Implementation

• Acyclovir treatment should be started as soon as possible after herpes simplex symptoms appear and within 24 hr of a herpes zoster outbreak

• PO: Acyclovir may be administered with food or on an empty stomach, with a full glass of water

» Shake oral suspension well before administration

• IV:
Maintain adequate hydration (2000–3000 ml/day), especially during first 2 hr after IV infusion, to prevent crystalluria
Observe infusion site for phlebitis. Rotate infusion site to prevent phlebitis
Acyclovir injectable should not be administered topically, IM, subcut, PO, or in the eye

• Intermittent Infusion:
Diluent: Reconstitute 500-mg or 1-g vial with 10 ml or 20 ml, respectively, of sterile water for injection. Do not reconstitute with bacteriostatic water with benzyl alcohol or parabens. Shake well to dissolve completely. Further dilute in at least 100 ml of D5W, 0.9% NaCl, dextrose/saline combinations or LR.
Concentration: 7 mg/ml. Patients requiring fluid restriction: 10 mg/ml

• Rate:
Administer via infusion pump over 1 hr to minimize renal tubular damage

• Use reconstituted solution within 12 hr. Once diluted for infusion, the solution should be used within 24 hr. Refrigeration results in precipitation, which dissolves at room temperature

• Y-Site Compatibility:

» allopurinol

» amikacin

» amphotericin B cholesteryl sulfate

» ampicillin

» anidulafungin

» cefazolin

» cefotaxime

» cefoxitin

» ceftazidime

» ceftizoxime

» ceftriaxone

» cefuroxime

» chloramphenicol

» cimetidine

» clindamycin

» dexamethasone sodium phosphate

» dimenhydrinate

» diphenhydramine

» docetaxel

» doxorubicin liposome

» doxycycline

» erythromycin lactobionate

» etoposide phosphate

» famotidine

» filgrastim

» fluconazole

» gentamicin

» granisetron

» heparin

» hydrocortisone sodium succinate

» hydromorphone

» imipenem/cilastatin

» lansoprazole

» linezolid

» lorazepam

» magnesium sulfate

» melphalan

» methylprednisolone sodium succinate

» metoclopramide

» metronidazole

» milrinone

» multivitamin infusion

» nafcillin

» oxacillin

» paclitaxel

» pemetrexed

» penicillin G potassium

» pentobarbital

» perphenazine

» piperacillin

» potassium chloride

» propofol

» ranitidine

» remifentanil

» sodium bicarbonate

» teniposide

» theophylline

» thiotepa

» tobramycin

» trimethoprim/sulfamethoxazole

» vancomycin

» zidovudine

• Y-Site Incompatibility:

» amifostine

» aztreonam

» cefepime

» dobutamine

» dopamine

» fludarabine

» foscarnet

» gemcitabine

» idarubicin

» levofloxacin

» ondansetron

» piperacillin/tazobactam

» sargramostim

» tacrolimus

» vinorelbine

• Additive Compatibility:

» fluconazole

• Additive Incompatibility:

» blood products

» pantoprazole

» protein-containing solutions

• Topical: Apply to skin lesions only; do not use in the eye

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