Zovirax - instructions for use, analogs, reviews and release forms (eye ointment 3%, cream 5%, tablets 200 mg, injections in ampoules) for oral and genital herpes in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Zovirax. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Zovirax in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Zovirax in the presence of existing structural analogues.Use to treat oral and genital herpes in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Zovirax An antiviral drug, a synthetic analogue of the purine nucleoside, which has the ability to inhibit the in vitro and in vivo replication of herpes simplex virus type 1 and 2, the Varicella zoster virus, the Epstein-Barr virus (EBV) and cytomegalovirus (CMV). In the cell culture, Acyclovir (the active substance of Zovirax) has the most pronounced antiviral activity against Herpes simplex type 1 (oral herpes), followed by Herpes simplex type 2 (genital herpes), Varicella zoster, EBV and CMV.

The effect of Zovirax on viruses is highly selective. Acyclovir is not a substrate for the enzyme thymidine kinase of uninfected cells, so it is low-toxic for mammalian cells. Thymidine kinase cells infected with Herpes simplex type 1 and 2 viruses, Varicella zoster, EBV and CMV, converts acyclovir to acyclovir monophosphate, an analogue of the nucleoside, which is then sequentially converted to a diphosphate and triphosphate by cell enzymes. Inclusion of acyclovir triphosphate in a chain of viral DNA and subsequent chain termination block further replication of the viral DNA.

In patients with severe immunodeficiency, prolonged or repeated courses of therapy with acyclovir can lead to the formation of resistant strains, and therefore further treatment with acyclovir may not be effective. Most of the isolated strains with reduced sensitivity to acyclovir showed a relatively low content of viral thymidine kinase, a breakdown in the structure of viral thymidine kinase or DNA polymerase.

Composition

Acyclovir + excipients.

Pharmacokinetics

When administered orally, acyclovir is only partially absorbed from the intestine. The concentration of acyclovir in the cerebrospinal fluid is approximately 50% of its plasma concentration. Acyclovir to a small extent (9-33%) binds to blood plasma proteins. The main metabolite of acyclovir is 9-carboxymethoxy-methylguanine, which accounts for about 10-15% of the administered dose in urine. Most of the drug is excreted by the kidneys unchanged.

Indications

• treatment of skin and mucous membrane infections caused by the herpes virus type 1 and 2, including primary and recurrent genital herpes;
• prevention of recurrence of infections caused by the herpes simplex (herpes virus) type 1 and 2, in patients with normal immune status;
• prevention of infections caused by the herpes virus type 1 and 2, in patients with immunodeficiency;
• treatment of infections caused by the virus Varicella zoster (varicella and herpes zoster);
• treatment of patients with severe immunodeficiency, mainly with HIV infection, with early clinical manifestations of HIV infection and with a developed clinical picture of AIDS);
• prevention of cytomegalovirus infection in bone marrow transplant recipients;
• Keratitis caused by the herpes virus type 1 and 2.

Forms of release

Eye ointment 3%.

Cream for external use 5%.

Tablets 200 mg.

Lyophilizate for the preparation of a solution for infusions (injections in ampoules for injections).

Instructions for use and dosage

Ointment

For adults and children, a preparation in the form of an ointment strip 10 mm long should be placed in the lower conjunctival sac. Multiplicity of application 5 times a day with an interval of about 4 hours. Therapy should be continued for another 3 days after the healing.

Cream

The drug is recommended to apply 5 times a day (approximately every 4 hours) a thin layer on the affected and adjacent areas of the skin and mucous membranes.

Duration of treatment - at least 4 days.In the absence of healing, treatment can be continued up to 10 days. If the symptoms persist for more than 10 days, you should consult your doctor.

The cream is applied either with a cotton swab or with clean hands to avoid additional infection of the affected areas.

Pills

Adults for the treatment of infections caused by the Herpes simplex virus type 1 and 2, the recommended dose of Zovirax is 200 mg 5 times a day every 4 hours (except during the night sleep). Usually the course of treatment is 5 days, but can be prolonged with severe primary infections.

If the immunodeficiency is expressed (for example, after bone marrow transplantation) or if there is a violation of absorption from the intestine, the dose of Zovirax for oral administration may be increased to 400 mg 5 times a day. Treatment should be started as soon as possible after the onset of infection; with relapses the drug is recommended to be prescribed already in the prodromal period or with the appearance of the first elements of the rash.

To prevent recurrence of infections caused by the herpes simplex virus type 1 and 2, the recommended dose of Zovirax is 200 mg 4 times a day (every 6 hours) in patients with normal immune status.A more convenient therapy scheme is suitable for many patients: 400 mg twice a day (every 12 hours). In some cases, lower doses of Zovirax are effective: 200 mg 3 times a day (every 8 hours) or 2 times a day (every 12 hours). Treatment with Zovirax should be interrupted periodically for 6-12 months to identify possible changes in the course of the disease.

To prevent the occurrence of infections caused by the herpes virus type 1 and 2, in patients with immunodeficiency the recommended dose of Zovirax is 200 mg 4 times a day (every 6 hours). If the immunodeficiency is expressed (for example, after bone marrow transplantation) or if there is a violation of absorption from the intestine, the dose of Zovirax for oral administration may be increased to 400 mg 5 times a day. The duration of the preventive course of therapy is determined by the duration of the infection risk period.

For the treatment of varicella zoster and herpes zoster, the recommended dose of Zovirax is 800 mg 5 times a day, the drug is taken every 4 hours, except during the night sleep. The course of treatment is 7 days.

The drug should be prescribed as soon as possible after the onset of infection, tk. in this case, treatment is more effective.

For treatment of patients with severe immunodeficiency, the recommended dose of Zovirax is 800 mg 4 times a day (every 6 hours).

Patients who underwent bone marrow transplantation before the appointment of Zovirax inside are usually advised to take intravenous therapy with acyclovir within 1 month. In clinical trials, the maximum duration of treatment for bone marrow transplant recipients was 6 months (from the 1st to the 7th month after transplantation). In patients with a developed clinical picture of HIV infection, the course of treatment with Zovirax was 12 months, but there is reason to believe that longer courses of therapy may be effective in such patients.

Treatment and prevention of infections caused by herpes viruses in children with immunodeficiency aged 2 years and older - the same dose as for adults; at the age younger than 2 years - half the dose for adults.

For treatment of chicken pox for children over 6 years of age, the drug is prescribed in a single dose of 800 mg; from 2 to 6 years - 400 mg; less than 2 years - 200 mg. Multiplicity of admission 4 times a day. More precisely, a single dose can be determined from the calculation of 20 mg / kg body weight (but not more than 800 mg).The course of treatment is 5 days.

Data on the use of Zovirax for the prevention of recurrence of infections caused by herpes viruses and in the treatment of herpes zoster in children with normal immunity parameters are absent.

Zovirax tablets can be taken with meals, because eating does not violate a significant extent of its absorption. Tablets should be washed down with a full glass of water.

Ampoules

The drug is intended for intravenous infusion.

Adults for treatment of infections caused by herpes viruses (with the exception of herpetic encephalitis) and Varicella zoster, the drug is prescribed at a dose of 5 mg / kg body weight every 8 hours.

For the treatment of infections caused by the Varicella zoster virus and herpetic encephalitis in patients with immunodeficiency, intravenous infusions are administered at a dose of 10 mg / kg body weight every 8 hours (with normal kidney function).

To prevent cytomegalovirus infection during bone marrow transplantation, the drug is used at a dose of 500 mg / m2 body surface 3 times a day at intervals of 8 hours. The duration of treatment is from 5 days to transplantation and up to 30 days after transplantation.

In patients with obesity, the same doses are recommended, as in patients with normal body weight.

Children aged 3 months to 12 years of dose of Zoviraks for IV infusion are set depending on the body surface area.

In newborns the dosing regimen is set depending on the body weight; for infections caused by the Herpes simplex virus type 1 and 2, the recommended dose is 10 mg / kg every 8 hours. The duration of treatment for herpes encephalitis and infections caused by the Herpes simplex virus in newborns is usually 10 days.

For infections caused by Herpes simplex viruses (other than herpetic encephalitis) and Varicella zoster, the drug is administered at a dose of 250 mg / m2 every 8 hours.

For the treatment of herpetic encephalitis and infections caused by the virus Varicella zoster, in children with immunodeficiency the drug is prescribed at a dose of 500 mg / m2 every 8 hours (with normal kidney function).

Limited data suggest that for the prevention of cytomegalovirus infection in children older than 2 years who underwent bone marrow transplantation, Zovirax can be administered at the doses recommended for adults.

Children with reduced renal function require a dose adjustment in accordance with the degree of renal failure.

In elderly patients with reduced clearance of creatinine, a dose reduction should be considered.

The course of treatment with Zovirax in the form of IV infusions is usually 5 days, but may vary depending on the patient's condition and response to therapy.

The duration of preventive use of Zovirax in the form of intravenous infusions is determined by the duration of the infection risk period.

Side effect

• nausea, vomiting;
• anemia, leukopenia, thrombocytopenia;
• increased levels of urea and creatinine in the blood;
• confusion of consciousness;
• hallucinations;
• excitation;
• tremor;
• drowsiness;
• psychosis;
• convulsions and coma (usually in predisposed patients);
• rash;
• photosensitization;
• hives;
• itching;
• fever;
• dyspnea;
• angioedema;
• anaphylaxis;
• severe inflammatory reactions leading to necrosis, when the solution of Zovirax falls under the skin.

Contraindications

• increased sensitivity to acyclovir or valacyclovir.

Application in pregnancy and lactation

The appointment of Zovirax during pregnancy and lactation (breastfeeding) requires caution and is possible only after assessing the intended benefit to the mother and the potential risk to the fetus and the baby.

There was no increase in the number of birth defects in children whose mothers received Zovirax during pregnancy, compared with the general population.

When using Zoviraks in the form of lyophilizate during lactation (breastfeeding), it should be borne in mind that after taking Zovirax inside at a dose of 200 mg 5 times a day, acyclovir was detected in breast milk in concentrations of 0.6-4.1% of plasma concentrations. At such concentrations in breast milk, infants breastfed can receive acyclovir in a dose of up to 0.3 mg / kg per day.

Use in children

Children aged 3 months to 12 years of dose of Zovirax for intravenous infusion are set depending on the surface area of ​​the body.

In newborns the dosing regimen is set depending on the body weight; for infections caused by the herpes virus type 1 and 2, the recommended dose is 10 mg / kg every 8 hours. The duration of treatment for herpes encephalitis and infections caused by the herpes virus in newborns is usually 10 days.

Treatment and prevention of infections caused by Herpes simplex viruses in children with immunodeficiency at the age of 2 years and older - the same dose as for adults; at the age younger than 2 years - half the dose for adults.

For treatment of chicken pox for children over 6 years of age, the drug is prescribed in a single dose of 800 mg; from 2 to 6 years - 400 mg; less than 2 years - 200 mg. Multiplicity of admission 4 times a day. More precisely, a single dose can be determined from the calculation of 20 mg / kg body weight (but not more than 800 mg). The course of treatment is 5 days.

Data on the use of Zovirax for the prevention of recurrence of infections caused by Herpes simplex viruses and in the treatment of herpes zoster in children with normal immunity parameters are absent.

According to the very limited information available for treatment of children older than 2 years with severe immunodeficiency, the same dose of Zovirax can be used as for the treatment of adults.

special instructions

In patients with herpetic encephalitis receiving Zovirax in high doses, it is necessary to monitor renal function (especially with dehydration or with an initial impairment of kidney function).

With caution and under the control of kidney function, Zovirax should be used concomitantly with drugs that disrupt kidney function (eg, cyclosporin, tacrolimus).

The prepared Zoviraks solution has pH = 11, so it can not be used inside.

Drug Interactions

Clinically significant interactions of Zovirax with other medications have not been reported.

When applied simultaneously with Zovirax preparations outputting by active tubular secretion, may increase the concentration of the active substances or their metabolites in plasma (caution is required when assigning such combinations).

The combined use of acyclovir and mycophenolate mofenila, immunosuppressant employed during organ transplantation, increases the parameter AUC of acyclovir and mycophenolate mofenila inactive metabolite.

Analogues of the drug Zovirax

Structural analogs for the active substance:

• Acigerpine;
• Acyclovir;
• Acyclostad;
• Vero Acyclovir;
• Vivorax;
• Virolex;
• Gervirax;
• Gerpevir;
• Gerperax;
• Herpes;
• Zovirax;
• Lysavir;
• The Medovar;
• Provirsan;
• Supperan;
• Cyclovax;
• Cyclovir;
• Cytivir.

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