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Mucocutaneous HSV: Topical: Ointment: Non-life-threatening, immunocompromised: 1 / 2 ” ribbon of ointment for a 4” square surface area every 3 hours (6 times/day) for 7 days Dosing: Pediatric (For additional information see "Acyclovir (topical): Pediatric drug information" )

Herpes labialis (cold sores): Topical: Children ≥12 years: Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Cream, topical: Zovirax®: 5% (2 g, 5 g) Ointment, topical: 5% (15 g) Zovirax®: 5% (15 g, 30 g) Generic Equivalent Available: U.S. Yes: Excludes cream Administration Topical: Not for use in the eye. Apply using a finger cot or rubber glove to avoid transmission to other parts of the body or to other persons. Use Treatment of herpes labialis (cold sores), mucocutaneous HSV in immunocompromised patients Medication Safety Issues Sound-alike/look-alike issues: Acyclovir may be confused with ganciclovir, Retrovir®, valacyclovir Zovirax® may be confused with Doribax®, Valtrex®, Zithromax®, Zostrix®, Zyloprim®, Zyvox® International issues: Opthavir [Mexico] may be confused with Optivar brand name for azelastine [U.S.] Adverse Reactions Significant >10%: Dermatologic: Mild pain, burning, or stinging (ointment 30%) 1% to 10%: Dermatologic: Pruritus (ointment 4%), itching Contraindications Hypersensitivity to acyclovir, valacyclovir, or any component of the formulation Warnings/Precautions

Disease-related concerns: • Genital herpes: Appropriate use: Physical contact should be avoided when lesions are present; transmission may also occur in the absence of symptoms. Treatment should begin with the first signs or symptoms. • Herpes labialis: Appropriate use: For external use only to the lips and face; do not apply to eye or inside the mouth or nose. Treatment should begin with the first signs or symptoms.

Special populations: • Immunocompromised patients: Use with caution in immunocompromised patients. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) There are no known significant interactions. Pregnancy Risk Factor B ( show table ) Pregnancy Implications Teratogenic effects were not observed in animal studies. When administered orally, acyclovir crosses the placenta. Refer to the Acyclovir, Systemic monograph for details. The amount of acyclovir available systemically following topical application of the cream or ointment is significantly less in comparison to oral doses. Breast-Feeding Considerations When administered orally, acyclovir enters breast milk. Refer to the Acyclovir, Systemic monograph for details. The amount of acyclovir available systemically following topical application of the cream or ointment is significantly less in comparison to oral doses. Nursing mothers with herpetic lesions near or on the breast should avoid breast-feeding. Pricing: U.S. (Medi-Span®)

Ointment (Zovirax External) 5% (30 g): $807.28 International Brand Names A.C.V. (TH); Acic (EE); Acic Creme (DE); Aciclidan (DK); Aciclomed (BE); Aciclor (VE); Aciclosina (PT); Acifar (ID); Aciherpin (PH); Acilax Cream (HK); Acivir (CH, IL, IN); Acivir Cold Sore Cream (AU); Acivirex (GT, HN, NI, SV); Activir (FR); Acyvir (EC); Anti (SE); Antix (NO); Avir (VE); Avorax (SG); Cicloferon (CR, DO, GT, PA, SV); Cicloviral (CO); Clinovir (ID, TH); Clovir (TW); Covelay (PH); Covir Cream (TH); Cycloherp (HK); Cyclomed (IL); Cyclostad (PH); Cyclovax (HK); Cyclovir (IN); Danovir (ID); Declovir (HK); Deherp (TW); Dravyr (SG); Ecuvir (EC); Entir (TH); Eurovir (PY); Expit (UY); Ezopen Creme (BR); Herpesin (CZ); Herpevir (FR); Herpex (IN); Lisovyr Cream (AR); Lisovyr Crema (CN); Lovire (ZA); Marvir (TH); Medovir (MY); Oppvir (TW); Poviral (AR); Qualiclovir (HK); Remex (FR); Vicorax (TW); Viratop (BE); Virex (CO); Virless (SG); Virogon (TH); Virzin (DE); Vivir (KP); Zeven (MY); Zevin (TH); Zoral (HK, MY, SG); Zorax (SG); Zovir (DK); Zovirax (AR, AU, BB, BE, BM, BR, BS, CH, CL, CN, CZ, EC, EE, FI, FR, GB, GY, HK, ID, IE, IL, JM, KP, MY, NL, NO, NZ, PE, PR, PT, PY, SE, TH, TT, TW, UY, ZA) Mechanism of Action Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA. Pharmacodynamics/Kinetics Absorption: Plasma concentrations following topical application of the cream were below the limit of detection in 5/6 male volunteers (<0.01μM) and 0.014 μM in one subject. Following application of the ointment to patients with varicella-zoster infection, acyclovir plasma concentrations were <0.01-0.28 mcg/mL in patients with normal renal function and <0.01-0.78 mcg/mL in a patient with renal impairment. Excretion: Urine (0.04% of the daily dose following topical application of the cream; <0.02% to 9.4% of the daily dose following topical application of the ointment) Use of UpToDate is subject to the Subscription and License Agreement . Topic 8649 Version 40.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0603-125.39.66.147-B9BF6B98CC-S244013.14]