- ACRONYMS AND DEFINITIONS
- PI - Dosing from manufacturer's package insert
- IDSA - Infectious Disease Society of America
- CDC - Centers for Disease Control and Prevention
- CTE - Dosing based on clinical trial(s) and/or expert opinion
- HERPES MEDICATIONS
Acyclovir | Zovirax® | Sitavig® | Xerese®
Dosage forms
Capsule
- 200 mg ($)
Tablet
- 400 mg ($)
- 800 mg ($)
Buccal tablet (Sitavig®)
- 50 mg ($$$$)
- Comes in pack with 2 tablets
Suspension
- 200 mg/5ml ($)
Cream
- 5% cream ($$$$)
- Comes in 5 gram tube
Ointment
- 5% ointment ($)
- Comes in 15 and 30 gram tube
Xerese® cream
- Acyclovir : Hydrocortisone
- 5% : 1% ($$$$)
- Comes in 5 gram tube
Dosing
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)
- Capsule, tablet, suspension
- Acute episode - 400 mg five times a day for 5 days
- Preventive therapy (chronic suppressive) - 400 mg twice a day
- Buccal tablet (Sitavig®)
- Apply one 50 mg buccal tablet to the upper gum region (canine fossa) (PI)
- 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.
Other
- May take without regard to food
- Pregnancy - based on available data, appears to be safe
- Kidney disease
- CrCl > 25 ml/min: - no adjustment necessary
- CrCl ≤ 25 ml/min: - see Acyclovir PI
Famciclovir (Famvir®)
Dosage forms
Tablet
- 125 mg ($)
- 250 mg ($)
- 500 mg ($)
Dosing
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)
Other
- May take without regard to food
- Pregnancy - based on available data, appears to be safe
- Kidney disease
- CrCl ≥ 60 ml/min: no adjustment necessary
- CrCl ≤ 59 ml/min: - see Famciclovir PI
Valacyclovir (Valtrex®)
Dosage forms
Tablet
- 500 mg ($)
- 1000 mg ($)
Dosing
Pediatric
- Chickenpox (ages 2 - 18 years) - 20 mg/kg/dose (max 1000 mg/dose) administered 3 times daily for 5 days (PI)
- Herpes labialis (ages 12 years and older) - 2000 mg twice a day for 1 day (PI)
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)
Other
- May take without regard to food
- Pregnancy - based on available data, appears to be safe
- 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
- INFLUENZA MEDICATIONS
Baloxavir (Xofluza®)
Dosage forms
Tablet
- 40 mg ($$$$)
- 80 mg ($$$$)
Suspension
- 40 mg/20 mL (2 mg/mL)
- Comes in 20 ml bottle ($$$$)
- After constitution, good for 10 hours at room temp
Dosing
Influenza treatment or postexposure prophylaxis (adults and children ≥ 5 years old)
- Tablets
- 44 lbs (20 kg) to less than 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 or contact with an infected person (prophylaxis)
- Suspension
- < 44 lbs (20 kg): 2 mg/kg taken as a single dose
- 44 lbs (20 kg) to less than 176 lbs (80 kg): 40 mg (20 ml) taken as a single dose
- ≥ 176 lbs (80 kg): 80 mg (40 ml) taken as a single dose
- Should be taken within 48 hours of symptom onset or contact with an infected person (prophylaxis)
Efficacy
Influenza infection
Influenza prevention
Other
- May take without regard to food
- Avoid co-administration of baloxavir with polyvalent cation-containing laxatives, dairy products, calcium-fortified beverages, antacids, or oral supplements (e.g., calcium, iron, magnesium, selenium, or zinc)
- Store constituted suspension no longer than 10 hours at room temperature. Discard suspension after 10 hours if unused.
- 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
Oseltamivir (Tamiflu®)
Dosage forms
Capsule
- 30 mg ($)
- 45 mg ($)
- 75 mg ($)
Suspension
- 6 mg/ml ($)
Dosing
Pediatric (CDC recommendation)
- 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 recommendation)
- Influenza - Acute infection
- 75 mg twice daily for 5 days
- Influenza - Prophylaxis
- 75 mg once daily for 7 days
Efficacy
Other
- 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
Zanamivir (Relenza®)
Dosage forms
Inhalation powder
- 1 package contains twenty 5 mg inhalations ($$)
- 1 dose = 10 mg (two inhalations)
Dosing
Pediatric (CDC recommendations)
- Influenza - Acute infection
- Age ≥ 7 years: 10 mg (two 5 mg inhalations) twice a day for 5 days
- Influenza - Prophylaxis
- Age ≥ 5 years: 10 mg (two 5 mg inhalations) once a day for 7 days
Adults (CDC recommendations)
- Influenza - Acute infection
- 10 mg (two 5 mg inhalations) twice daily for 5 days
- Influenza - Prophylaxis
- 10 mg (two 5 mg inhalations) once daily for 7 days
Other
- 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
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $150
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- Manufacturer's package insert