SUPPORT DOCUMENT II: Oral Antiviral Agents* Acyclovir Famciclovir Valacyclovir Brand Zovirax® Famvir® Valtrex® Generic Yes Yes Yes Available Adult HSV HSV HSV Indications 1. Genital infection 1. Genital infection 1. Genital infection 2. Encephalitis 2. Encephalitis 2. Labialis 3. Mucocutaneous 3. Recurrent labialis VZV VZV VZV 1. Shingles 1. Shingles 1. Shingles 2. Chickenpox 2. Chickenpox 2. Chickenpox Immunocompromised Immunocompromised Immunocompromised Patients Patients Patients 1. Prevention of HSV 1. Recurrent 1. Treatment of HSV reactivation mucocutaneous/ or VZV (Cancer) (HIV and HSCT) genital (HIV) 2. CMV prophylaxis 2. Prevention of VZV 2. Prevention of HSV (HSCT) reactivation (HSCT) reactivation (HIV) 3. Treatment of disseminated HSV or VZV (cancer) 4. Treatment of suspected HSV or VZV encephalitis (cancer) 5. Treatment of episodic HSV infection (HIV) Pediatric HSV none HSV Indications 1. Genital infection 1. Labialis 2. Encephalitis 3. Mucocutaneous VZV 4. Neonatal 1. Chickenpox 5. Prevention of reactivation (HIV exposed or positive patients, HSCT) VZV 1. Shingles 2. Chickenpox 3. Acute retinal necrosis (HIV exposed or positive patients) Pediatric Age > 2 years old > 18 years old > 2 years old (neonatal indication) U.S. Dosage Oral Oral Oral Forms Capsule Tablet Caplets Tablet (suspension can be Suspension prepared from 500mg caplets) IV Powder Solution Disease 1. Renal impairment 1. Renal impairment 1. Renal impairment Related Concerns Dosage 1. Lactose intolerance Concerns Warnings 1. Acute renal failure 1. Acute renal failure 1. TTP/HUS 2. TTP 2. Acute renal failure 3. CNS (agitation, hallucination, encephalopathy) Pregnancy B B B Category Dosing BID BID QD Frequency (Chronic Suppressive HSV Therapy) Adult Half 3 hours 2–4 hours 2.5–3 hours Life *Based on FDA Prescribing Information. HSCT: Hematopoetic stem cell transplantation TTP: Thrombotic thrombocytopenic purpura HUS: Hemolytic uremic syndrome .