Acyclovir Dosing in Renal Impairment

Oral Acyclovir Dosing Adjustments

• For patients with CrCl <10 mL/min, the Centers for Disease Control and Prevention recommends a dose reduction to 200 mg every 12 hours, and for those on hemodialysis, the first daily dose should be administered after dialysis 1

Intravenous Acyclovir Dosing Adjustments

• The Infectious Diseases Society of America recommends dose adjustments for intravenous acyclovir based on renal function: for CrCl 25-50 mL/min, 5-10 mg/kg IV every 12 hours; for CrCl 10-24 mL/min, 5-10 mg/kg IV every 24 hours; and for CrCl <10 mL/min, 2.5-5 mg/kg IV every 24 hours 2, 3, 4
• For patients on hemodialysis, the dose should be administered post-dialysis on dialysis days, with a recommended dose of 2.5-5 mg/kg IV every 24 hours 2, 3

Critical Administration Considerations

• To prevent nephrotoxicity, the Clinical Infectious Diseases society advises against rapid IV bolus administration, recommending slow infusion over 1 hour, and ensuring adequate hydration with at least 1.5 liters of water daily 4, 5
• The Centers for Disease Control and Prevention recommends supplemental dosing after each dialysis session for patients on hemodialysis 1