Valacyclovir

What is Valacyclovir

Valacyclovir is an antiviral agent with activity against alpha-herpes viruses.

It is FDA approved for the treatment of: herpes labialis (cold sores) in patients 12 years and older; chickenpox in pediatric patients aged 2 to less than 18 years; herpes zoster (shingles) in immunocompetent adults; and genital herpes (initial episode, recurrent episodes, suppressive therapy, and reduction of transmission) in immunocompetent adults.

Valacyclovir is the L-valyl ester of acyclovir; the result of an effort to develop a prodrug to improve acyclovir oral bioavailability. Improved bioavailability means less frequent dosing for valacyclovir than acyclovir, which is especially beneficial during maintenance therapy.

While valacyclovir is only available as an oral tablet, extemporaneous compounding instructions are available to prepare an oral suspension.

Brand Name

Valtrex

Indications

  1. acute retinal necrosis (ARN)
  2. B virus (cercopithecine herpesvirus)
  3. Bell’s palsy
  4. cytomegalovirus (CMV)
  5. cytomegalovirus (CMV) disease prophylaxis
  6. encephalitis
  7. Epstein-Barr virus
  8. herpes genitalis
  9. herpes genitalis prophylaxis
  10. herpes labialis
  11. herpes simplex infection prophylaxis
  12. herpes simplex virus infection
  13. herpes simplex virus type 1
  14. herpes simplex virus type 2
  15. herpes zoster (shingles) infection
  16. varicella (chickenpox) infection
  17. varicella (chickenpox) infection prophylaxis
  18. varicella-zoster virus

Side Effects

  1. abdominal pain
  2. agitation
  3. alopecia
  4. anaphylactoid reactions
  5. anemia
  6. angioedema
  7. anuria
  8. aplastic anemia
  9. arthralgia
  10. ataxia
  11. coma
  12. confusion
  13. dehydration
  14. delirium
  15. depression
  16. diarrhea
  17. dizziness
  18. dysarthria
  19. dysmenorrhea
  20. dyspnea
  21. elevated hepatic enzymes
  22. encephalopathy
  23. erythema multiforme
  24. fatigue
  25. fever
  26. hallucinations
  27. headache
  28. hemolytic-uremic syndrome
  29. hepatitis
  30. hypertension
  31. impaired cognition
  32. mania
  33. nausea
  34. neutropenia
  35. pharyngitis
  36. photosensitivity
  37. pruritus
  38. psychosis
  39. rash
  40. renal failure (unspecified)
  41. rhinorrhea
  42. seizures
  43. sinus tachycardia
  44. sinusitis
  45. thrombocytopenia
  46. thrombotic thrombocytopenic purpura (TTP)
  47. tremor
  48. urticaria
  49. vasculitis
  50. visual impairment
  51. vomiting

Monitoring Parameters

  • serum creatinine/BUN

Contraindications

  • acyclovir hypersensitivity
  • breast-feeding
  • children
  • dehydration
  • famciclovir hypersensitivity
  • ganciclovir hypersensitivity
  • geriatric
  • infants
  • neonates
  • penciclovir hypersensitivity
  • pregnancy
  • renal failure
  • renal impairment
  • valacyclovir hypersensitivity
  • valganciclovir hypersensitivity

Interactions

  • Adefovir
  • Aldesleukin, IL-2
  • Aminoglycosides
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Aprotinin
  • Bictegravir; Emtricitabine; Tenofovir Alafenamide
  • Capreomycin
  • Cidofovir
  • Cimetidine
  • Cisplatin
  • Colchicine; Probenecid
  • Cyclosporine
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine
  • Emtricitabine; Rilpivirine; Tenofovir alafenamide
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir alafenamide
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Entecavir
  • Foscarnet
  • Fosphenytoin
  • Gallium Ga 68 Dotatate
  • Hyaluronidase, Recombinant; Immune Globulin
  • Immune Globulin IV, IVIG, IGIV
  • Inotersen
  • Iohexol
  • Ionic Contrast Media
  • Iopamidol
  • Iopromide
  • Ioversol
  • Isosulfan Blue
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lithium
  • Mannitol
  • Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
  • Methotrexate
  • Mycophenolate
  • Non-Ionic Contrast Media
  • Nonsteroidal antiinflammatory drugs
  • Oxaliplatin
  • Phenytoin
  • Polymyxins
  • Probenecid
  • Tacrolimus
  • Talimogene Laherparepvec
  • Telbivudine
  • Tenofovir Alafenamide
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Vancomycin
  • Varicella-Zoster Virus Vaccine, Live
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