Herpes Simplex Virus Infection Drug Summary

Drug	Dosage	Remarks
Aciclovir(Acyclovir)	Genital HSV disease:  Primary infection: 200 mg PO 5x/day during waking hour x 5-10 days; may be increased to 400 mg/day in immunocompromised patients Recurrent infection: 200 mg PO 6 hourly to 5x/day or 400 mg PO 8-12 hourly x 5 days Suppressive treatment: 200 mg PO 6 hourly or 400 mg PO 12 hourly x 6-12 months	Adverse Reactions Generally well tolerated Oral: CNS effects (malaise, headache); GI effects (nausea/vomiting, diarrhea) IV: Local effects (inflammation and phlebitis at injection site); Renal effects (increased BUN and creatinine, possible acute renal failure); GI effects (nausea/vomiting); Dermatologic effects (hives, pruritus, rash); Hepatic effect (elevated liver enzymes)  Special Instructions Use with caution in patients with renal impairment (adjust dose according to CrCl), neurological abnormalities, significant hypoxia, serious hepatic or electrolyte abnormalities Parenteral administration by slow IV over 1 hour to avoid precipitation in kidney; rapid bolus injection should be avoided, maintain adequate hydration
	Orolabial HSV disease: Primary infection: Children <2 years old: 15 mg/kg PO 5x/day x 7-10 days or 100 mg PO 5x/day during waking hour x 5-10 days Adults and children >2 years old: 200 mg PO 5x/day during waking hour x 5-10 days  Recurrent infection: 200-400 mg PO 5x/day x 4-5 days or until lesions are healed Prophylaxis against recurrent infection due to known stimulation (eg UV exposure): 400 mg PO 12 hourly x 4-5 days or until lesions are healed
	For severe infection: Children <3 months: 10 mg/kg IV 8 hourly x 10 days Children 3 months-12 years old: 250 mg/m2 IV 8 hourly x 5 days Adults: 5-20 mg/kg IV over 1 hour 8 hourly x 5-7 days or until with clinical improvement followed by oral antiviral therapy to complete at least 10 days of total therapy
Famciclovir	Genital HSV disease: Primary infection: 250 mg PO 8 hourly x 5 days Recurrent infection: 1,000 mg PO 12 hourly on day 1, 500 mg PO as single dose on day 2, 250 mg PO 12 hourly on day 3 and 4 or 125 mg PO 12 hourly x 5 days or 1 g 12 hourly x 1 day Suppressive treatment: 250 mg PO 12 hourly x 6-12 months	Adverse Reactions CNS effects (headache, dizziness, confusion, hallucination); GI effects (abdominal pain, nausea/vomiting); Other effects (fever, skin rash) Rarely: Granulocytopenia, thrombocytopenia Special Instructions Reduce dose in patient with renal impairment Not recommended in children
	Orolabial HSV disease: Primary infection: 250 mg PO 8 hourly x 7-10 days Recurrent infection: 1,500 mg PO as single dose
Valaciclovir  (Valacyclovir)	Genital HSV disease: Primary infection: 500-1,000 mg PO 12 hourly x 5-10 days Recurrent infection: 500 mg PO 12 hourly x 3-5 days  Suppressive treatment: 500-1,000 mg PO 24 hourly or 250-500 mg PO 12 hourly Immunocompromised: 1,000 mg PO 12 hourly x at least 5 days	Adverse Reactions Generally well tolerated Oral: CNS effects (malaise, headache); GI effects (nausea/vomiting, diarrhea) IV: Local effects (inflammation and phlebitis at injection site); Renal effects (increased BUN and creatinine, possible acute renal failure); GI effects (nausea/vomiting); Dermatologic effects (hives, pruritus, rash); Hepatic effect (elevated liver enzymes)  Special Instructions Use with caution in patients with renal impairment (adjust dose according to CrCl), neurological abnormalities, significant hypoxia, serious hepatic or electrolyte abnormalities Parenteral administration by slow IV over 1 hour to avoid precipitation in kidney; rapid bolus injection should be avoided, maintain adequate hydration
	Orolabial HSV disease: Primary infection: 2,000 mg PO 12 hourly  Second dose to be taken 12 hours after first dose or 250 mg PO 8 hourly x 7-10 days Recurrent infection: 1-2 g PO 12-24 hourly x 1 day or 500 mg PO 12 hourly x 3 days  Suppressive treatment: 500 mg PO 24 hourly
Other Antiviral
Inosine dimepranol acedoben  (Inosine pranobex, Inosiplex,  Methisoprinol)	Children: 1.5-2 g PO in divided doses Adult: 3-4 g PO in divided doses or Adult and children >5 years old: 50 mg/kg/day PO divided 6-8 hourly Severe infections: 100 mg/kg/day PO divided into 4-6 doses Usual treatment duration: 7-10 days	Adverse Reactions Transient nausea/vomiting, increased uric acid concentration in serum and urine Special Instructions Use with caution in patients with impaired renal function, gout or hyperuricemia

Drug	Dosage	Remarks
Aciclovir (Acyclovir)1	Apply 5% cream on affected area 3-4 hourly x 5-10 days	Adverse Reactions Dermatologic effects (transient stinging, burning, erythema, pruritus) Special Instructions Use with caution in patients with renal impairment (adjust dose according to CrCl), neurological abnormalities, significant hypoxia, serious hepatic or electrolyte abnormalities
Penciclovir	Recurrent orolabial HSV disease: Apply 1% cream onto affected area 2 hourly during waking hour x 4 days	Adverse Reactions Transient stinging, burning and numbness Special Instructions Start at first sign of HSV infection and continue until healed
Tromantadine	Orolabial HSV disease:  Apply 1% gel onto affected area 3-5x/day or more often as needed	Adverse Reactions Contact dermatitis Special Instructions Do not use when vesicles have formed or already broken

¹Aciclovir combined with Zinc oxide is available. Please see the latest MIMS for specific formulations and prescribing information.

Drug	Dosage	Remarks
Carbenoxolone Na	Adults and children >3 years old: Apply gel 6 hourly on lesions	Special Instructions Contraindicated in pregnancy Avoid in patients with cardiac, hepatic, or renal failure and patients on digitalis glycosides
Deproteinized calf blood extract/ Polidocanol	Apply paste 3-5x/day to dried lesions	Special Instructions Not to be used in deep wounds subsequently closed by surgical suture Use with caution in infected mucous membrane or wound or in patients suffering from other illness
Povidone-iodine	Gargle undiluted 15-20 mL solution x 30 seconds 2-4x/day as required	Special Instructions Contraindicated in patients with hyperthyroidism or any thyroid diseases, on Lithium therapy and those having specific treatment involving use of radioactive iodine

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.