ANTIVIRAL 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
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


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)

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)
Adults (CDC recommendations)

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


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