Drugs five years later: acyclovir.

Abstract

In the 5 years since its release for clinical use, acyclovir (9-[2-hydroxyethoxymethyl]guanine) has proved to be a safe and effective agent for therapy of herpes simplex and varicella-zoster infections. The drug's availability in topical, oral, and intravenous preparations has allowed its use in a range of clinical situations. Acyclovir must be phosphorylated by viral thymidine kinase in infected cells, where it then acts to inhibit viral DNA replication specifically. Epstein-Barr virus and human cytomegalovirus infections do not seem to respond to acyclovir therapy, although in-vitro effects on these viruses may be seen. Acyclovir is well absorbed and distributed, with cerebrospinal fluid levels 50% that of plasma. Clearance is almost entirely by the renal route, with a half-life of 20 hours in the anuric patient. Acyclovir has an excellent safety profile, its major adverse effect being transient serum creatinine elevations during high-dose intravenous use. Major uses include treatment of primary and recurrent genital herpes and herpes encephalitis and prophyllaxis and therapy of mucocutaneous herpes and varicella-zoster infections in immunocompromised patients. Resistance to acyclovir in herpes simplex virus is rarely encountered and does not seem to be due to long-term chronic suppressive therapy.

• Authors: D I Dorsky, C S Crumpacker
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 107 Issue 6 Pg. 859-74 (Dec 1987) ISSN: 0003-4819 [Print] United States
• PMID: 3318610 (Publication Type: Journal Article, Review)

Chemical References

• Ganciclovir
• Acyclovir

Topics

• Acyclovir (adverse effects, analogs & derivatives, pharmacokinetics, pharmacology, therapeutic use)
• Chickenpox (drug therapy)
• Drug Interactions
• Drug Resistance, Microbial
• Ganciclovir
• Herpes Simplex (drug therapy)
• Herpes Zoster (drug therapy)
• Herpesviridae (drug effects)
• Humans
• Postoperative Complications (prevention & control)
• Transplantation