposes other than those listed in this medication guide. What is the most important information I should know about acyclovir?Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Treatment with acyclovir should be started as soon as possible after the first appearance of symptoms (such as tingling, burning, blisters). Herpes infections are contagious and you can infect other people, even while you are being treated with acyclovir. Avoid letting infected areas come into contact with other people. Avoid touching an infected area and then touching your eyes. Wash your hands frequently to prevent passing the infection to others. What should I discuss with my healthcare provider before taking acyclovir?Do not take this medicine if you are allergic to acyclovir or valacyclovir (Valtrex). Before taking acyclovir, tell your doctor if you are allergic to any drugs, or if you have kidney disease. You may need a dosage adjustment or special tests during treatment. FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Herpes virus can be passed from an infected mother to her baby during childbirth. If you have genital herpes, it is very important to prevent herpes lesions during your pregnancy so that you do not have a genital lesion when your baby is born. Acyclovir passes into breast milk and may harm a nursing infant. Do not take this medication without telling your doctor if you are breast-feeding a baby. How should I take acyclovir?Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Treatment with acyclovir should be started as soon as possible after the first appearance of symptoms (such as tingling, burning, blisters). Take each dose with a full glass of water. Drink plenty of water while you are taking acyclovir to keep your kidneys working properly. Acyclovir can be taken with or without food. Taking acyclovir with food may decrease stomach upset. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Acyclovir will not treat a viral infection such as the common cold or flu. Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions. Store acyclovir at room temperature away from moisture and heat. What happens if I miss a dose?Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose?Seek emergency medical attention if you think you have used too much of this medicine. Symptoms of an acyclovir overdose may include seizure (convulsions), hallucinations, and urinating less than usual or not at all. What should I avoid while taking acyclovir?Herpes infections are contagious and you can infect other people, even while you are being treated with acyclovir. Avoid letting infected areas come into contact with other people. Avoid touching an infected area and then touching your eyes. Wash your hands frequently to prevent passing the infection to others. Acyclovir will not prevent the spread of genital herpes. Avoid sexual intercourse or use a latex condom to prevent spreading the virus to others. Acyclovir side effectsGet emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using acyclovir and call your doctor at once if you have any of these serious side
Continue using acyclovir and talk with your doctor if you have any of these less serious side effects:
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. What other drugs will affect acyclovir?Before taking acyclovir, tell your doctor if you are also taking probenecid (Benemid). If you are using probenecid, you may not be able to use acyclovir, or you may need dosage adjustments or special tests during treatment. There may be other drugs that can affect acyclovir. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. What is the shelf life of the pills?
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Clinical Trials
Initial Genital Herpes
Double-blind, placebo-controlled studies have demonstrated that orally administered Zovirax significantly reduced the duration of acute infection and duration of lesion healing. The duration of pain and new lesion formation was decreased in some patient groups.
Recurrent Genital Herpes
Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that orally administered Zovirax given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences in greater than 95% of patients.
In a study of patients who received Zovirax400 mg twice daily for 3 years, 45%, 52%, and 63% of patients remained free of recurrences in the first, second, and third years, respectively. Serial analyses of the 3-month recurrence rates for the patients showed that 71% to 87% were recurrence free in each quarter.
Herpes Zoster Infections
In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, Zovirax (800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced the duration of viral shedding and the duration of new lesion formation.
In a similar double-blind, placebo-controlled study, Zovirax (800 mg 5 times daily for 7 days) shortened the times to complete lesion scabbing, healing, and cessation of pain; reduced the duration of new lesion formation; and reduced the prevalence of localized zoster-associated neurologic symptoms (paresthesia, dysesthesia, or hyperesthesia).
Treatment was begun within 72 hours of rash onset and was most effective if started within the first 48 hours.
Adults greater than 50 years of age showed greater benefit.
Adverse Reactions
Herpes Simplex
Short-Term Administration
The most frequent adverse events reported during clinical trials of treatment of genital herpes with Zovirax 200 mg administered orally 5 times daily every 4 hours for 10 days were nausea and/or vomiting in 8 of 298 patient treatments (2.7%). Nausea and/or vomiting occurred in 2 of 287 (0.7%) patients who received placebo.
Long-Term Administration
The most frequent adverse events reported in a clinical trial for the prevention of recurrences with continuous administration of 400 mg (two 200-mg capsules) 2 times daily for 1 year in 586 patients treated with Zovirax were nausea (4.8%) and diarrhea (2.4%). The 589 control patients receiving intermittent treatment of recurrences with Zovirax for 1 year reported diarrhea (2.7%), nausea (2.4%), and headache (2.2%).
Herpes Zoster
The most frequent adverse event reported during 3 clinical trials of treatment of herpes zoster (shingles) with 800 mg of oral Zovirax 5 times daily for 7 to 10 days in 323 patients was malaise (11.5%). The 323 placebo recipients reported malaise (11.1%).
Chickenpox
The most frequent adverse event reported during 3 clinical trials of treatment of chickenpox with oral Zovirax at doses of 10 to 20 mg/kg 4 times daily for 5 to 7 days or 800 mg 4 times daily for 5 days in 495 patients was diarrhea (3.2%). The 498 patients receiving placebo reported diarrhea (2.2%).
Overdosage
Overdoses involving ingestion of up to 100 capsules (20 g) have been reported. Adverse events that have been reported in association with overdosage include agitation, coma, seizures, and lethargy. Precipitation of acyclovir in renal tubules may occur when the solubility (2.5 mg/mL) is exceeded in the intratubular fluid. Overdosage has been reported following bolus injections or inappropriately high doses and in patients whose fluid and electrolyte balance were not properly monitored. This has resulted in elevated BUN and serum creatinine and subsequent renal failure. In the event of acute renal failure and anuria, the patient may benefit from hemodialysis until renal function is restored .
Zovirax Dosage and Administration
Acute Treatment of Herpes Zoster
800 mg every 4 hours orally, 5 times daily for 7 to 10 days.
Genital Herpes
Treatment of Initial Genital Herpes
200 mg every 4 hours, 5 times daily for 10 days.
Chronic Suppressive Therapy for Recurrent Disease
400 mg 2 times daily for up to 12 months, followed by re-evaluation. Alternative regimens have included doses ranging from 200 mg 3 times daily to 200 mg 5 times daily.
The frequency and severity of episodes of untreated genital herpes may change over time. After 1 year of therapy, the frequency and severity of the patient’s genital herpes infection should be re-evaluated to assess the need for continuation of therapy with Zovirax.
Intermittent Therapy
200 mg every 4 hours, 5 times daily for 5 days. Therapy should be initiated at the earliest sign or symptom (prodrome) of recurrence.
Treatment of Chickenpox
Children (2 years of age and older)
20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox.
Adults and Children over 40 kg
800 mg 4 times daily for 5 days.
Intravenous Zovirax is indicated for the treatment of varicella-zoster infections in immunocompromised patients.
When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox. There is no information about the efficacy of therapy initiated more than 24 hours after onset of signs and symptoms.
Pregnancy and Urinary Tract Infection
A urinary tract infection is an infection in the body's system involved in excreting urine. This system includes:
* The kidneys
* The ureter (tube that carries urine from the kidneys to the bladder)
* The bladder
* The urethra (a short tube that carries urine from the bladder to outside
the body)
The infection most often occurs in the urethra and bladder. It can also travel from the bladder into the ureter and kidneys.
What Causes Urinary Tract Infections (UTIs)?
Bacteria are usually the cause of UTIs. Normally a person's urine does
not contain bacteria. Bacteria are naturally present on the skin, in
the lower bowel and in the stool itself. Sometimes bacteria from one
of these sources enter the urinary tract system. Once there, they multiply
and cause pain and irritation.
How Does Bacteria Lead to an Urinary Tract Infection?
Many times there is no obvious reason. The ways urinary tract infections occur in pregnancy is the same as in a nonpregnant woman. Some of the ways bacteria enter the urinary tract include:
* Partial blockage of a urinary passage (from the pressure of an enlarged
uterus, for example).
* Sexual intercourse.
* Catheters (tubes placed into the bladder that empty the bladder for
sick people).
* Stool that gets wiped into the vagina after a bowel movement.
Who Gets Urinary Tract Infections?
Anyone can get a urinary tract infection, but it is most common in women. Women can get the infection from sexual intercourse when bacteria near the vagina gets pushed up into the urinary tract.
Do Urinary Tract Infections Cause Serious Health Problems?
With proper care, urinary tract infections rarely cause serious health
problems. Most infections are limited to the bladder and urethra. Once
in awhile a urinary tract infection will lead to a kidney infection.
Are Urinary Tract Infections Harmful to Pregnant Women?
Pregnancy and urinary tract infections often go hand in hand since pregnant women are at an increased risk to develop UTIs. Pregnancy hormones cause changes in the urinary tract which predispose women to infections. In addition, as the uterus grows it presses on the bladder and can prevent complete emptying of urine. This stagnant urine is a likely source for infection. Untreated, these infections may lead to kidney infections. Urinary tract infections in pregnant women should be treated to prevent complications.
How Do I Know If I Have an Urinary Tract Infection?
Urinary tract infection symptoms include:
* Feeling an urgent need to urinate or frequent urination.
* Having difficulty urinating.
* Having a burning sensation or cramps in the lower back or lower abdomen.
* Having a burning sensation during urination.
* Urine that looks cloudy or has an odor.
If I Think I May Have an Urinary Tract Infection, What Should I Do?
If you think you have a urinary tract infection, tell your health care provider. He or she will test a small sample of urine for bacteria and red and white blood cells. The urine may also be tested to see what kind of bacteria are in the urine (called a urine culture).
If your infection is causing discomfort, you will probably be treated before the urine test results come back.
How Are Urinary Tract Infections Treated?
Urinary tract infections are treated with antibiotics. You will need to take the medicine for 7 days or as determined by your health care provider.
How Soon Does the Medicine Work for Urinary Tract Infections?
The symptoms should go away in three days. But, don't stop taking your medication early, even if the symptoms go away (unless instructed by your health care provider).
How Can I Avoid Getting Urinary Tract Infections?
* Drink at least eight glasses of water a day.
* Wipe yourself from front to back.
* Empty your bladder shortly before and after sex.
* Use a water-based lubricant during intercourse if you feel dry.
* Don't douche.
* Don't use feminine deodorants or strong soaps.
* Change feminine pads often.
* Wash the genital area with warm water before sex.
* Wear cotton underwear.
* Take showers instead of baths.
* Avoid tight fighting clothing and pantyhose.
Bacterial Vaginosis
Bacterial vaginosis is the most common type of vaginal infection.
What is bacterial vaginosis?
Bacterial vaginosis is a mild infection of the vagina caused by bacteria. Normally, there are a lot of "good" bacteria and some "bad" bacteria in the vagina. The good types help control the growth of the bad types. In women with bacterial vaginosis, the balance is upset. There are not enough good bacteria and too many bad bacteria.
Bacterial vaginosis is usually a mild problem that goes away on its
own in a few days. But it can lead to more serious problems, so it’s
a good idea to see your doctor and get treatment.
What causes bacterial vaginosis?
Experts are not sure what causes the bacteria in the vagina to get out of balance. But certain things make it more likely to happen. Your risk of getting bacterial vaginosis is higher if you:
* Have more than one sex partner.
* Have a female sex partner.
* Have a sexually transmitted disease (STD).
* Use an IUD for birth control.
* Douche.
You may be able to avoid bacterial vaginosis if you limit your number of sex partners and don't douche.
Bacterial vaginosis is more common in women who are sexually active, but it is not something you catch from another person.
What are the symptoms?
The most common symptom is a smelly vaginal discharge. It may look grayish white or yellow. A sure sign of bacterial vaginosis is a "fishy" smell, which may be worse after sex. About half of women who have bacterial vaginosis do not notice any symptoms.
Many things can cause abnormal vaginal discharge, including some sexually transmitted diseases (STDs). See your doctor so you can be tested and get the right treatment.
How is bacterial vaginosis diagnosed?
Doctors diagnose bacterial vaginosis by asking about the symptoms, doing a pelvic exam, and taking a sample of the vaginal discharge. The sample can be tested to find out if you have bacterial vaginosis.
What problems can bacterial vaginosis cause?
Bacterial vaginosis usually does not cause other health problems. But it can lead to serious problems in some cases.
* If you have it when you are pregnant, it increases the risk of miscarriage,
early (preterm) delivery, and uterine infection after pregnancy.
* If you have it when you have a pelvic procedure such as a C-section,
abortion, or hysterectomy, you are more likely to get a pelvic infection.
* If you have it and you are exposed to a sexually transmitted disease
(including HIV), you are more likely to catch the disease.
Getting treated with antibiotics can help prevent these problems.
How is it treated?
Doctors usually prescribe an antibiotic to treat bacterial vaginosis. The ones used most often are metronidazole and clindamycin. They come as pills you swallow or as a cream or capsules (called ovules) you put in your vagina. If you are pregnant, you will need to take pills.
Bacterial vaginosis usually clears up in 2 or 3 days with antibiotics, but treatment goes on for 7 days. Do not stop using your medicine just because your symptoms are better. It is important to take the full course of antibiotics.
If you are treated with antibiotics:
* Avoid all alcohol use if you are taking metronidazole. This includes
over-the-counter medicines that contain alcohol, such as NyQuil. Mixing
alcohol and metronidazole can cause severe nausea and vomiting.
* Don't trust condoms or diaphragms if you use antibiotic creams or
ovules. These treatments have an oil that can weaken latex. This can
cause condoms and diaphragms to fail.
Antibiotics usually work well and have few side effects. But taking them can lead to a vaginal yeast infection. A yeast infection can cause itching, redness, and a lumpy, white discharge. If you have these symptoms, talk to your doctor about what to do.