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Aciclovir 250mg Powder for Solution for Infusion

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Aciclovir sodium may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Aciclovir sodium

Equivalent medicines (same active substance, strength and form)

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for Aciclovir belongs to a group of medicines called antivirals. It works by killing or stopping the growth of viruses. Aciclovir for Infusion can be used to:

  • treat chickenpox
  • treat severe cases of genital herpes
  • treat and stop cold sores and genital herpes in people whose immune systems work less well, which means their bodies are less able to fight infections
  • treat serious virus infections in children up to 3 months of age. This can rarely be caused by the virus responsible for cold sore infection and genital herpes.
  • treat inflammation of the brain. This can rarely be caused by the virus responsible for cold sore infection and genital herpes.

What you need to know before you take it

e Aciclovir for Infusion Do not take aciclovir for infusion:

  • if you are allergic to aciclovir or valaciclovir or to any of the other ingredients of this medicine (listed in section 6). Do not take Aciclovir for Infusion if the above applies to you. If you are not sure, talk to your doctor or pharmacist before having Aciclovir for Infusion. Warnings and precautions Talk to your doctor or pharmacist or nurse before using Aciclovir for Infusion if you:
  • have had severe skin reactions with aciclovir or valaciclovir
  • have kidney problems
  • are over 65 years of age. If you are not sure if the above apply to you, talk to your doctor or pharmacist before taking Aciclovir for Infusion. It is important that you drink plenty of water while taking Aciclovir for Infusion. Conditions you need to look out for Aciclovir for Infusion can cause severe skin reactions. You must look out for certain symptoms while you are

taking Aciclovir for Infusion, to reduce the risk of any problems. If you experience any signs or symptoms of severe skin reactions, stop taking Aciclovir for Infusion and contact your doctor immediately (see 'Possible side effects'). Other medicines and Aciclovir for Infusion Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines obtained without a prescription, including herbal medicines. In particular tell your doctor or pharmacist if you are taking any of the following medicines:

  • probenecid, used to treat gout
  • cimetidine, used to treat stomach ulcers
  • tacrolimus, ciclosporin or mycophenolate mofetil, used to stop your body rejecting transplanted organs. Pregnancy breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machines Some side effects such as feeling drowsy or sleepy may impair your ability to concentrate and react. Make sure you are not affected before you drive or operate machinery. Aciclovir for Infusion contains sodium Each vial contains 26mg of sodium. You should tell your doctor or pharmacist if you are on a controlled sodium diet.

3. How to use Aciclovir for Infusion

How to take it

You will never be expected to give yourself this medicine. It will always be given to you by a person who is trained to do so. Before the medicine is given to you it will be diluted. Aciclovir for Infusion will be given to you as a continuous infusion into your vein. This is where the drug is slowly given to you over a period of time. The dose you will be given, the frequency and the duration of the dose will depend on:

  • the type of infection you have
  • your weight
  • your age. Your doctor may adjust the dose of Aciclovir for Infusion if:
  • you have kidney problems. If you have kidney problems, it is important you receive plenty of fluids while you are being treated with Aciclovir for Infusion. Talk to your doctor before having Aciclovir for Infusion if any of the above apply. If you use more aciclovir for infusion than you should If you think you have been given too much Aciclovir for Infusion, talk to your doctor or nurse straight away. If you have been given too much Aciclovir for Infusion you may:
  • feel confused or agitated
  • have hallucinations (seeing or hearing things that aren't there)
  • have fits
  • become unconscious (coma). If you forget to use aciclovir for infusion A doctor or a nurse will usually give you this medicine. If you think you have missed a dose, please tell your doctor or nurse.

Aciclovir 250mg Powder for Solution for Infusion The following information is intended for healthcare professionals only: DOSAGE AND ADMINISTRATION INFORMATION ONLY Please refer to the Summary of Product Characteristics (SPC) for complete prescribing information Qualitative and Quantitative Composition Each vial contains 250mg of aciclovir as the sodium salt Pharmaceutical Form Powder for solution for infusion. White powder. Therapeutic indications Aciclovir for infusion is indicated for the treatment of Herpes simplex infections in immunocompromised patients and severe initial genital herpes in the non-immunocompromised. Aciclovir for infusion is indicated for the prophylaxis of Herpes simplex infections in immunocompromised patients. Aciclovir for infusion is indicated for the treatment of Varicella zoster infections. Aciclovir for infusion is indicated for the treatment of herpes encephalitis. Aciclovir for infusion is indicated for the treatment of Herpes simplex infections in the neonate and infant up to three months of age. Posology and method of administration Route of administration: Slow intravenous infusion over 1 hour. A course of treatment with aciclovir for infusion usually lasts 5 days, but this may be adjusted according to the patient's condition and response to therapy. Treatment for herpes encephalitis usually lasts 10 days. Treatment for neonatal herpes usually lasts 14 days for mucocutaneous (skin-eye-mouth) infections and 21 days for disseminated or central nervous system disease. The duration of prophylactic administration of aciclovir for infusion is determined by the duration of the period at risk. Dosage in adults: Patients with Herpes simplex (except herpes encephalitis) or Varicella zoster infections should be given aciclovir for infusion in doses of 5mg/kg bodyweight every 8 hours provided renal function is not impaired (see Dosage in renal impairment). Immunocompromised patients with Varicella zoster infections or patients with herpes encephalitis should be given aciclovir for infusion in doses of 10mg/kg bodyweight every 8 hours provided renal function is not impaired (see Dosage in renal impairment). In obese patients who receive aciclovir intravenously based on their actual body weight, increased plasma concentrations may be obtained (see SPC section 5.2 Pharmacokinetic properties). A dose reduction should be therefore considered in obese patients, especially in patients with renal impairment or in elderly patients. Dosage in children: The dose of aciclovir for infusion for children aged between 3 months and 12 years is calculated on the basis of body surface area. Children 3 months of age or older with Herpes simplex (except herpes encephalitis) or Varicella zoster infections should be given aciclovir for infusion in doses of 250 mg per square metre of body surface area every 8 hours if renal function is not impaired. In immunocompromised children with Varicella zoster infections or children with herpes encephalitis, aciclovir for infusion should be given in doses of 500 mg per square metre body surface area every 8 hours if renal function is not impaired. The dosage of aciclovir for infusion in neonates and infants up to 3 months of age is calculated on the basis of bodyweight. The recommended regimen for infants treated for known or suspected neonatal herpes is aciclovir 20 mg/kg body weight IV every 8 hours for 21 days for disseminated and CNS disease, or for 14 days for disease limited to the skin and mucous membranes. Infants and children with impaired renal function require an appropriately modified dose, according to the degree of impairment (see Dosage in renal impairment). Dosage in the elderly: The possibility of renal impairment in the elderly must be considered and dosage should be adjusted accordingly (see Dosage in renal impairment below). Adequate hydration should be maintained.

Customer

Wockhardt UK Limited

Description

Aciclovir 250mg 5pk Vial leaflet

Item Code

103376/10

Profile

As per the uploaded annotated pdf

Size

297mm x 420mm

Min.Point Size

Other

Market

UK

Language

English

N/A

Pharma Height

7mm Minimum

Dosage in renal impairment: Caution is advised when administering aciclovir for infusion to patients with impaired renal function. Adequate hydration should be maintained. Dosage adjustment for patients with renal impairment is based on creatinine clearance, in units of ml/min for adults and adolescents and in units of ml/min/1.73m2 for infants and children less than 12 years of age. The following adjustments in dosage are suggested: Dosage adjustments in adults and adolescents with renal impairment for treatment of Herpes Simplex or Varicella Zoster virus infections: Creatinine Clearance Dosage for Herpes simplex infection or Varicella zoster 25 to 50 ml/min 5 mg/kg body weight given every 12 hours. 10 to 25 ml/min 5 mg/kg body weight given every 24 hours. 0 (anuric) to 2.5 mg/kg body weight given every 10 ml/min 24 hours. Patients on 2.5 mg/kg body weight given every haemodialysis 24 hours after dialysis.

Dosage adjustments in neonates, infants and children with renal impairment for treatment of Herpes Simplex or Varicella Zoster virus infections: Creatinine Clearance Dosage for Herpes simplex infection or Varicella zoster (mL/min/1.73 m2) 25 to 50 ml/min 250 mg/m2 body surface area given every 12 hours. 10 to 25 ml/min 125 mg/m2 body surface area given every 12 hours. 0 (anuric) to 62.5 mg/m2 body surface area given every 12 hours. 10 ml/min Patients on 62.5 mg/m2 body surface area given every 12 hours after dialysis. haemodialysis

DATE

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Dosage for Herpes encephalitis or immunecompromised patients with Varicella zoster 500 mg/m2 body surface area given every 12 hours. 250 mg/m2 body surface area given every 12 hours. 125 mg/m2 body surface area given every 12 hours. 125 mg/m2 body surface area given every 12 hours after dialysis.

Contraindications Hypersensitivity to aciclovir and valaciclovir, or to any of the excipients listed in section 6.1. Special warnings and precautions for use Severe cutaneous adverse reactions: Cases of severe cutaneous adverse reactions (SCARs), including toxic epidermal necrolysis (TEN), StevensJohnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and erythema multiforme (EM) have been reported in patients treated with aciclovir. As SCARs can be life-threatening or fatal, if signs and symptoms suggestive of SCARs appear, treatment with aciclovir must be discontinued immediately, and alternative treatment should be given. Patients who have developed SCARs with the use of aciclovir or valaciclovir must not receive aciclovir (see Contraindications and Adverse Reactions). Use in patients with renal impairment and in elderly patients: Adequate hydration should be maintained in patients given i.v. or high oral doses of aciclovir. Intravenous doses should be given by infusion over one hour to avoid precipitation of aciclovir in the kidney; rapid or bolus injection should be avoided. The risk of renal impairment is increased by use with other nephrotoxic drugs. Care is required if administering i.v. aciclovir with other nephrotoxic drugs. Aciclovir is eliminated by renal clearance, therefore the dose must be adjusted in patients with renal impairment (see SPC section 4.2 Posology and method of administration). Elderly patients are likely to have reduced renal function and therefore the need for dose adjustment must be considered in this group of patients. Both elderly patients and patients with renal impairment are at increased risk of developing

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Dosage for Herpes encephalitis or immunecompromised patients with Varicella zoster 10 mg/kg body weight given every 12 hours. 10 mg/kg body weight given every 24 hours. 5 mg/kg body weight given every 24 hours. 5 mg/kg body weight given every 24 hours after dialysis.

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If you have any further questions on the use of this medicine, ask your doctor or pharmacist or nurse.

4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them. The following

Possible side effects

may happen with this medicine: Conditions you need to look out for Allergic reactions (may affect 1 in 10,000 people) If you have an allergic reaction, stop taking Aciclovir for Injection and see a doctor straight away. The signs may include:

  • rash, itching or hives on your skin
  • swelling of your face, lips, tongue or other parts of your body
  • shortness of breath, wheezing or trouble breathing
  • unexplained fever (high temperature) and feeling faint, especially when standing up. Severe skin reactions: These are very rare (these may affect up to 1 in 10,000 people) taking Aciclovir for Injection. Signs include:
  • widespread red or scaly rash with blisters (that may contain pus), bumps under the skin or peeling of the skin. Flu-like symptoms with rash, fever swollen glands, and abnormal blood test results. Contact a doctor immediately if you get these symptoms. Stop taking Aciclovir for Injection. Other side effects include: Common (may affect up to 1 in 10 people)
  • feeling or being sick
  • Itchy, hive like rash
  • skin reactions after exposure to light (photosensitivity)
  • itching
  • swelling, redness and tenderness at the site of injection
  • increase in the liver enzymes. Uncommon (may affect up to 1 in 100 people)
  • reduced number of red blood cells (anaemia)
  • reduced number of white blood cells (leukopenia)
  • reduced number of blood platelets (cells that help the blood to clot) (thrombocytopenia). Very rare (may affect up to 1 in 10,000 people)
  • headache or feeling dizzy
  • diarrhoea or stomach pains
  • feeling tired
  • fever
  • effects on some blood urine tests
  • feeling weak
  • feeling agitated or confused
  • shaking or tremors
  • hallucinations (seeing or hearing things that aren't there)
  • fits
  • feeling unusually sleepy or drowsy
  • unsteadiness when walking and lack of coordination
  • difficulty speaking
  • inability to think or judge clearly
  • unconsciousness (coma)
  • paralysis of part or all of your body
  • disturbances of behaviour, speech, and eye movements
  • stiff neck and sensitivity to light
  • inflammation of the liver (hepatitis)
  • yellowing of your skin and whites of your eyes (jaundice)

neurological side effects and should be closely monitored for evidence of these effects. In the reported cases, these reactions were generally reversible on discontinuation of treatment (see SPC section 4.8 Undesirable effects). Prolonged or repeated courses of aciclovir in severely immune-compromised individuals may result in the selection of virus strains with reduced sensitivity, which may not respond to continued aciclovir treatment (see SPC section 5.1). In patients receiving aciclovir for infusion at higher doses (e.g. for herpes encephalitis), specific care regarding renal function should be taken, particularly when patients are dehydrated or have any renal impairment. Reconstituted aciclovir for infusion has a pH of approximately 11 and should not be administered by mouth. Product contains sodium (26mg, approx. 1,13mmol). To be taken into consideration by patients on a controlled sodium diet. Aciclovir for infusion contains no antimicrobial preservative. Reconstitution and dilution should therefore be carried out under full aseptic conditions immediately before use and any unused solution discarded. The reconstituted or diluted solutions should not be refrigerated. This vial contains approximately 26mg of sodium in total. The sodium content should be taken into consideration when prescribing to patients requiring sodium restriction. Interaction with other medicinal products and other forms of interaction Aciclovir is eliminated primarily unchanged in the urine via active renal tubular secretion. Any drugs administered concurrently that compete with this mechanism may increase aciclovir plasma concentrations. Probenecid and cimetidine increase the AUC of aciclovir by this mechanism, and reduce aciclovir renal clearance. However no dosage adjustment is necessary because of the wide therapeutic index of aciclovir. In patients receiving intravenous aciclovir, caution is required during concurrent administration with drugs which compete with aciclovir for elimination, because of the potential for increased plasma levels of one or both drugs or their metabolites. Increases in plasma AUCs of aciclovir and of the inactive metabolite of mycophenolate mofetil, an immunosuppressant agent used in transplant patients, have been shown when the drugs are co-administered. If lithium is administered concurrently with high dose aciclovir IV, the lithium serum concentration should be closely monitored because of the risk of lithium toxicity. Care is also required (with monitoring for changes in renal function) if administering intravenous aciclovir with drugs which affect other aspects of renal physiology (e.g. ciclosporin, tacrolimus). An experimental study on five male subjects indicates that concomitant therapy with aciclovir increases AUC of totally administered theophylline with approximately 50%. It is recommended to measure plasma concentrations during concomitant therapy with aciclovir. Overdose Overdosage of intravenous aciclovir has resulted in elevations of serum creatinine, blood urea nitrogen and subsequent renal failure. Neurological effects including confusion, hallucinations, agitation, seizures and coma have been described in association with overdosage. Patients should be observed closely for signs of toxicity. Haemodialysis significantly enhances the removal of aciclovir from the blood and may, therefore, be considered a management option in the event of symptomatic overdose.

• • •

kidney problems where you pass little or no urine pain in your lower back, the kidney area of your back or just above your hip (renal pain) severe skin reactions, such as widespread or scaly rash with blisters (that may contain pus), bumps under the skin or peeling of skin. Flu-like symptoms with a rash, swollen glands, and abnormal blood test results. (see 'Conditions you need to look out for'). Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme, website: www.mhra.gov.uk/yellowcard or search for the MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

How to store it

Aciclovir for Infusion • •

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and the label on the small glass container (vial). The expiry date refers to the last day of that month.

  • Your doctor, nurse or pharmacist will be responsible for storing and preparing aciclovir before use and for checking that the vials have not passed their expiry date.
  • Do not store above 25°C. The vials should be kept in their outer carton, in order to protect from light.
  • Once the powder has been made into a solution the product should be used immediately. If this is not possible it would generally not be stored for more than 24 hours at 2-8°C. Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

Contents of the pack and other information

What Aciclovir for Infusion contains Each vial contains 250mg of the active ingredient, aciclovir (as the sodium salt), as a powder. The other ingredient is sodium hydroxide. What Aciclovir for Infusion looks like and contents of the pack The white powder comes in a glass vial with a rubber cap and metal/plastic seal. It is available in packs of 1, 5 or 10 vials. Not all pack sizes may be marketed.

Other formats To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge: 0800 198 5000 (UK Only) Please be ready to give the following information: Product name Reference number Aciclovir 250mg Powder for Solution for Infusion 29831/0320 This is a service provided by the Royal National Institute of Blind People. Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder: Wockhardt UK Ltd, Ash Road North, Wrexham, LL13 9UF, UK. Manufacturer: CP Pharmaceuticals Ltd, Ash Road North, Wrexham, LL13 9UF, UK. This leaflet was last revised in 02/2026

103376/10

The reconstituted solution appears light yellow and slightly opalescent. After reconstitution aciclovir powder for solution for infusion may be administered by a controlled-rate infusion pump. Alternatively, the reconstituted solution may be further diluted to give an aciclovir concentration of not greater than 5 mg/ml (0.5% w/v) for administration by infusion: For further dilution, add the required volume of reconstituted solution to the chosen infusion solution, as recommended below, and shake well to ensure adequate mixing occurs. For children and neonates, where it is advisable to keep the volume of infusion fluid to a minimum, it is recommended that dilution is on the basis of 4ml reconstituted solution (100mg aciclovir) added to 20 ml of infusion fluid. For adults, it is recommended that infusion bags containing 100ml of infusion fluid are used, even when this would give an aciclovir concentration substantially below 0.5% w/v. Thus, one 100 ml infusion bag may be used for any dose between 250mg and 500mg aciclovir (10 and 20 ml of reconstituted solution) but a second bag must be used for doses between 500 and 1000mg. When diluted in accordance with the recommended schedules, aciclovir for infusion is known to be compatible with the following infusion fluids:

  • sodium chloride intravenous infusion BP (0.45% and 0.9% w/v);
  • sodium chloride (0.18% w/v) and glucose (4% w/v) intravenous infusion BP
  • sodium chloride (0.45% w/v) and glucose (2.5% w/v) intravenous infusion BP
  • compound sodium lactate intravenous infusion BP (Hartmann's Solution). Aciclovir for infusion, when diluted in accordance with the above schedule will give an aciclovir concentration not greater than 0.5% w/v. Since no antimicrobial preservative is included, reconstitution and dilution must be carried out under full aseptic conditions, immediately before use, and any unused solution discarded. Should any visible turbidity or crystallisation appear in the solution before or during infusion, the preparation should be discarded. Marketing Authorisation Holder Wockhardt UK Limited Ash Road North Wrexham LL13 9UF United Kingdom Marketing Authorisation Number PL 29831/0320 Information for the Healthcare Professional Leaflet date 02/2026

List of excipients Sodium hydroxide Incompatibilities This medicinal product must not be mixed with other medicinal products except those mentioned in section 6.6. Nature and contents of container Packs* of one, five or ten Type II colourless glass 10ml vials stoppered with a chlorobutyl stopper and an aluminium and polypropylene flip-off cap. *Not all pack sizes may be marketed Special precautions for disposal and other handling Reconstitution: Aciclovir 250mg for infusion should be reconstituted using 10ml of either Water for Injections PhEur or Sodium Chloride Intravenous Infusion BP (0.9% w/v) to provide a solution containing 25mg aciclovir per ml. From the calculated dose, determine the appropriate number and strength of vials to be used. To reconstitute each vial add the recommended volume of infusion fluid and shake gently until the contents of the vial have dissolved completely.

Customer

Wockhardt UK Limited

Description

Aciclovir 250mg 5pk Vial leaflet

Item Code

103376/10

103376/10

PRINTING COLOURS

16 East Park Road | Leicester | LE5 4QA | UK

APPROVAL SIGNATURE

DATE

Warning! We cannot accept responsibility for any errors in this proof after approval. Whilst we take extreme care at all times to ensure accuracy to our client's brief, the final responsibility must be taken by our client. IF YOU SIGN THIS PROOF YOU ARE SIGNIFYING FULL APPROVAL OF DESIGN AND TEXT.

Profile

As per the uploaded annotated pdf

Size

297mm x 420mm

Min.Point Size

Other

Market

UK

Language

English

N/A

Pharma Height

7mm Minimum

Barcode Proof By

EBR

Proof No.

1

Date

16.02.2026

Body Text Fonts: Myriad Pro

Actual Min Point Size 9pt

Black

TECHNICAL COLOURS Keyline (Non-Printing)

Frequently asked questions about Aciclovir 250mg Powder for Solution for Infusion

How do I take Aciclovir 250mg Powder for Solution for Infusion?

Aciclovir 250mg Powder for Solution for Infusion comes as infusion containing 250mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Aciclovir 250mg Powder for Solution for Infusion?

The active substance in Aciclovir 250mg Powder for Solution for Infusion is aciclovir sodium.

Are there equivalent medicines to Aciclovir 250mg Powder for Solution for Infusion?

Medicines with the same active substance, strength and form include: Aciclovir 250mg powder for solution for infusion vials. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Aciclovir 250mg Powder for Solution for Infusion, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Aciclovir 250mg Powder for Solution for Infusion without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Aciclovir sodium (4 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Aciclovir for infusion is indicated for the treatment of Herpes simplex infections in immunocompromised patients and severe initial genital herpes in the non-immunocompromised.

Aciclovir for infusion is indicated for the prophylaxis of Herpes simplex infections in immunocompromised patients.

Aciclovir for infusion is indicated for the treatment of Varicella zoster infections.

Aciclovir for infusion is indicated for the treatment of herpes encephalitis.

Aciclovir for infusion is indicated for the treatment of Herpes simplex infections in the neonate and infant up to three months of age.

4.2. Posology and method of administration

Route of administration: Slow intravenous infusion over 1 hour.

A course of treatment with aciclovir for infusion usually lasts 5 days, but this may be adjusted according to the patient's condition and response to therapy. Treatment for herpes encephalitis usually lasts 10 days. Treatment for neonatal herpes usually lasts 14 days for mucocutaneous (skin-eye-mouth) infections and 21 days for disseminated or central nervous system disease.

The duration of prophylactic administration of aciclovir for infusion is determined by the duration of the period at risk.

Posology

Dosage in adults:

Patients with Herpes simplex (except herpes encephalitis) or Varicella zoster infections should be given aciclovir for infusion in doses of 5mg/kg bodyweight every 8 hours provided renal function is not impaired (see Dosage in renal impairment).

Immunocompromised patients with Varicella zoster infections or patients with herpes encephalitis should be given aciclovir for infusion in doses of 10mg/kg bodyweight every 8 hours provided renal function is not impaired (see Dosage in renal impairment).

In obese patients who receive aciclovir intravenously based on their actual body weight, increased plasma concentrations may be obtained (see 5.2 Pharmacokinetic properties). A dose reduction should therefore be considered in obese patients, especially in patients with renal impairment or in elderly patients.

Dosage in infants and children:

The dose of aciclovir for infusion for children aged between 3 months and 12 years is calculated on the basis of body surface area.

Infants and children 3 months of age or older with Herpes simplex (except herpes encephalitis) or Varicella zoster infections should be given aciclovir for infusion in doses of 250 mg per square metre of body surface area every 8 hours if renal function is not impaired.

In immunocompromised children with Varicella zoster infections or children with herpes encephalitis, aciclovir for infusion should be given in doses of 500 mg per square metre body surface area every 8 hours if renal function is not impaired.

The dosage of aciclovir for infusion in neonates and infants up to 3 months of age is calculated on the basis of bodyweight.

The recommended regimen for infants treated for known or suspected neonatal herpes is aciclovir 20 mg/kg body weight IV every 8 hours for 21 days for disseminated and CNS disease, or for 14 days for disease limited to the skin and mucous membranes.

Infants and children with impaired renal function require an appropriately modified dose, according to the degree of impairment (see Dosage in renal impairment).

Dosage in the elderly:

The possibility of renal impairment in the elderly must be considered and dosage should be adjusted accordingly (see Dosage in renal impairment below).

Adequate hydration should be maintained.

Dosage in renal impairment:

Caution is advised when administering aciclovir for infusion to patients with impaired renal function. Adequate hydration should be maintained.

Dosage adjustment for patients with renal impairment is based on creatinine clearance, in units of ml/min for adults and adolescents and in units of ml/min/1.73m2 for infants and children less than 12 years of age. The following adjustments in dosage are suggested:

Dosage adjustments in adults and adolescents with renal impairment for treatment of Herpes Simplex or Varicella Zoster virus infections:

Creatinine Clearance

Dosage for Herpes simplex infection or Varicella zoster

Dosage for Herpes encephalitis or immune-compromised patients with Varicella zoster

25 to 50 ml/min

5 mg/kg body weight given every 12 hours.

10 mg/kg body weight given every 12 hours.

10 to 25 ml/min

5 mg/kg body weight given every 24 hours.

10 mg/kg body weight given every 24 hours.

0 (anuric) to 10 ml/min

2.5 mg/kg body weight given every 24 hours.

5 mg/kg body weight given every 24 hours.

Patients on haemodialysis

2.5 mg/kg body weight given every 24 hours after dialysis.

5 mg/kg body weight given every 24 hours after dialysis.

Dosage adjustments in neonates, infants and children with renal impairment for treatment of Herpes Simplex or Varicella Zoster virus infections:

Creatinine Clearance

(mL/min/1.73 m2)

Dosage for Herpes simplex infection or Varicella zoster

Dosage for Herpes encephalitis or immune-compromised patients with Varicella zoster

25 to 50 ml/min

250 mg/m2 body surface area given every 12 hours.

500 mg/m2 body surface area given every 12 hours.

10 to 25 ml/min

125 mg/m2 body surface area given every 12 hours.

250 mg/m2 body surface area given every 12 hours.

0 (anuric) to 10 ml/min

62.5 mg/m2 body surface area given every 12 hours.

125 mg/m2 body surface area given every 12 hours.

Patients on haemodialysis

62.5 mg/m2 body surface area given every 12 hours after dialysis.

125 mg/m2 body surface area given every 12 hours after dialysis.

4.3. Contraindications

Hypersensitivity to aciclovir and valaciclovir, or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

Severe cutaneous adverse reactions:

Cases of severe cutaneous adverse reactions (SCARs), including toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and erythema multiforme (EM) have been reported in patients treated with aciclovir.

As SCARs can be life-threatening or fatal, if signs and symptoms suggestive of SCARs appear, treatment with aciclovir must be discontinued immediately, and alternative treatment should be given. Patients who have developed SCARs with the use of aciclovir or valaciclovir must not receive aciclovir (see Contraindications and Adverse Reactions).

Adequate hydration should be maintained in patients given i.v. or high oral doses of aciclovir.

Intravenous doses should be given by infusion over one hour to avoid precipitation of aciclovir in the kidney; rapid or bolus injection should be avoided.

The risk of renal impairment is increased by use with other nephrotoxic drugs. Care is required if administering i.v. aciclovir with other nephrotoxic drugs.

Use in patients with renal impairment and in elderly patients:

Aciclovir is eliminated by renal clearance, therefore the dose must be adjusted in patients with renal impairment (see section 4.2 Posology and method of administration). Elderly patients are likely to have reduced renal function and therefore the need for dose adjustment must be considered in this group of patients. Both elderly patients and patients with renal impairment are at increased risk of developing neurological side effects and should be closely monitored for evidence of these effects. In the reported cases, these reactions were generally reversible on discontinuation of treatment (see section 4.8 Undesirable effects). Prolonged or repeated courses of aciclovir in severely immune-compromised individuals may result in the selection of virus strains with reduced sensitivity, which may not respond to continued aciclovir treatment (see section 5.1).

In patients receiving aciclovir for infusion at higher doses (e.g. for herpes encephalitis), specific care regarding renal function should be taken, particularly when patients are dehydrated or have any renal impairment.

Reconstituted aciclovir for infusion has a pH of approximately 11 and should not be administered by mouth. Product contains sodium (26mg, approx. 1,13mmol). To be taken into consideration by patients on a controlled sodium diet.

Aciclovir for infusion contains no antimicrobial preservative. Reconstitution and dilution should therefore be carried out under full aseptic conditions immediately before use and any unused solution discarded. The reconstituted or diluted solutions should not be refrigerated.

Other warnings and precautions

The labels shall contain the following statements:

For intravenous infusion only.

Keep out of the reach and sight of children.

Do not store above 25°C.

Prepare immediately prior to use.

Discard unused solution.

Excipients:

This vial contains approximately 26mg of sodium in total. The sodium content should be taken into consideration when prescribing to patients requiring sodium restriction.

4.5. Interaction with other medicinal products and other forms of interaction

Aciclovir is eliminated primarily unchanged in the urine via active renal tubular secretion. Any drugs administered concurrently that compete with this mechanism may increase aciclovir plasma concentrations. Probenecid and cimetidine increase the AUC of aciclovir by this mechanism, and reduce aciclovir renal clearance. However, no dosage adjustment is necessary because of the wide therapeutic index of aciclovir.

In patients receiving intravenous aciclovir, caution is required during concurrent administration with drugs which compete with aciclovir for elimination, because of the potential for increased plasma levels of one or both drugs or their metabolites. Increases in plasma AUCs of aciclovir and of the inactive metabolite of mycophenolate mofetil, an immunosuppressant agent used in transplant patients, have been shown when the drugs are co-administered.

If lithium is administered concurrently with high dose aciclovir IV, the lithium serum concentration should be closely monitored because of the risk of lithium toxicity.

Care is also required (with monitoring for changes in renal function) if administering intravenous aciclovir with drugs which affect other aspects of renal physiology (e.g. ciclosporin, tacrolimus).

An experimental study on five male subjects indicates that concomitant therapy with aciclovir increases AUC of totally administered theophylline with approximately 50%. It is recommended to measure plasma concentrations during concomitant therapy with aciclovir.

4.6. Fertility, pregnancy and lactation

Pregnancy

A post-marketing aciclovir pregnancy registry has documented pregnancy outcomes in women exposed to any formulation of aciclovir. The registry findings have not shown an increase in the number of birth defects amongst aciclovir exposed subjects compared with the general population, and any birth defects showed no uniqueness or consistent pattern to suggest a common cause. Systemic administration of aciclovir in internationally accepted standard tests did not produce embryotoxic or teratogenic effects in rabbits, rats or mice. In a non-standard test in rats, foetal abnormalities were observed but only following such high subcutaneous doses that maternal toxicity was produced. The clinical relevance of these findings is uncertain.

Caution should therefore be exercised by balancing the potential benefits of treatment against any possible hazard. Findings from reproduction toxicology studies are included in Section 5.3.

Fertility

There is no information on the effect of aciclovir on human female fertility. In a study of 20 male patients with normal sperm count, oral aciclovir administered at doses of up to 1g per day for up to six months has been shown to have no clinically significant effect on sperm count, motility or morphology.

See clinical studies in section 5.2

Breast-feeding

Following oral administration of 200mg five times a day, aciclovir has been detected in human breast milk at concentrations ranging from 0.6 to 4.1 times the corresponding plasma levels. These concentrations would potentially expose nursing infants to aciclovir dosages of up to 0.3 mg/kg bodyweight/day. Caution is therefore advised if aciclovir is to be administered to a nursing woman.

4.7. Effects on ability to drive and use machines

Aciclovir for infusion is generally used in an in-patient hospital population and information on ability to drive and operate machinery is not usually relevant. There have been no studies to investigate the effect of aciclovir on driving performance or the ability to operate machinery.

4.8. Undesirable effects

The frequency categories associated with the adverse events below are estimates. For most events, suitable data for estimating incidence were not available. In addition, adverse events may vary in their incidence depending on the indication.

The following convention has been used for the classification of undesirable effects in terms of frequency:-

Very common ≥ 1/10, common ≥1/100 and <1/10, uncommon ≥1/1,000 and <1/100, rare ≥1/10,000 and <1/1,000, very rare <1/10,000.

Blood and lymphatic system disorders

Uncommon: Decreases in haematological indices (anaemia, thrombocytopenia, leucopenia).

Immune system disorders

Very rare: Anaphylaxis.

Psychiatric and nervous system disorders

Very rare: Headache, dizziness, confusion, hallucinations, agitation, tremor, ataxia, dysarthria, somnolence, psychotic symptoms, encephalopathy, convulsions and coma.

The above events are generally reversible and usually reported in patients with renal impairment or with other predisposing factors (see section 4.4 Special Warnings and Precautions for use).

Vascular disorders

Common: Phlebitis.

Respiratory, thoracic and mediastinal disorders

Very rare: Dyspnoea.

Gastrointestinal disorders

Common: Nausea, vomiting

Very rare: Diarrhoea, abdominal pain.

Hepato-biliary disorders

Common: Reversible increases in liver-related enzymes

Very rare: Reversible increases in bilirubin, hepatitis and jaundice.

Skin and subcutaneous tissue disorders

Common: Rashes including photosensitivity, urticaria, pruritus

Very rare: Angioedema, Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), erythema multiforme (EM) (See Special warnings and precautions for use).

Renal and urinary disorders

Common: Increases in blood urea and creatinine.

Rapid increases in blood urea and creatinine levels are believed to be related to peak plasma levels and the state of hydration of the patient. To avoid this effect the drug should not be given as an intravenous bolus injection but by slow infusion over a one hour period.

Very rare: Renal impairment, acute renal failure, renal pain.

Adequate hydration of the patient should be maintained. Renal impairment usually responds rapidly to rehydration of the patient and/or dosage reduction or withdrawal of the drug. Progression to acute renal failure, however, can occur in exceptional cases.

Renal pain may be associated with renal failure and crystalluria.

General disorders and administration site conditions

Very rare: Fatigue, fever, local inflammatory reactions

Severe local inflammatory reactions sometimes leading to breakdown of the skin have occurred when aciclovir for intravenous use has been inadvertently infused into extravascular tissues.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

Overdosage of intravenous aciclovir has resulted in elevations of serum creatinine, blood urea nitrogen and subsequent renal failure. Neurological effects including confusion, hallucinations, agitation, seizures and coma have been described in association with overdosage.

Patients should be observed closely for signs of toxicity. Haemodialysis significantly enhances the removal of aciclovir from the blood and may, therefore, be considered a management option in the event of symptomatic overdose.

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