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Thursday, February 10, 2011

valacyclovir hydrochloride

Posted by Sampil 2:27 AM, under | 1 comment

valacyclovir hydrochloride
(val ah sye' kloe ver)
Valtrex

Pregnancy Category B

Drug class
Antiviral

Therapeutic actions
Antiviral activity; inhibits viral DNA replication and deactivates viral DNA polymerase.

Indications
·        Treatment of herpes zoster (shingles)
·        Episodic treatment of first-episode or recurrent genital herpes in immunocompetent patients
·        Suppression of recurrent episodes of genital herpes in HIV patients
·        Reduction of risk of heterosexual transmission of genital herpes to healthy partners when combined with safe sex practices
·        Treatment of cold sores (herpes labialis) in healthy adults

Contraindications and cautions
·        Contraindicated with allergy to valacyclovir or acyclovir.
·        Use cautiously with pregnancy, renal impairment, thrombotic thrombocytopenic purpura, lactation.

Available forms
Tablets—500 mg, 1 g

Dosages
ADULTS
·        Herpes zoster: 1 g tid PO for 7 days; most effective if started within 48 hr of onset of symptoms.
·        Genital herpes: 1 g PO bid for 7–10 days.
·        Episodic treatment of recurrent genital herpes: 500 mg PO bid for 3 days.
·        Suppression of recurrent episodes of genital herpes: 1 g PO daily; patients with history of less than nine episodes in 1 yr may respond to 500 mg PO daily.
·        Reduction of risk of transmission: 500 mg/day PO daily for the source partner.
·        Cold sores: 2 g PO bid for 1 day.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH RENAL IMPAIRMENT
Creatinine Clearance (mL/min)
Dose
> 50
1 g q 8 hr
30–49
1 g q 12 hr
10–29
1 g q 24 hr
< 10
500 mg q 24 hr
Dosage adjustment varies depending on indications

Normal Dose



Indication
Creatinine clearance > 50
Creatinine clearance 30–49
Creatinine clearance 10–29
Creatinine clearance 10
Herpes zoster
1 g q 8 hr
1 g q 12 hr
1 g q 24 hr
500 mg q 24 hr
Genital herpes
initial treatment
1 g q 12 hr
1 g q 12 hr
1 g q 24 hr
500 mg q 24 hr
Genital herpes
recurrent episodes
500 mg q 12 hr
500 mg q 12 hr
500 mg q 24 hr
500 mg q 24 hr
Genital herpes
suppressive therapy
1 g q 24 hr
1 g q 24 hr
500 mg q 24 hr
500 mg q 24 hr
For 9 or fewer recurrences per year
500 mg q 24 hr
500 mg q 24 hr
500 mg q 48 hr
500 mg q 48 hr

Pharmacokinetics
Route
Onset
Peak
Oral
Rapid
3 hr

Metabolism: Not metabolized; T1/2: 2.5–3.3 hr
Distribution: Crosses placenta: enters breast milk
Excretion: Feces, urine

Adverse effects
·        CNS: Headache, dizziness
·        GI: Nausea, vomiting, diarrhea, anorexia
·        GU: Acute renal failure

Interactions
·        Decreased rate of effectiveness with probenecidcimetidine

Nursing considerations
CLINICAL ALERT!
Name confusion has been reported with Valtrex (valacyclovir) and Valcyte (valganciclovir); use caution.

Assessment
·        History: Allergy to valacyclovir, acyclovir; renal disease; lactation; thrombotic thrombocytopenic purpura, pregnancy
·        Physical: Orientation; urinary output; abdominal examination, normal output; BUN, creatinine clearance

Interventions
·        Begin treatment within 72 hr of onset of symptoms of shingles.
·        Administer without regard to meals; administer with meals to decrease GI upset if needed.
·        Provide appropriate analgesics for headache, discomfort of shingles.
·        Advise continued use of safe sex practices.

Teaching points
·        Take this drug without regard to meals; if GI upset is a problem, take with meals.
·        Take the full course of therapy as prescribed.
·        Avoid contact with lesions and avoid intercourse when lesions or symptoms are present to avoid infecting others.
·        Start therapy at first sign of an episode when treating recurrent herpes.
·        You may experience these side effects: Nausea, vomiting, loss of appetite, diarrhea; headache, dizziness.
·        Report severe diarrhea, nausea; headache; worsening of the shingles.

Adverse effects in Italic are most common; those in Bold are life-threatening.

1 comments:

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