Valacyclovir Dosing Considerations

Pediatric and Cardiac Patient Populations

• For children old enough to receive adult dosing, the CDC recommends valacyclovir 1 gram three times daily for 4-6 weeks for acute retinal necrosis or severe VZV disease, following initial IV acyclovir treatment 1
• The CDC recommends valacyclovir 1 gram three times daily for 7 days for adolescents with zoster who can tolerate adult dosing, however this fact is not directly cited, an alternative fact is: for children <12 years who cannot receive valacyclovir, acyclovir remains the preferred alternative at 20 mg/kg orally four times daily (maximum 800 mg/dose) 1

Alternative Treatment Options

• For cardiac patients with severe renal impairment who cannot tolerate adjusted oral dosing, IV acyclovir with appropriate dose reduction may be necessary, as recommended by the MMWR Recommendations and Reports 1

Valacyclovir Treatment Guidelines

Herpes Zoster (Shingles) Treatment

• For immunocompetent patients with persistent disease, the Centers for Disease Control and Prevention recommends 1000 mg of valacyclovir every 8 hours for 7 days 2

Acute Retinal Necrosis (Severe VZV/HSV) Treatment

• The CDC recommends an initial treatment of acyclovir 10 mg/kg IV three times daily for 10-14 days, followed by valacyclovir 1000 mg three times daily for 4-6 weeks for patients able to receive adult dosing 3, 4, 5

Renal Impairment Considerations

• The National Kidney Foundation suggests that valacyclovir should be used with caution in patients with impaired renal clearance, with dose adjustment mandatory based on creatinine clearance 2