ANTIVIRAL MEDICATIONS

PRICING INFO


References:

Medication Dosage Form Dosing Other
Acyclovir

Zovirax®
Xerese®
Capsule
  • 200 mg ($)

Tablet
  • 400 mg
  • 800 mg ($)

Suspension
  • 200 mg/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 - 80 mg/kg/day (max 3200 mg/day) given in 4 divided doses for 5 days (PI)

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

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

Famvir®
Tablet
  • 125 mg
  • 250 mg
  • 500 mg ($-$$)
Adults
  • Genital herpes
    • Initial episode - 250 mg 3 times a day for 7 - 10 days (CDC)
    • Recurrent episode
      • 125 mg twice daily for 5 days (CDC)
      • 1000 mg twice daily for 1 day (CDC)
      • 500 mg once, followed by 250 mg twice daily for 2 days (CDC)
    • Preventive therapy (chronic suppressive) - 250 mg twice daily (CDC)
  • Herpes labialis (fever blister)
    • Acute episode - 1500 mg one time dose
    • Preventive therapy (chronic suppressive) - 500 mg twice a day
  • Herpes zoster (shingles) - 500 mg every 8 hours for 7 days (IDSA, PI)
  • May take without regard to food
  • Pregnancy category B
  • Kidney disease
    • CrCl ≥ 60 ml/min: no adjustment necessary
    • CrCl ≤ 59 ml/min: - see Famciclovir PI
Valacyclovir

Valtrex®
Tablet
  • 500 mg
  • 1000 mg ($)
Pediatric
Adults
  • Bell Palsy - 1000 mg three times a day for 7 days (CTE)
  • Genital herpes
    • Initial episode - 1000 mg twice daily for 7 - 10 days (CDC)
    • Recurrent episode
      • 500 mg twice daily for 3 days (CDC)
      • 1000 mg once daily for 5 days (CDC)
    • Preventive therapy (chronic suppressive) - 500 - 1000 mg once daily. For patients with ≥ 10 episodes a year, 1000 mg a day is preferred (CDC)
  • Herpes labialis (fever blister)
    • Acute episode - 2000 mg twice a day for 1 day (PI)
    • Preventive therapy (chronic suppressive) - 500 - 1000 mg once a day (PI)
  • Herpes zoster (shingles) - 1000 mg three times a day for 7 days (IDSA, PI)
  • May take without regard to food
  • Pregnancy category B
  • Kidney disease
    • CrCl ≥ 50 ml/min: no adjustment necessary
    • CrCl ≤ 49 ml/min: - see Valacyclovir PI
  • Instructions for forming an oral suspension from a valacyclovir tablet are available in the PI - Oral suspension instructions

Medication Dosage Form Dosing Other
Oseltamivir

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

Suspension
  • 6 mg/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)
      • ≤ 15 kg: 30 mg twice a day for 5 days
      • > 15 to 23 kg: 45 mg twice a day for 5 days
      • > 23 to 40 kg: 60 mg twice a day for 5 days
      • > 40 kg: 75 mg 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: 30 mg once a day for 7 days
      • > 15 to 23 kg: 45 mg once a day for 7 days
      • > 23 to 40 kg: 60 mg once a day for 7 days
      • > 40 kg: 75 mg once a day for 7 days

Adults - CDC recommendations
  • 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.
  • Kidney disease
    • Treatment
      • CrCl 31 - 60 ml/min - 30 mg two times a day for 5 days
      • CrCl 11 - 30 ml/min - 30 mg once daily for 5 days
      • CrCl ≤ 10ml/min - 30 mg after hemodialysis for 5 days
    • Prophylaxis
      • CrCl 31 - 60 ml/min - 30 mg once daily
      • CrCl 11 - 30 ml/min - 30 mg every other day
      • CrCl ≤ 10 ml/min - 30 mg after alternate hemodialysis cycles
Baloxavir

Xofluza®
Tablet
  • 20 mg
  • 40 mg ($$$$)
  • Comes in dose pack of two 20 mg tablets or two 40 mg tablets
Adults and adolescents (≥ 12 years old)
  • Influenza - acute infection
    • 88 lbs (40 kg) to < 176 lbs (80 kg): single dose of 40 mg
    • ≥ 176 lbs (80 kg): single dose of 80 mg
    • Should be taken within 48 hours of symptom onset
  • May take without regard to food
  • Avoid co-administration of baloxavir with polyvalent cation-containing laxatives, antacids, or oral supplements (e.g., calcium, iron, magnesium, selenium, or zinc)
  • Baloxavir may decrease the effectiveness of intranasal live attenuated influenza vaccine (LAIV)
  • Kidney disease
    • CrCl ≥ 50 ml/min: no dose adjustment necessary
    • CrCl < 50 ml/min - has not been studied
  • Liver disease
    • Child-Pugh A/B: no dose adjustment necessary
    • Child-Pugh C - has not been studied

Studies:
  • Baloxavir vs Placebo for Influenza, NEJM (2018) - Randomized, controlled trial (N=922) in patients with influenza and symptoms < 48 hours. Results: Median time to alleviation of symptoms (Baloxavir - 53.7 hours, Placebo - 80.2 hours, p<0.001) [PMID 30184455]
Zanamivir

Relenza®
Inhalation powder
  • 1 package contains twenty 5 mg inhalations ($$)
  • 1 dose = 10 mg (two inhalations)
Pediatric - CDC recommendations

Adults - CDC recommendations
  • The strongest evidence for a benefit from zanamivir is when it is initiated within 48 hours of symptom onset
  • 10 mg 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