HERPES MEDICATIONS

Medication Dosage Form Dosing Other
Acyclovir

(Zovirax®)
Capsule
  • 200mg ($)

Tablet
  • 400mg, 800mg ($)

Suspension
  • 200mg/5ml ($$)

Cream
  • 5% cream ($$$$)
  • Comes in 5 gram tube

Ointment
  • 5% ointment ($$$$)
  • Comes in 15 and 30 gram tube

Xerese® cream
Acyclovir : hydrocortisone
  • 5% : 1% ($$$$)
  • Comes in 5 gram tube
Pediatric (2 years of age and older)
  • Chickenpox - 80mg/kg/day (max 3200mg/day) given in 4 divided doses for 5 days (PI)

Adults
  • Bell Palsy - 400mg five times daily for 10 days (CTE)
  • Herpes labialis (fever blister)
    • Acute episode - 400mg five times a day for 5 days
    • Preventive therapy (chronic suppressive) - 400mg twice a day
  • Herpes zoster (shingles) - 800 mg every 4 hours, 5 times daily for 7 to 10 days (IDSA, PI)
  • Herpes, genital
    • Initial episode
      • 400mg 3 times a day for 7 - 10 days (CDC)
      • 200mg 5 times a day for 7 - 10 days (CDC)
    • Recurrent episode
      • 400mg 3 times a day for 5 days (CDC)
      • 800mg twice a day for 5 days (CDC)
      • 800mg 3 times a day for 2 days (CDC)
    • Preventive therapy (chronic suppressive) - 400mg twice daily (CDC)
  • Chickenpox - 800mg four times daily for 5 days (PI)

Topical
  • Herpes labialis, recurrent
    • Cream - apply 5 times a day for 4 days. Approved for ≥ 12 years.
    • Xerese - apply 5 times a day for 5 days. Approved for ≥ 6 years.
  • Herpes, genital
    • Ointment - apply every 3 hours, 6 times a day, for 7 days
  • May take without regard to food
  • Kidney disease
    • CrCl > 25 ml/min: - no adjustment necessary
    • CrCl ≤ 25 ml/min: - See Zovirax PI
Famciclovir

(Famvir®)
Tablet
  • 125mg, 250mg, 500mg ($-$$)
Adults
  • Herpes labialis (fever blister)
    • Acute episode - 1500mg one time dose
    • Preventive therapy (chronic suppressive) - 500mg twice a day
  • Herpes, genital
    • Initial episode - 250mg 3 times a day for 7 - 10 days (CDC)
    • Recurrent episode
      • 125mg twice daily for 5 days (CDC)
      • 1000mg twice daily for 1 day (CDC)
      • 500mg once, followed by 250mg twice daily for 2 days (CDC)
    • Preventive therapy (chronic suppressive) - 250 mg twice daily (CDC)
  • Herpes zoster (shingles) - 500 mg every 8 hours for 7 days (IDSA, PI)
Valacyclovir

(Valtrex®)
Tablet
  • 500mg, 1000mg ($)
Pediatric
Adults
  • Bell Palsy - 1000mg three times a day for 7 days (CTE)
  • Herpes labialis (fever blister)
    • Acute episode - 2000mg twice a day for 1 day (PI)
    • Preventive therapy (chronic suppressive) - 500 - 1000mg once a day (PI)
  • Herpes zoster (shingles) - 1000mg three times a day for 7 days (IDSA, PI)
  • Herpes, genital
    • Initial episode - 1000mg twice daily for 7 - 10 days (CDC)
    • Recurrent episode
      • 500mg twice daily for 3 days (CDC)
      • 1000mg once daily for 5 days (CDC)
    • Preventive therapy (chronic suppressive) - 500 - 1000mg once daily. For patients with ≥ 10 episodes a year, 1000mg a day is preferred (CDC)



INFLUENZA MEDICATIONS

Medication Dosage Form Dosing Other
Oseltamivir

(Tamiflu®)
Capsule
  • 30mg, 45mg, 75mg ($$$)

Suspension
  • 6mg/ml ($$$)
Pediatric - CDC recommendations
  • Influenza - Acute infection
    • Age 14 days - 1 year: 3 mg/kg/dose twice daily for 5 days
    • Age > 1 year (dose based on weight)
      • 15kg or less, the dose is 30mg twice a day for 5 days
      • > 15 to 23kg, the dose is 45mg twice a day for 5 days
      • > 23 to 40kg, the dose is 60mg twice a day for 5 days
      • > 40kg, the dose is 75mg twice a day for 5 days
  • Influenza - Prophylaxis
    • Age 3 months - 1 year: 3 mg/kg/dose once daily for 7 days
    • Age > 1 year (dose based on weight)
      • 15 kg or less, the dose is 30mg once a day for 7 days
      • > 15 to 23kg, the dose is 45mg once a day for 7 days
      • > 23 to 40kg, the dose is 60mg once a day for 7 days
      • > 40kg, the dose is 75mg once a day for 7 days

Adults - CDC recommendations
  • Influenza - Acute infection
    • 75mg twice daily for 5 days
  • Influenza - Prophylaxis
    • 75mg once daily for 7 days
  • May take without regard to food
  • The strongest evidence for a benefit from oseltamivir is when it is initiated within 48 hours of symptom onset
  • Do not give live influenza vaccine (intranasal) within 2 weeks before or 48 hours after oseltamivir is given. Oseltamivir may interfere with vaccine effectiveness.
  • See influenza for more information on influenza treatment
  • Kidney disease
    • Treatment
      • CrCl 31 - 60ml/min - 30mg two times a day for 5 days
      • CrCl 11 - 30ml/min - 30mg once daily for 5 days
      • CrCl ≤ 10ml/min - 30mg after hemodialysis for 5 days
    • Prophylaxis
      • CrCl 31 - 60ml/min - 30mg once daily
      • CrCl 11 - 30ml/min - 30mg every other day
      • CrCl ≤ 10ml/min - 30mg after alternate hemodialysis cycles
Zanamivir

(Relenza®)
Inhalation powder
  • 1 package contains twenty 5mg inhalations ($$)
  • 1 dose = 10mg (two inhalations)
Pediatric - CDC recommendations
  • Influenza - Acute infection
    • Age ≥ 7 years: 10mg (two 5mg inhalations) twice a day for 5 days
  • Influenza - Prophylaxis
    • Age ≥ 5 years: 10mg (two 5mg inhalations) once a day for 7 days

Adults - CDC recommendations
  • Influenza - Acute infection
    • 10mg (two 5mg inhalations) twice daily for 5 days
  • Influenza - Prophylaxis
    • 10mg (two 5mg inhalations) once daily for 7 days
  • The strongest evidence for a benefit from zanamivir is when it is initiated within 48 hours of symptom onset
  • 10mg dose requires 2 inhalations
  • Contains lactose - do not use if have milk allergy
  • Not recommended in patients with asthma or COPD
  • Do not give live influenza vaccine (intranasal) within 2 weeks before or 48 hours after zanamivir is given. Zanamivir may interfere with vaccine effectiveness.
  • Kidney disease - no dose adjustment necessary
  • See influenza for more information on influenza treatment