{"id":"acyclovir","rwe":[],"_fda":{"id":"cb9a2970-e0e8-4faf-9ed9-06bec3649207","set_id":"01ae85df-d1a0-44f7-b4c0-0ac74d2216d4","openfda":{"nui":["N0000020060","N0000180187","N0000180188","N0000175468","N0000175459"],"unii":["X4HES1O11F"],"route":["ORAL"],"rxcui":["197310"],"spl_id":["cb9a2970-e0e8-4faf-9ed9-06bec3649207"],"brand_name":["Acyclovir"],"spl_set_id":["01ae85df-d1a0-44f7-b4c0-0ac74d2216d4"],"package_ndc":["71335-1290-1","71335-1290-2","71335-1290-3","71335-1290-4","71335-1290-5","71335-1290-6","71335-1290-7","71335-1290-8","71335-1290-9","71335-1290-0"],"product_ndc":["71335-1290"],"generic_name":["ACYCLOVIR"],"product_type":["HUMAN PRESCRIPTION DRUG"],"substance_name":["ACYCLOVIR"],"pharm_class_epc":["Herpes Simplex Virus Nucleoside Analog DNA Polymerase Inhibitor [EPC]","Herpes Zoster Virus Nucleoside Analog DNA Polymerase Inhibitor [EPC]","Herpesvirus Nucleoside Analog DNA Polymerase Inhibitor [EPC]"],"pharm_class_moa":["DNA Polymerase Inhibitors [MoA]"],"manufacturer_name":["Bryant Ranch Prepack"],"application_number":["ANDA206261"],"original_packager_product_ndc":["61442-114"]},"version":"7","warnings":["WARNINGS Acyclovir capsules are intended for oral ingestion only. Renal failure, in some cases resulting in death, has been observed with acyclovir therapy (see ADVERSE REACTIONS: Observed During Clinical Practice and OVERDOSAGE ). Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), which has resulted in death, has occurred in immunocompromised patients receiving acyclovir therapy."],"pregnancy":["Pregnancy: Teratogenic Effects: Pregnancy Category B. Acyclovir administered during organogenesis was not teratogenic in the mouse (450 mg/kg/day, p.o.), rabbit (50 mg/kg/day, s.c. and IV), or rat (50 mg/kg/day, s.c.). These exposures resulted in plasma levels 9 and 18, 16 and 106, and 11 and 22 times, respectively, human levels. There are no adequate and well-controlled studies in pregnant women. A prospective epidemiologic registry of acyclovir use during pregnancy was established in 1984 and completed in April 1999. There were 749 pregnancies followed in women exposed to systemic acyclovir during the first trimester of pregnancy resulting in 756 outcomes. The occurrence rate of birth defects approximates that found in the general population. However, the small size of the registry is insufficient to evaluate the risk for less common defects or to permit reliable or definitive conclusions regarding the safety of acyclovir in pregnant women and their developing fetuses. Acyclovir should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus."],"overdosage":["OVERDOSAGE Overdoses involving ingestion of up to 100 capsules (20 g) have been reported. Adverse events that have been reported in association with overdosage include agitation, coma, seizures, and lethargy. Precipitation of acyclovir in renal tubules may occur when the solubility (2.5 mg/mL) is exceeded in the intratubular fluid. Overdosage has been reported following bolus injections or inappropriately high doses and in patients whose fluid and electrolyte balance were not properly monitored. This has resulted in elevated BUN and serum creatinine and subsequent renal failure. In the event of acute renal failure and anuria, the patient may benefit from hemodialysis until renal function is restored (see DOSAGE AND ADMINISTRATION )."],"description":["DESCRIPTION Acyclovir is a synthetic nucleoside analogue active against herpesviruses. Acyclovir capsules are formulations for oral administration. Each capsule contains 200 mg of acyclovir and the inactive ingredients: lactose monohydrate, sodium lauryl sulfate, corn starch, and magnesium stearate. The capsule shell consists of FD&C Blue #1, gelatin, and titanium dioxide. The imprinting ink contains, alcohol, FD&C Blue #2, FD&C Red #40, FD&C Yellow#10, iron oxide black, shellac Glaze. Acyclovir is a white, crystalline powder with the molecular formula C 8 H 11 N 5 O 3 and a molecular weight of 225. The maximum solubility in water at 37°C is 2.5 mg/mL. The pka's of acyclovir are 2.27 and 9.25. The chemical name of acyclovir is 2-amino-1,9-dihydro-9-[(2-hydroxyethoxy)methyl]-6 H -purin-6-one; it has the following structural formula:"],"precautions":["PRECAUTIONS Dosage adjustment is recommended when administering acyclovir to patients with renal impairment (see DOSAGE AND ADMINISTRATION ). Caution should also be exercised when administering acyclovir to patients receiving potentially nephrotoxic agents since this may increase the risk of renal dysfunction and/or the risk of reversible central nervous system symptoms such as those that have been reported in patients treated with intravenous acyclovir. Adequate hydration should be maintained. Information for Patients: Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become pregnant or intend to become pregnant, they intend to breast feed while taking orally administered acyclovir, or they have any other questions. Patients should be advised to maintain adequate hydration. Herpes Zoster : There are no data on treatment initiated more than 72 hours after onset of the zoster rash. Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster. Genital Herpes Infections: Patients should be informed that acyclovir is not a cure for genital herpes. There are no data evaluating whether acyclovir will prevent transmission of infection to others. Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes can also be transmitted in the absence of symptoms through asymptomatic viral shedding. If medical management of a genital herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode. Chickenpox: Chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Adolescents and adults tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course. Drug Interactions: See CLINICAL PHARMACOLOGY: Pharmacokinetics . Carcinogenesis, Mutagenesis, Impairment of Fertility: The data presented below include references to peak steady-state plasma acyclovir concentrations observed in humans treated with 800 mg given orally 5 times a day (dosing appropriate for treatment of herpes zoster) or 200 mg given orally 5 times a day (dosing appropriate for treatment of genital herpes). Plasma drug concentrations in animal studies are expressed as multiples of human exposure to acyclovir at the higher and lower dosing schedules (see CLINICAL PHARMACOLOGY: Pharmacokinetics ). Acyclovir was tested in lifetime bioassays in rats and mice at single daily doses of up to 450 mg/kg administered by gavage. There was no statistically significant difference in the incidence of tumors between treated and control animals, nor did acyclovir shorten the latency of tumors. Maximum plasma concentrations were 3 to 6 times human levels in the mouse bioassay and 1 to 2 times human levels in the rat bioassay. Acyclovir was tested in 16 in vitro and in vivo genetic toxicity assays. Acyclovir was positive in 5 of the assays. Acyclovir did not impair fertility or reproduction in mice (450 mg/kg/day, p.o.) or in rats (25 mg/kg/day, s.c.). In the mouse study, plasma levels were 9 to 18 times human levels, while in the rat study, they were 8 to 15 times human levels. At higher doses (50 mg/kg/day, s.c.) in rats and rabbits (11 to 22 and 16 to 31 times human levels, respectively) implantation efficacy, but not litter size, was decreased. In a rat peri- and post-natal study at 50 mg/kg/day, s.c., there was a statistically significant decrease in group mean numbers of corpora lutea, total implantation sites, and live fetuses. No testicular abnormalities were seen in dogs given 50 mg/kg/day, IV for 1 month (21 to 41 times human levels) or in dogs given 60 mg/kg/day orally for 1 year (6 to 12 times human levels). Testicular atrophy and aspermatogenesis were observed in rats and dogs at higher dose levels. Pregnancy: Teratogenic Effects: Pregnancy Category B. Acyclovir administered during organogenesis was not teratogenic in the mouse (450 mg/kg/day, p.o.), rabbit (50 mg/kg/day, s.c. and IV), or rat (50 mg/kg/day, s.c.). These exposures resulted in plasma levels 9 and 18, 16 and 106, and 11 and 22 times, respectively, human levels. There are no adequate and well-controlled studies in pregnant women. A prospective epidemiologic registry of acyclovir use during pregnancy was established in 1984 and completed in April 1999. There were 749 pregnancies followed in women exposed to systemic acyclovir during the first trimester of pregnancy resulting in 756 outcomes. The occurrence rate of birth defects approximates that found in the general population. However, the small size of the registry is insufficient to evaluate the risk for less common defects or to permit reliable or definitive conclusions regarding the safety of acyclovir in pregnant women and their developing fetuses. Acyclovir should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Nursing Mothers: Acyclovir concentrations have been documented in breast milk in 2 women following oral administration of acyclovir and ranged from 0.6 to 4.1 times corresponding plasma levels. These concentrations would potentially expose the nursing infant to a dose of acyclovir up to 0.3 mg/kg/day. Acyclovir should be administered to a nursing mother with caution and only when indicated. Pediatric Use: Safety and effectiveness of oral formulations of acyclovir in pediatric patients younger than 2 years of age have not been established. Geriatric Use: Of 376 subjects who received acyclovir in a clinical study of herpes zoster treatment in immunocompetent subjects ≥50 years of age, 244 were 65 and over while 111 were 75 and over. No overall differences in effectiveness for time to cessation of new lesion formation or time to healing were reported between geriatric subjects and younger adult subjects. The duration of pain after healing was longer in patients 65 and over. Nausea, vomiting, and dizziness were reported more frequently in elderly subjects. Elderly patients are more likely to have reduced renal function and require dose reduction. Elderly patients are also more likely to have renal or CNS adverse events. With respect to CNS adverse events observed during clinical practice, somnolence, hallucinations, confusion, and coma were reported more frequently in elderly patients (see CLINICAL PHARMACOLOGY , ADVERSE REACTIONS: Observed During Clinical Practice , and DOSAGE AND ADMINISTRATION )."],"how_supplied":["HOW SUPPLIED Acyclovir Capsules, 200 mg oval capsule, opaque light blue cap imprinted with a mark “200” and aqua blue opaque body imprinted with Imprint \"CTI;114\". NDC: 71335-1290-1: 30 Capsules in a BOTTLE NDC: 71335-1290-2: 25 Capsules in a BOTTLE NDC: 71335-1290-3: 35 Capsules in a BOTTLE NDC: 71335-1290-4: 50 Capsules in a BOTTLE NDC: 71335-1290-5: 100 Capsules in a BOTTLE NDC: 71335-1290-6: 40 Capsules in a BOTTLE NDC: 71335-1290-7: 60 Capsules in a BOTTLE NDC: 71335-1290-8: 120 Capsules in a BOTTLE NDC: 71335-1290-9: 20 Capsules in a BOTTLE NDC: 71335-1290-0: 90 Capsules in a BOTTLE Store at 20° to 25°C (68° to 77°F). Protect from moisture. Repackaged/Relabeled by: Bryant Ranch Prepack, Inc. Burbank, CA 91504"],"geriatric_use":["Geriatric Use: Of 376 subjects who received acyclovir in a clinical study of herpes zoster treatment in immunocompetent subjects ≥50 years of age, 244 were 65 and over while 111 were 75 and over. No overall differences in effectiveness for time to cessation of new lesion formation or time to healing were reported between geriatric subjects and younger adult subjects. The duration of pain after healing was longer in patients 65 and over. Nausea, vomiting, and dizziness were reported more frequently in elderly subjects. Elderly patients are more likely to have reduced renal function and require dose reduction. Elderly patients are also more likely to have renal or CNS adverse events. With respect to CNS adverse events observed during clinical practice, somnolence, hallucinations, confusion, and coma were reported more frequently in elderly patients (see CLINICAL PHARMACOLOGY , ADVERSE REACTIONS: Observed During Clinical Practice , and DOSAGE AND ADMINISTRATION )."],"pediatric_use":["Pediatric Use: Safety and effectiveness of oral formulations of acyclovir in pediatric patients younger than 2 years of age have not been established."],"effective_time":"20240905","nursing_mothers":["Nursing Mothers: Acyclovir concentrations have been documented in breast milk in 2 women following oral administration of acyclovir and ranged from 0.6 to 4.1 times corresponding plasma levels. These concentrations would potentially expose the nursing infant to a dose of acyclovir up to 0.3 mg/kg/day. Acyclovir should be administered to a nursing mother with caution and only when indicated."],"clinical_studies":["Clinical Trials : Initial Genital Herpes: Double-blind, placebo-controlled studies have demonstrated that orally administered acyclovir significantly reduced the duration of acute infection and duration of lesion healing. The duration of pain and new lesion formation was decreased in some patient groups. Recurrent Genital Herpes: Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that orally administered acyclovir given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences in greater than 95% of patients. In a study of patients who received acyclovir 400 mg twice daily for 3 years, 45%, 52%, and 63% of patients remained free of recurrences in the first, second, and third years, respectively. Serial analyses of the 3-month recurrence rates for the patients showed that 71% to 87% were recurrence free in each quarter. Herpes Zoster Infections: In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, acyclovir (800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced the duration of viral shedding and the duration of new lesion formation. In a similar double-blind, placebo-controlled study, acyclovir (800 mg 5 times daily for 7 days) shortened the times to complete lesion scabbing, healing, and cessation of pain; reduced the duration of new lesion formation; and reduced the prevalence of localized zoster-associated neurologic symptoms (paresthesia, dysesthesia, or hyperesthesia). Treatment was begun within 72 hours of rash onset and was most effective if started within the first 48 hours. Adults greater than 50 years of age showed greater benefit. Chickenpox: Three randomized, double-blind, placebo-controlled trials were conducted in 993 pediatric patients aged 2 to 18 years with chickenpox. All patients were treated within 24 hours after the onset of rash. In 2 trials, acyclovir was administered at 20 mg/kg 4 times daily (up to 3,200 mg per day) for 5 days. In the third trial, doses of 10, 15, or 20 mg/kg were administered 4 times daily for 5 to 7 days. Treatment with acyclovir shortened the time to 50% healing; reduced the maximum number of lesions; reduced the median number of vesicles; decreased the median number of residual lesions on day 28; and decreased the proportion of patients with fever, anorexia, and lethargy by day 2. Treatment with acyclovir did not affect varicella-zoster virus-specific humoral or cellular immune responses at 1 month or 1 year following treatment."],"pharmacokinetics":["Pharmacokinetics: The pharmacokinetics of acyclovir after oral administration have been evaluated in healthy volunteers and in immunocompromised patients with herpes simplex or varicella-zoster virus infection. Acyclovir pharmacokinetic parameters are summarized in Table 1 . In one multiple-dose, crossover study in healthy subjects (n = 23), it was shown that increases in plasma Acyclovir concentrations were less than dose proportional with increasing dose, as shown in Table 2 . The decrease in bioavailability is a function of the dose and not the dosage form. There was no effect of food on the absorption of acyclovir (n = 6); therefore, acyclovir capsules may be administered with or without food. The only known urinary metabolite is 9-[(carboxymethoxy)methyl]guanine. Special Populations: Adults with Impaired Renal Function: The half-life and total body clearance of acyclovir are dependent on renal function. A dosage adjustment is recommended for patients with reduced renal function (see DOSAGE AND ADMINISTRATION ). Geriatrics: Acyclovir plasma concentrations are higher in geriatric patients compared with younger adults, in part due to age-related changes in renal function. Dosage reduction may be required in geriatric patients with underlying renal impairment (see PRECAUTIONS: Geriatric Use ). Pediatrics: In general, the pharmacokinetics of acyclovir in pediatric patients is similar to that of adults. Mean half-life after oral doses of 300 mg/m 2 and 600 mg/m 2 in pediatric patients aged 7 months to 7 years was 2.6 hours (range 1.59 to 3.74 hours)."],"adverse_reactions":["ADVERSE REACTIONS Herpes Simplex: Short-Term Administration: The most frequent adverse events reported during clinical trials of treatment of genital herpes with acyclovir 200 mg administered orally 5 times daily every 4 hours for 10 days were nausea and/or vomiting in 8 of 298 patient treatments (2.7%). Nausea and/or vomiting occurred in 2 of 287 (0.7%) patients who received placebo. Long-Term Administration: The most frequent adverse events reported in a clinical trial for the prevention of recurrences with continuous administration of 400 mg (two 200-mg capsules) 2 times daily for 1 year in 586 patients treated with acyclovir were nausea (4.8%) and diarrhea (2.4%). The 589 control patients receiving intermittent treatment of recurrences with acyclovir for 1 year reported diarrhea (2.7%), nausea (2.4%), and headache (2.2%). Herpes Zoster : The most frequent adverse event reported during 3 clinical trials of treatment of herpes zoster (shingles) with 800 mg of oral acyclovir 5 times daily for 7 to 10 days in 323 patients was malaise (11.5%). The 323 placebo recipients reported malaise (11.1%). Chickenpox : The most frequent adverse event reported during 3 clinical trials of treatment of chickenpox with oral acyclovir at doses of 10 to 20 mg/kg 4 times daily for 5 to 7 days or 800 mg 4 times daily for 5 days in 495 patients was diarrhea (3.2%). The 498 patients receiving placebo reported diarrhea (2.2%). Observed During Clinical Practice : In addition to adverse events reported from clinical trials, the following events have been identified during post-approval use of acyclovir. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to either their seriousness, frequency of reporting, potential causal connection to acyclovir, or a combination of these factors. General: Anaphylaxis, angioedema, fever, headache, pain, peripheral edema. Nervous: Aggressive behavior, agitation, ataxia, coma, confusion, decreased consciousness, delirium, dizziness, dysarthria, encephalopathy, hallucinations, paresthesia, psychosis, seizure, somnolence, tremors. These symptoms may be marked, particularly in older adults or in patients with renal impairment (see PRECAUTIONS ). Digestive: Diarrhea, gastrointestinal distress, nausea. Hematologic and Lymphatic: Anemia, leukocytoclastic vasculitis, leukopenia, lymphadenopathy, thrombocytopenia. Hepatobiliary Tract and Pancreas: Elevated liver function tests, hepatitis, hyperbilirubinemia, jaundice. Musculoskeletal: Myalgia. Skin: Alopecia, erythema multiforme, photosensitive rash, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria. Special Senses: Visual abnormalities. Urogenital: Renal failure, renal pain (may be associated with renal failure), elevated blood urea nitrogen, elevated creatinine, hematuria (see WARNINGS )."],"contraindications":["CONTRAINDICATIONS Acyclovir is contraindicated for patients who develop hypersensitivity to acyclovir or valacyclovir."],"drug_interactions":["Drug Interactions: See CLINICAL PHARMACOLOGY: Pharmacokinetics ."],"mechanism_of_action":["Mechanism of Antiviral Action: Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and varicella-zoster virus (VZV). The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV. This viral enzyme converts acyclovir into acyclovir monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. In vitro , acyclovir triphosphate stops replication of herpes viral DNA. This is accomplished in 3 ways: 1) competitive inhibition of viral DNA polymerase, 2) incorporation into and termination of the growing viral DNA chain, and 3) inactivation of the viral DNA polymerase. The greater antiviral activity of acyclovir against HSV compared with VZV is due to its more efficient phosphorylation by the viral TK. Antiviral Activities: The quantitative relationship between the in vitro susceptibility of herpes viruses to antivirals and the clinical response to therapy has not been established in humans, and virus sensitivity testing has not been standardized. Sensitivity testing results, expressed as the concentration of drug required to inhibit by 50% the growth of virus in cell culture (IC 50 ), vary greatly depending upon a number of factors. Using plaque-reduction assays, the IC 50 against herpes simplex virus isolates ranges from 0.02 to 13.5 mcg/mL for HSV-1 and from 0.01 to 9.9 mcg/mL for HSV-2. The IC 50 for acyclovir against most laboratory strains and clinical isolates of VZV ranges from 0.12 to 10.8 mcg/mL. Acyclovir also demonstrates activity against the Oka vaccine strain of VZV with a mean IC 50 of 1.35 mcg/mL. Drug Resistance: Resistance of HSV and VZV to acyclovir can result from qualitative and quantitative changes in the viral TK and/or DNA polymerase. Clinical isolates of HSV and VZV with reduced susceptibility to acyclovir have been recovered from immunocompromised patients, especially with advanced HIV infection. While most of the acyclovir-resistant mutants isolated thus far from immunocompromised patients have been found to be TK-deficient mutants, other mutants involving the viral TK gene (TK partial and TK altered) and DNA polymerase have been isolated. TK-negative mutants may cause severe disease in infants and immunocompromised adults. The possibility of viral resistance to acyclovir should be considered in patients who show poor clinical response during therapy."],"clinical_pharmacology":["CLINICAL PHARMACOLOGY Pharmacokinetics: The pharmacokinetics of acyclovir after oral administration have been evaluated in healthy volunteers and in immunocompromised patients with herpes simplex or varicella-zoster virus infection. Acyclovir pharmacokinetic parameters are summarized in Table 1 . In one multiple-dose, crossover study in healthy subjects (n = 23), it was shown that increases in plasma Acyclovir concentrations were less than dose proportional with increasing dose, as shown in Table 2 . The decrease in bioavailability is a function of the dose and not the dosage form. There was no effect of food on the absorption of acyclovir (n = 6); therefore, acyclovir capsules may be administered with or without food. The only known urinary metabolite is 9-[(carboxymethoxy)methyl]guanine. Special Populations: Adults with Impaired Renal Function: The half-life and total body clearance of acyclovir are dependent on renal function. A dosage adjustment is recommended for patients with reduced renal function (see DOSAGE AND ADMINISTRATION ). Geriatrics: Acyclovir plasma concentrations are higher in geriatric patients compared with younger adults, in part due to age-related changes in renal function. Dosage reduction may be required in geriatric patients with underlying renal impairment (see PRECAUTIONS: Geriatric Use ). Pediatrics: In general, the pharmacokinetics of acyclovir in pediatric patients is similar to that of adults. Mean half-life after oral doses of 300 mg/m 2 and 600 mg/m 2 in pediatric patients aged 7 months to 7 years was 2.6 hours (range 1.59 to 3.74 hours). Drug Interactions : Coadministration of probenecid with intravenous acyclovir has been shown to increase the mean acyclovir half-life and the area under the concentration-time curve. Urinary excretion and renal clearance were correspondingly reduced. Clinical Trials : Initial Genital Herpes: Double-blind, placebo-controlled studies have demonstrated that orally administered acyclovir significantly reduced the duration of acute infection and duration of lesion healing. The duration of pain and new lesion formation was decreased in some patient groups. Recurrent Genital Herpes: Double-blind, placebo-controlled studies in patients with frequent recurrences (6 or more episodes per year) have shown that orally administered acyclovir given daily for 4 months to 10 years prevented or reduced the frequency and/or severity of recurrences in greater than 95% of patients. In a study of patients who received acyclovir 400 mg twice daily for 3 years, 45%, 52%, and 63% of patients remained free of recurrences in the first, second, and third years, respectively. Serial analyses of the 3-month recurrence rates for the patients showed that 71% to 87% were recurrence free in each quarter. Herpes Zoster Infections: In a double-blind, placebo-controlled study of immunocompetent patients with localized cutaneous zoster infection, acyclovir (800 mg 5 times daily for 10 days) shortened the times to lesion scabbing, healing, and complete cessation of pain, and reduced the duration of viral shedding and the duration of new lesion formation. In a similar double-blind, placebo-controlled study, acyclovir (800 mg 5 times daily for 7 days) shortened the times to complete lesion scabbing, healing, and cessation of pain; reduced the duration of new lesion formation; and reduced the prevalence of localized zoster-associated neurologic symptoms (paresthesia, dysesthesia, or hyperesthesia). Treatment was begun within 72 hours of rash onset and was most effective if started within the first 48 hours. Adults greater than 50 years of age showed greater benefit. Chickenpox: Three randomized, double-blind, placebo-controlled trials were conducted in 993 pediatric patients aged 2 to 18 years with chickenpox. All patients were treated within 24 hours after the onset of rash. In 2 trials, acyclovir was administered at 20 mg/kg 4 times daily (up to 3,200 mg per day) for 5 days. In the third trial, doses of 10, 15, or 20 mg/kg were administered 4 times daily for 5 to 7 days. Treatment with acyclovir shortened the time to 50% healing; reduced the maximum number of lesions; reduced the median number of vesicles; decreased the median number of residual lesions on day 28; and decreased the proportion of patients with fever, anorexia, and lethargy by day 2. Treatment with acyclovir did not affect varicella-zoster virus-specific humoral or cellular immune responses at 1 month or 1 year following treatment."],"indications_and_usage":["INDICATIONS AND USAGE Herpes Zoster Infections : Acyclovir is indicated for the acute treatment of herpes zoster (shingles). Genital Herpes : Acyclovir is indicated for the treatment of initial episodes and the management of recurrent episodes of genital herpes. Chickenpox : Acyclovir is indicated for the treatment of chickenpox (varicella)."],"information_for_patients":["Information for Patients: Patients are instructed to consult with their physician if they experience severe or troublesome adverse reactions, they become pregnant or intend to become pregnant, they intend to breast feed while taking orally administered acyclovir, or they have any other questions. Patients should be advised to maintain adequate hydration. Herpes Zoster : There are no data on treatment initiated more than 72 hours after onset of the zoster rash. Patients should be advised to initiate treatment as soon as possible after a diagnosis of herpes zoster. Genital Herpes Infections: Patients should be informed that acyclovir is not a cure for genital herpes. There are no data evaluating whether acyclovir will prevent transmission of infection to others. Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes can also be transmitted in the absence of symptoms through asymptomatic viral shedding. If medical management of a genital herpes recurrence is indicated, patients should be advised to initiate therapy at the first sign or symptom of an episode. Chickenpox: Chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Adolescents and adults tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course."],"spl_unclassified_section":["Rx only","VIROLOGY Mechanism of Antiviral Action: Acyclovir is a synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types 1 (HSV-1), 2 (HSV-2), and varicella-zoster virus (VZV). The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV. This viral enzyme converts acyclovir into acyclovir monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular enzymes. In vitro , acyclovir triphosphate stops replication of herpes viral DNA. This is accomplished in 3 ways: 1) competitive inhibition of viral DNA polymerase, 2) incorporation into and termination of the growing viral DNA chain, and 3) inactivation of the viral DNA polymerase. The greater antiviral activity of acyclovir against HSV compared with VZV is due to its more efficient phosphorylation by the viral TK. Antiviral Activities: The quantitative relationship between the in vitro susceptibility of herpes viruses to antivirals and the clinical response to therapy has not been established in humans, and virus sensitivity testing has not been standardized. Sensitivity testing results, expressed as the concentration of drug required to inhibit by 50% the growth of virus in cell culture (IC 50 ), vary greatly depending upon a number of factors. Using plaque-reduction assays, the IC 50 against herpes simplex virus isolates ranges from 0.02 to 13.5 mcg/mL for HSV-1 and from 0.01 to 9.9 mcg/mL for HSV-2. The IC 50 for acyclovir against most laboratory strains and clinical isolates of VZV ranges from 0.12 to 10.8 mcg/mL. Acyclovir also demonstrates activity against the Oka vaccine strain of VZV with a mean IC 50 of 1.35 mcg/mL. Drug Resistance: Resistance of HSV and VZV to acyclovir can result from qualitative and quantitative changes in the viral TK and/or DNA polymerase. Clinical isolates of HSV and VZV with reduced susceptibility to acyclovir have been recovered from immunocompromised patients, especially with advanced HIV infection. While most of the acyclovir-resistant mutants isolated thus far from immunocompromised patients have been found to be TK-deficient mutants, other mutants involving the viral TK gene (TK partial and TK altered) and DNA polymerase have been isolated. TK-negative mutants may cause severe disease in infants and immunocompromised adults. The possibility of viral resistance to acyclovir should be considered in patients who show poor clinical response during therapy."],"dosage_and_administration":["DOSAGE AND ADMINISTRATION Acute Treatment of Herpes Zoster : 800 mg every 4 hours orally, 5 times daily for 7 to 10 days. Genital Herpes : Treatment of Initial Genital Herpes: 200 mg every 4 hours, 5 times daily for 10 days. Chronic Suppressive Therapy for Recurrent Disease: 400 mg 2 times daily for up to 12 months, followed by re-evaluation. Alternative regimens have included doses ranging from 200 mg 3 times daily to 200 mg 5 times daily. The frequency and severity of episodes of untreated genital herpes may change over time. After 1 year of therapy, the frequency and severity of the patient's genital herpes infection should be re-evaluated to assess the need for continuation of therapy with acyclovir. Intermittent Therapy: 200 mg every 4 hours, 5 times daily for 5 days. Therapy should be initiated at the earliest sign or symptom (prodrome) of recurrence. Treatment of Chickenpox : Children (2 years of age and older): 20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox. Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. Intravenous acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients. When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox. There is no information about the efficacy of therapy initiated more than 24 hours after onset of signs and symptoms. Patients With Acute or Chronic Renal Impairment : In patients with renal impairment, the dose of acyclovir capsules should be modified as shown in Table 3 : Hemodialysis : For patients who require hemodialysis, the mean plasma half-life of acyclovir during hemodialysis is approximately 5 hours. This results in a 60% decrease in plasma concentrations following a 6-hour dialysis period. Therefore, the patient's dosing schedule should be adjusted so that an additional dose is administered after each dialysis. Peritoneal Dialysis : No supplemental dose appears to be necessary after adjustment of the dosing interval. Bioequivalence of Dosage Forms : Acyclovir Suspension was shown to be bioequivalent to acyclovir Capsules (n = 20) and 1 acyclovir 800-mg capsule was shown to be bioequivalent to 4 acyclovir 200-mg capsules (n = 24)."],"spl_product_data_elements":["Acyclovir Acyclovir LACTOSE MONOHYDRATE SODIUM LAURYL SULFATE MAGNESIUM STEARATE STARCH, CORN ACYCLOVIR ACYCLOVIR blue CAPSULE CTI;114 Structural Formula Table 1 Table 2 Table 3"],"package_label_principal_display_panel":["Acyclovir 200 mg Capsules Label"],"carcinogenesis_and_mutagenesis_and_impairment_of_fertility":["Carcinogenesis, Mutagenesis, Impairment of Fertility: The data presented below include references to peak steady-state plasma acyclovir concentrations observed in humans treated with 800 mg given orally 5 times a day (dosing appropriate for treatment of herpes zoster) or 200 mg given orally 5 times a day (dosing appropriate for treatment of genital herpes). Plasma drug concentrations in animal studies are expressed as multiples of human exposure to acyclovir at the higher and lower dosing schedules (see CLINICAL PHARMACOLOGY: Pharmacokinetics ). Acyclovir was tested in lifetime bioassays in rats and mice at single daily doses of up to 450 mg/kg administered by gavage. There was no statistically significant difference in the incidence of tumors between treated and control animals, nor did acyclovir shorten the latency of tumors. Maximum plasma concentrations were 3 to 6 times human levels in the mouse bioassay and 1 to 2 times human levels in the rat bioassay. Acyclovir was tested in 16 in vitro and in vivo genetic toxicity assays. Acyclovir was positive in 5 of the assays. Acyclovir did not impair fertility or reproduction in mice (450 mg/kg/day, p.o.) or in rats (25 mg/kg/day, s.c.). In the mouse study, plasma levels were 9 to 18 times human levels, while in the rat study, they were 8 to 15 times human levels. At higher doses (50 mg/kg/day, s.c.) in rats and rabbits (11 to 22 and 16 to 31 times human levels, respectively) implantation efficacy, but not litter size, was decreased. In a rat peri- and post-natal study at 50 mg/kg/day, s.c., there was a statistically significant decrease in group mean numbers of corpora lutea, total implantation sites, and live fetuses. No testicular abnormalities were seen in dogs given 50 mg/kg/day, IV for 1 month (21 to 41 times human levels) or in dogs given 60 mg/kg/day orally for 1 year (6 to 12 times human levels). Testicular atrophy and aspermatogenesis were observed in rats and dogs at higher dose levels."]},"tags":[{"label":"Herpes Simplex Virus Nucleoside Analog DNA Polymerase Inhibitor","category":"class"},{"label":"Small Molecule","category":"modality"},{"label":"Purine nucleoside phosphorylase","category":"target"},{"label":"PNP","category":"gene"},{"label":"D06BB03","category":"atc"},{"label":"Cutaneous","category":"route"},{"label":"Oral","category":"route"},{"label":"Intravenous","category":"route"},{"label":"Capsule","category":"form"},{"label":"Cream","category":"form"},{"label":"Injection","category":"form"},{"label":"Ointment","category":"form"},{"label":"Generic Available","category":"availability"},{"label":"Established","category":"status"},{"label":"Encephalitis due to Herpesvirus","category":"indication"},{"label":"Genital herpes simplex","category":"indication"},{"label":"Herpes labialis","category":"indication"},{"label":"Herpes simplex","category":"indication"},{"label":"Herpes simplex infection of skin","category":"indication"},{"label":"Herpes zoster","category":"indication"},{"label":"Ligand Pharms","category":"company"},{"label":"Approved 1980s","category":"decade"},{"label":"Anti-Infective Agents","category":"pharmacology"},{"label":"Antiviral Agents","category":"pharmacology"}],"phase":"marketed","safety":{"boxedWarnings":[],"safetySignals":[{"llr":3216.703,"date":"","count":2299,"signal":"Plasma cell myeloma","source":"DrugCentral FAERS","actionTaken":"Reported 2,299 times (LLR=3217)"},{"llr":1504.592,"date":"","count":2827,"signal":"Febrile neutropenia","source":"DrugCentral FAERS","actionTaken":"Reported 2,827 times (LLR=1505)"},{"llr":1439.171,"date":"","count":2536,"signal":"White blood cell count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 2,536 times (LLR=1439)"},{"llr":1201.618,"date":"","count":2384,"signal":"Platelet count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 2,384 times (LLR=1202)"},{"llr":1099.955,"date":"","count":2104,"signal":"Neuropathy peripheral","source":"DrugCentral FAERS","actionTaken":"Reported 2,104 times (LLR=1100)"},{"llr":1022.835,"date":"","count":5081,"signal":"Pneumonia","source":"DrugCentral FAERS","actionTaken":"Reported 5,081 times (LLR=1023)"},{"llr":880.267,"date":"","count":2736,"signal":"Neutropenia","source":"DrugCentral FAERS","actionTaken":"Reported 2,736 times (LLR=880)"},{"llr":791.702,"date":"","count":761,"signal":"Cytokine release syndrome","source":"DrugCentral FAERS","actionTaken":"Reported 761 times (LLR=792)"},{"llr":778.575,"date":"","count":789,"signal":"Full blood count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 789 times (LLR=779)"},{"llr":744.144,"date":"","count":1242,"signal":"Neutrophil count decreased","source":"DrugCentral FAERS","actionTaken":"Reported 1,242 times (LLR=744)"},{"llr":712.246,"date":"","count":66,"signal":"Rheumatoid arthritis","source":"DrugCentral FAERS","actionTaken":"Reported 66 times (LLR=712)"},{"llr":690.276,"date":"","count":4532,"signal":"Pyrexia","source":"DrugCentral FAERS","actionTaken":"Reported 4,532 times (LLR=690)"},{"llr":689.377,"date":"","count":31,"signal":"Contraindicated product administered","source":"DrugCentral FAERS","actionTaken":"Reported 31 times (LLR=689)"},{"llr":688.961,"date":"","count":719,"signal":"Neurotoxicity","source":"DrugCentral FAERS","actionTaken":"Reported 719 times (LLR=689)"},{"llr":635.861,"date":"","count":2309,"signal":"Thrombocytopenia","source":"DrugCentral FAERS","actionTaken":"Reported 2,309 times (LLR=636)"}],"drugInteractions":[{"url":"/drug/fosphenytoin","drug":"fosphenytoin","action":"Monitor closely","effect":"May interact with Fosphenytoin Sodium","source":"DrugCentral","drugSlug":"fosphenytoin"},{"url":"/drug/phenytoin","drug":"phenytoin","action":"Monitor closely","effect":"May interact with Phenytoin","source":"DrugCentral","drugSlug":"phenytoin"},{"url":"/drug/rifampicin","drug":"rifampicin","action":"Avoid combination","effect":"May interact with Rifampin","source":"DrugCentral","drugSlug":"rifampicin"},{"url":"/drug/theophylline","drug":"theophylline","action":"Monitor closely","effect":"May interact with Theophylline","source":"DrugCentral","drugSlug":"theophylline"},{"url":"/drug/tizanidine","drug":"tizanidine","action":"Monitor closely","effect":"May interact with Tizanidine","source":"DrugCentral","drugSlug":"tizanidine"}],"commonSideEffects":[{"effect":"Inflammation or phlebitis at the injection site","drugRate":"9%","severity":"common","_validated":true},{"effect":"Transient elevations of serum creatinine or BUN","drugRate":"5% to 10%","severity":"common","_validated":true},{"effect":"Nausea and/or vomiting","drugRate":"7%","severity":"common","_validated":true},{"effect":"Itching, rash, or hives","drugRate":"2%","severity":"common","_validated":true},{"effect":"Elevation of transaminases","drugRate":"1% to 2%","severity":"common","_validated":true},{"effect":"Anemia","drugRate":"reported","severity":"unknown"},{"effect":"Neutropenia","drugRate":"reported","severity":"unknown"},{"effect":"Thrombocytopenia","drugRate":"reported","severity":"unknown"},{"effect":"Thrombocytosis","drugRate":"reported","severity":"unknown"},{"effect":"Leukocytosis","drugRate":"reported","severity":"unknown"},{"effect":"Neutrophilia","drugRate":"reported","severity":"unknown"},{"effect":"Anorexia","drugRate":"reported","severity":"unknown"},{"effect":"Hematuria","drugRate":"reported","severity":"unknown"},{"effect":"Anaphylaxis","drugRate":"reported","severity":"serious"},{"effect":"Angioedema","drugRate":"reported","severity":"serious"},{"effect":"Fatigue","drugRate":"reported","severity":"mild"},{"effect":"Fever","drugRate":"reported","severity":"mild"},{"effect":"Headache","drugRate":"reported","severity":"mild"},{"effect":"Pain","drugRate":"reported","severity":"mild"},{"effect":"Peripheral edema","drugRate":"reported","severity":"mild"},{"effect":"Abdominal pain","drugRate":"reported","severity":"mild"},{"effect":"Diarrhea","drugRate":"reported","severity":"mild"},{"effect":"Gastrointestinal distress","drugRate":"reported","severity":"mild"},{"effect":"Hypotension","drugRate":"reported","severity":"serious"},{"effect":"Disseminated intravascular coagulation","drugRate":"reported","severity":"serious"},{"effect":"Hemolysis","drugRate":"reported","severity":"serious"},{"effect":"Leukocytoclastic vasculitis","drugRate":"reported","severity":"serious"},{"effect":"Leukopenia","drugRate":"reported","severity":"serious"},{"effect":"Lymphadenopathy","drugRate":"reported","severity":"serious"},{"effect":"Elevated liver function tests","drugRate":"reported","severity":"serious"},{"effect":"Hepatitis","drugRate":"reported","severity":"serious"},{"effect":"Hyperbilirubinemia","drugRate":"reported","severity":"serious"},{"effect":"Jaundice","drugRate":"reported","severity":"serious"},{"effect":"Myalgia","drugRate":"reported","severity":"mild"},{"effect":"Aggressive behavior","drugRate":"reported","severity":"serious"},{"effect":"Ataxia","drugRate":"reported","severity":"serious"},{"effect":"Coma","drugRate":"reported","severity":"serious"},{"effect":"Confusion","drugRate":"reported","severity":"serious"},{"effect":"Delirium","drugRate":"reported","severity":"serious"},{"effect":"Dizziness","drugRate":"reported","severity":"mild"},{"effect":"Dysarthria","drugRate":"reported","severity":"serious"},{"effect":"Encephalopathy","drugRate":"reported","severity":"serious"},{"effect":"Hallucinations","drugRate":"reported","severity":"serious"},{"effect":"Obtundation","drugRate":"reported","severity":"serious"},{"effect":"Paresthesia","drugRate":"reported","severity":"mild"},{"effect":"Psychosis","drugRate":"reported","severity":"serious"},{"effect":"Seizure","drugRate":"reported","severity":"serious"},{"effect":"Somnolence","drugRate":"reported","severity":"mild"},{"effect":"Tremor","drugRate":"reported","severity":"mild"},{"effect":"Alopecia","drugRate":"reported","severity":"mild"},{"effect":"Erythema multiforme","drugRate":"reported","severity":"serious"},{"effect":"Photosensitive rash","drugRate":"reported","severity":"mild"},{"effect":"Pruritus","drugRate":"reported","severity":"mild"},{"effect":"Rash","drugRate":"reported","severity":"mild"},{"effect":"Stevens-Johnson syndrome","drugRate":"reported","severity":"serious"},{"effect":"Toxic epidermal necrolysis","drugRate":"reported","severity":"serious"},{"effect":"Urticaria","drugRate":"reported","severity":"mild"},{"effect":"Visual abnormalities","drugRate":"reported","severity":"serious"},{"effect":"Renal failure","drugRate":"reported","severity":"serious"},{"effect":"Elevated blood urea nitrogen","drugRate":"reported","severity":"serious"},{"effect":"Elevated creatinine","drugRate":"reported","severity":"serious"}],"contraindications":["Adrenal cortical hypofunction","Atrophoderma","Breastfeeding (mother)","Cardiovascular event risk","Cerebrovascular accident","Dehydration","Diabetes mellitus","Hemolytic uremic syndrome","Hypercholesterolemia","Hyperglycemia","Hypertensive disorder","Impaired renal function disorder","Kidney disease","Myocardial infarction","Obesity","Osteopenia","Peripheral vascular disease","Pregnancy, function","Smokes tobacco daily","Telangiectasia disorder","Thrombotic thrombocytopenic purpura","Urinary tract obstruction","Vertebral Metastases"],"specialPopulations":{"Pregnancy":"Pregnancy Category B. Acyclovir administered during organogenesis was not teratogenic in the mouse (450 mg/kg/day, p.o.), rabbit (50 mg/kg/day, s.c. and IV), or rat (50 mg/kg/day, s.c.). These exposures resulted in plasma levels and 18, 16 and 106, and 11 and 22 times, respectively, human levels.There are no adequate and well-controlled studies in pregnant women. prospective epidemiologic registry of acyclovir use during pregnancy was established in 1984 and comple","Geriatric use":"Acyclovir plasma concentrations are higher in geriatric patients compared to younger adults, in part due to age-related changes in renal function. Dosage reduction may be required in geriatric patients with underlying renal impairment (see PRECAUTIONS: Geriatric Use).","Paediatric use":"Safety and effectiveness of oral formulations of acyclovir in pediatric patients younger than years of age have not been established.","Renal impairment":"Dosage reduction may be required in geriatric patients with underlying renal impairment (see PRECAUTIONS: Geriatric Use)."}},"trials":[],"aliases":["aciclovir"],"company":"Ligand Pharms","patents":[{"applNo":"N203791","source":"FDA Orange Book","status":"Active","expires":"Jun 3, 2027","useCode":"U-1460","territory":"US","drugProduct":true,"patentNumber":"8747896","drugSubstance":false},{"applNo":"N203791","source":"FDA Orange Book","status":"Active","expires":"Jun 16, 2030","useCode":"U-1460","territory":"US","drugProduct":true,"patentNumber":"8592434","drugSubstance":false},{"applNo":"N203791","source":"FDA Orange Book","status":"Active","expires":"Mar 23, 2027","useCode":"U-1460","territory":"US","drugProduct":true,"patentNumber":"8791127","drugSubstance":false}],"pricing":[{"market":"United States","source":"CMS National Average Drug Acquisition Cost (NADAC)","asOfDate":"2024-01-03","unitCost":"$0.1142/EA","priceType":"NADAC","sourceUrl":"https://data.medicaid.gov/dataset/4j6z-xnwq","annualCost":"$42","description":"ACYCLOVIR 200 MG CAPSULE","retrievedDate":"2026-04-07"}],"_sources":{"trials":{"url":"https://clinicaltrials.gov/search?intr=ACYCLOVIR","method":"api_direct","source":"ClinicalTrials.gov","rawText":"","confidence":1,"sourceType":"ctgov","retrievedAt":"2026-04-20T03:02:34.065285+00:00"},"patents":{"url":"","method":"deterministic","source":"FDA Orange Book","rawText":"","confidence":1,"sourceType":"fda_orange_book","retrievedAt":"2026-04-20T03:02:34.065203+00:00"},"timeline":{"url":"https://en.wikipedia.org/wiki/Acyclovir","method":"deterministic","source":"Wikipedia","rawText":"","confidence":0.8,"sourceType":"wikipedia","retrievedAt":"2026-04-20T03:02:40.979172+00:00"},"regulatory.ca":{"url":"","method":"api_direct","source":"Health Canada DPD","rawText":"","confidence":1,"sourceType":"health_canada_dpd","retrievedAt":"2026-04-20T03:02:39.637789+00:00"},"publicationCount":{"url":"https://pubmed.ncbi.nlm.nih.gov/?term=ACYCLOVIR","method":"api_direct","source":"PubMed/NCBI","rawText":"","confidence":1,"sourceType":"pubmed","retrievedAt":"2026-04-20T03:02:39.819403+00:00"},"mechanism.drugClass":{"url":"https://api.fda.gov/drug/label.json","method":"deterministic","source":"FDA Label (EPC)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:02:32.725273+00:00"},"administration.route":{"url":"","method":"deterministic","source":"FDA Label","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:02:32.725299+00:00"},"safety.boxedWarnings":{"url":"","method":"deterministic","source":"FDA Label (no boxed warning)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:02:32.725305+00:00"},"mechanism.target_chembl":{"url":"","method":"api_direct","source":"ChEMBL mechanism: Human herpesvirus 1 DNA polymerase inhibitor","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-20T03:02:40.979106+00:00"},"crossReferences.chemblId":{"url":"https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL1200380/","method":"api_direct","source":"ChEMBL (EMBL-EBI)","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-20T03:02:40.646800+00:00"},"regulatory.fda_application":{"url":"","method":"deterministic","source":"FDA Label","rawText":"ANDA206261","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-20T03:02:32.725307+00:00"}},"allNames":"zovirax","offLabel":[],"synonyms":["zovirax","acyclovir","aciclovir","acyclovir sodium"],"timeline":[{"date":"1982-01-01","type":"neutral","source":"FDA Orange Book","milestone":"Rights transferred from VALEANT BERMUDA to Ligand Pharms"},{"date":"1982-03-29","type":"positive","source":"DrugCentral","milestone":"FDA approval (Valeant Bermuda)"},{"date":"1985-01-25","type":"positive","source":"FDA Orange Book","milestone":"Zovirax approved — 200MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**"},{"date":"1989-12-22","type":"positive","source":"FDA Orange Book","milestone":"Zovirax approved — 200MG/5ML **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**"},{"date":"1991-04-30","type":"positive","source":"FDA Orange Book","milestone":"Zovirax approved — 400MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**"},{"date":"1998-04-13","type":"neutral","source":"FDA Orange Book","milestone":"Generic entry — 13 manufacturers approved"},{"date":"2002-12-30","type":"positive","source":"FDA Orange Book","milestone":"Zovirax approved — 5%"},{"date":"2019-03-29","type":"positive","source":"FDA Orange Book","milestone":"Avaclyr approved — 3% **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**"}],"aiSummary":"Zovirax (Acyclovir) is a small molecule drug developed by Valeant Bermuda and currently owned by Ligand Pharmaceuticals. It targets the enzyme purine nucleoside phosphorylase and works as a nucleoside analog DNA polymerase inhibitor to treat various herpes simplex virus infections. Zovirax has been FDA-approved since 1982 for multiple indications, including encephalitis, genital herpes, and herpes zoster. The drug has a bioavailability of 22% and a half-life of 2.5 hours. It is available as a generic medication from multiple manufacturers.","brandName":"Zovirax","ecosystem":[{"indication":"Encephalitis due to Herpesvirus","otherDrugs":[],"globalPrevalence":null},{"indication":"Genital herpes simplex","otherDrugs":[{"name":"valaciclovir","slug":"valaciclovir","company":"Glaxosmithkline"}],"globalPrevalence":962000000},{"indication":"Herpes labialis","otherDrugs":[{"name":"docosanol","slug":"docosanol","company":""},{"name":"penciclovir","slug":"penciclovir","company":"Denco Asset"},{"name":"valaciclovir","slug":"valaciclovir","company":"Glaxosmithkline"}],"globalPrevalence":null},{"indication":"Herpes simplex","otherDrugs":[{"name":"famciclovir","slug":"famciclovir","company":"Novartis"}],"globalPrevalence":962000000},{"indication":"Herpes simplex infection of skin","otherDrugs":[],"globalPrevalence":null},{"indication":"Herpes zoster","otherDrugs":[{"name":"famciclovir","slug":"famciclovir","company":"Novartis"},{"name":"valaciclovir","slug":"valaciclovir","company":"Glaxosmithkline"}],"globalPrevalence":null},{"indication":"Recurrent Mucocutaneous Herpes Simplex","otherDrugs":[],"globalPrevalence":null},{"indication":"Recurrent genital herpes simplex","otherDrugs":[{"name":"famciclovir","slug":"famciclovir","company":"Novartis"},{"name":"valaciclovir","slug":"valaciclovir","company":"Glaxosmithkline"}],"globalPrevalence":962000000}],"mechanism":{"target":"Purine nucleoside phosphorylase","novelty":"Follow-on","targets":[{"gene":"PNP","source":"DrugCentral","target":"Purine nucleoside phosphorylase","protein":"Purine nucleoside phosphorylase"}],"moaClass":"DNA Polymerase Inhibitors","modality":"Small Molecule","drugClass":"Herpes Simplex Virus Nucleoside Analog DNA Polymerase Inhibitor [EPC]","explanation":"Mechanism of Antiviral Action:. Acyclovir is synthetic purine nucleoside analogue with in vitro and in vivo inhibitory activity against herpes simplex virus types (HSV-1), (HSV-2), and varicella-zoster virus (VZV).The inhibitory activity of acyclovir is highly selective due to its affinity for the enzyme thymidine kinase (TK) encoded by HSV and VZV. This viral enzyme converts acyclovir into acyclovir monophosphate, nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by number of cellular enzymes. In vitro, acyclovir triphosphate stops replication of herpes viral DNA. This is accomplished in ways: 1) competitive inhibition of viral DNA polymerase, 2) incorporation into and termination of the growing viral DNA chain, and 3) inactivation of the viral DNA polymerase. The greater antiviral activity of acyclovir against HSV compared with VZV is due to its more efficient phosphorylation by the viral TK.","oneSentence":"Acyclovir works by mimicking a building block of DNA to prevent the herpes virus from replicating.","technicalDetail":"Acyclovir is a purine nucleoside analog that selectively inhibits viral DNA polymerase through its incorporation into viral DNA, thereby terminating viral DNA synthesis and replication."},"_wikipedia":{"url":"https://en.wikipedia.org/wiki/Aciclovir","title":"Aciclovir","extract":"Aciclovir, also known as acyclovir, is an antiviral medication. It is primarily used for the treatment of herpes simplex virus infections, chickenpox, and shingles. Other uses include the prevention of cytomegalovirus infections following transplant, and severe complications of Epstein–Barr virus infection. It can be taken by mouth, applied as a cream, or injected.","wiki_history":"==History==\nthumb|right|\n\nAciclovir was seen as the start of a new era in antiviral therapy, as it is extremely selective and low in cytotoxicity. It was codiscovered by Howard Schaeffer following his work with Robert Vince, S. Bittner and S. Gurwara on the adenosine analog acycloadenosine which showed promising antiviral activity.  A U.S. patent on aciclovir listing Schaeffer as inventor was issued in 1979. Vince later invented abacavir, an nRTI drug for HIV patients. Elion was awarded the 1988 Nobel Prize in Medicine, partly for the development of aciclovir.\n\nA related prodrug form, valaciclovir came into medical use in 1995. It is converted to aciclovir in the body after absorption.\n\nIn 2009, acyclovir in combination with hydrocortisone cream, marketed as Xerese, was approved in the United States for the early treatment of recurrent herpes labialis (cold sores) to reduce the likelihood of ulcerative cold sores and to shorten the lesion healing time in adults and children (six years of age and older).","wiki_society_and_culture":"==Society and culture==\n\n===Names===\nIt was originally marketed as Zovirax; patents expired in the 1990s and since then it has been generic and is marketed under many brand names worldwide."},"commercial":{"launchDate":"1982","_launchSource":"DrugCentral (FDA 1982-03-29, VALEANT BERMUDA)"},"references":[{"id":1,"url":"https://drugcentral.org/drugcard/85","fields":["approvals","synonyms","ATC","PK","indications","contraindications","DDIs","targets","patents","FAERS"],"source":"DrugCentral"},{"id":2,"url":"https://clinicaltrials.gov/search?intr=ACYCLOVIR","fields":["trials"],"source":"ClinicalTrials.gov"},{"id":3,"url":"https://pubmed.ncbi.nlm.nih.gov/?term=ACYCLOVIR","fields":["publications"],"source":"PubMed/NCBI"},{"id":4,"url":"https://en.wikipedia.org/wiki/Aciclovir","fields":["history","overview"],"source":"Wikipedia"},{"id":5,"url":"https://www.fda.gov/drugs/drug-approvals-and-databases/orange-book-data-files","fields":["patents","exclusivity","genericManufacturers"],"source":"FDA Orange Book"}],"_enrichedAt":"2026-03-30T08:27:09.027596","_validation":{"fieldsValidated":0,"lastValidatedAt":"2026-04-20T03:02:44.459667+00:00","fieldsConflicting":0,"overallConfidence":0.95},"biosimilars":[],"competitors":[{"drugName":"idoxuridine","drugSlug":"idoxuridine","fdaApproval":"1963-06-11","patentStatus":"Unknown","relationship":"same-class"},{"drugName":"podophyllotoxin","drugSlug":"podophyllotoxin","fdaApproval":"1990-12-13","relationship":"same-class"},{"drugName":"inosine","drugSlug":"inosine","fdaApproval":"","relationship":"same-class"},{"drugName":"penciclovir","drugSlug":"penciclovir","fdaApproval":"1996-09-24","genericCount":4,"patentStatus":"Off-patent — generic available","relationship":"same-class"},{"drugName":"imiquimod","drugSlug":"imiquimod","fdaApproval":"1997-02-27","patentExpiry":"Dec 11, 2029","patentStatus":"Patent protected","relationship":"same-class"},{"drugName":"docosanol","drugSlug":"docosanol","fdaApproval":"2000-07-25","genericCount":6,"patentStatus":"Off-patent — generic available","relationship":"same-class"},{"drugName":"sinecatechins","drugSlug":"sinecatechins","fdaApproval":"2006-10-31","patentExpiry":"Oct 2, 2026","patentStatus":"Patent protected","relationship":"same-class"}],"dataSources":[{"url":"https://data.medicaid.gov/dataset/4j6z-xnwq","name":"CMS National Average Drug Acquisition Cost (NADAC)","fields":["pricing"],"retrievedDate":"2026-04-07"}],"genericName":"acyclovir","indications":{"approved":[{"name":"Encephalitis due to Herpesvirus","source":"DrugCentral","snomedId":428638009,"regulator":"FDA"},{"name":"Genital herpes simplex","source":"DrugCentral","snomedId":33839006,"regulator":"FDA","globalPrevalence":962000000,"prevalenceMethod":"ai-extracted","prevalenceSource":"Sex Transm Infect, 2020 (PMID:39658199)"},{"name":"Herpes labialis","source":"DrugCentral","snomedId":1475003,"regulator":"FDA"},{"name":"Herpes simplex","source":"DrugCentral","snomedId":88594005,"regulator":"FDA","usPrevalence":null,"globalPrevalence":962000000,"prevalenceMethod":"curated","prevalenceSource":"Sex Transm Infect, 2020 (PMID:39658199)"},{"name":"Herpes simplex infection of skin","source":"DrugCentral","snomedId":240475000,"regulator":"FDA"},{"name":"Herpes zoster","source":"DrugCentral","snomedId":4740000,"regulator":"FDA"},{"name":"Recurrent Mucocutaneous Herpes Simplex","source":"DrugCentral","snomedId":"","regulator":"FDA"},{"name":"Recurrent genital herpes simplex","source":"DrugCentral","snomedId":402894005,"regulator":"FDA","usPrevalence":null,"globalPrevalence":962000000,"prevalenceMethod":"curated","prevalenceSource":"Sex Transm Infect, 2020 (PMID:39658199)"},{"name":"Recurrent herpes simplex labialis","source":"DrugCentral","snomedId":402892009,"regulator":"FDA"},{"name":"Suppression of Recurrent Herpes Simplex 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