Version May 2024
Herpetic keratitis: Ophthalmic: Apply a ½-inch ribbon of ointment in the lower cul-de-sac of the affected eye(s) 5 times daily (approximately every 3 hours while awake) until the corneal ulcer heals, then apply a ½-inch ribbon 3 times daily for 7 days.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
(For additional information see "Acyclovir (ophthalmic): Pediatric drug information")
Herpes simplex keratitis: Children ≥2 years and Adolescents: Ophthalmic: Apply a 1 cm ribbon in the lower eyelid of affected eye(s) 5 times a day (~every 3 hours while awake) until corneal ulcer heals, then apply a 1 cm ribbon 3 times daily for 7 more days
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%: Ophthalmic: Eye pain, follicular conjunctivitis, punctate keratitis, stinging of eyes
<1%, postmarketing, and/or case reports: Angioedema, blepharitis, type I hypersensitivity reaction, urticaria
Hypersensitivity to acyclovir, valacyclovir, or any component of the formulation
Special populations:
• Contact lens wearers: Contact lenses should not be worn during the course of therapy or in any patient with signs/symptoms of herpetic keratitis.
Other warnings/precautions:
• Appropriate use: For topical ophthalmic use only. Consult a health care professional if pain, redness, itching, or inflammation becomes aggravated.
Avaclyr: FDA approved April 2019; anticipated availability is currently unknown.
Ophthalmic: For topical ophthalmic use only; avoid touching tip of applicator to eye(s) or other surfaces. After application close the eye(s) for 1 to 2 minutes; excess ointment may be wiped away. Contact lenses should not be worn during therapy or with signs/symptoms of herpetic keratitis.
Ophthalmic: For ophthalmic application only; avoid touching tip of applicator to eye or other surfaces. Apply to inside of lower eyelid; instruct patient to close eye(s) for 1 to 2 minutes following application. Patients should avoid wearing contact lenses during the course of therapy or with signs/symptoms of herpetic keratitis.
Herpetic keratitis: Treatment of acute herpetic keratitis (dendritic ulcers) in patients with herpes simplex (HSV-1 and HSV-2) virus
None known.
There are no known significant interactions.
Acyclovir has not been detected in the blood following ophthalmic administration; limited systemic absorption would limit potential exposure to the fetus. Results from a pregnancy registry, established in 1984 and closed in 1999, did not find an increase in the number of birth defects with exposure to systemic acyclovir when compared to those expected in the general population.
Acyclovir is present in breast milk following oral administration; exposure following ophthalmic administration is unknown. However, acyclovir has not been detected in the blood following ophthalmic use; limited systemic absorption would limit potential exposure via breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Systemic use of acyclovir is considered compatible with breastfeeding (WHO 2002).
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.
Absorption: Not detected in blood by existing bioanalytical methods
Excretion: Trace quantities are detectable in the urine but are not therapeutically relevant
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