ACICLIN ® Aciclovir

ACICLIN ® is a drug based on Acyclovir

THERAPEUTIC GROUP: Antivirals for systemic use

IndicationsAction mechanismStudies and clinical effectiveness Usage and dosage instructionsWarnings Pregnancy and lactationInteractionsContraindicationsUndesirable effects

Indications ACICLIN ® Aciclovir

ACICLIN ® is effective in the treatment and prophylaxis of infections supported by Herpes Simplex and Varicella Zooster Virus.

Mechanism of action ACICLIN ® Aciclovir

ACICLIN ® is a drug based on acyclovir, a purine nucleoside analogue, which first converted into Aciclovir monophosphate from the viral thymidine kinases and subsequently into Acyclovir di and triphosphate from the host cell kinases, competes with deoxyguanosite triphosphate, becoming an integral part of the viral DNA.

This integration leads to the formation of inactive complexes consisting of viral DNA with viral viral polymers that prevent the elongation of the nascent nucleotide chain by blocking the mechanisms of viral replication.

Despite the good therapeutic efficacy, supported also by particularly advantageous pharmacokinetic properties, in some cases Aciclovir therapy is not very effective due to the onset of multiple resistance mechanisms characterized by:

Reduction of the expression of the thymidine viral kinase enzyme, initiator of the enzymatic reaction;
Alterations in binding specificity between substrate and thymidine kinase;
Modifications of the viral DNA polymerase, which manages to advance despite the presence of inactive complexes.

After a widespread distribution between the various tissues, the drug is largely eliminated unchanged by glomerular filtration and tubular secretion.

Studies carried out and clinical efficacy

ACICLOVIR AND PYTHYRIASIS ROSEA

Kathmandu Univ Med J (KUMJ). 2012 Jan-Mar; 10 (37): 57-61.

An interesting clinical trial that demonstrates how the oral administration of Aciclovir can be effective, even more than that based on Erythromycin, in determining a prompt remission of the symptoms characterizing pityriasis rosea.

THERAPEUTIC RESISTANCE OF HSV IN TRANSPLANTED PATIENTS

Skinmed. 2012 Jul-Aug; 10 (4): 208-11.

South American work that seeks to characterize the risk of Aciclovir resistance arising from the Herpse Simplex virus in transplant patients. Such characterization could be crucial in choosing the correct antiviral prophylaxis in patients potentially exposed to multiple infections.

RISK OF ENCEPHALITIS IN ELDERLY PATIENTS WITH HSE

Brain Nerve. 2012 Sep; 64 (9): 1063-8.

Case report that opens an important debate on the greater capacity of the HSE, virus responsible for encephalitis, to mutate acquiring a natural resistance to Aciclovir in the elderly population. This condition could lead to a significant aggravation of the patient's clinical conditions.

Method of use and dosage

ACICLIN ®

Tablets of 400 mg and 800 mg of Aciclovir;

Granules for 800 mg oral suspension of Aciclovir;

Oral suspension of 400 mg of Aciclovir for 5 ml of solution;

5% Acyclovir cream.

Treatment with ACICLIN ®, regardless of the chosen pharmaceutical format, should be defined and supervised by a competent doctor in the treatment of infectious diseases, considering the patient's physiopathological conditions and the severity of his clinical picture.

An adjustment of the dosages generally used should be provided for elderly patients rather than for patients suffering from renal diseases.

In order for the therapy to remain as effective as possible, it would be advisable for it to begin immediately after the appearance of the first lesions or the first symptoms and signs of illness.

Warnings ACICLIN ® Aciclovir

The use of ACICLIN ® should be preceded by a careful medical examination in order to assess the prescriptive appropriateness and the possible presence of conditions incompatible with the therapy itself.

Particular caution should in fact be reserved for patients suffering from renal pathologies rather than elderly patients, due to the reduced ability to provide for the elimination of the drug itself and therefore to increase the potential side effects of the therapy.

Prolonged use of the drug, especially in immunocompromised patients, could determine the selection of viral strains resistant to Aciclovir therapy, therefore potentially responsible for significant clinical pictures.

ACICLIN ® in granules for oral suspension contains aspartame, sucrose and sorbitol, therefore it is not very suitable for patients suffering from fructose intolerance, glucose-galactose malabsorption syndrome, phenylketonuria and fructose hereditary intolerance.

The presence of glycerol could also lead to the appearance of diarrhea, abdominal cramps and migraine.

It is recommended to avoid the application of ACICLIN ® in cream on mucous membranes, and eyes seeing the potential irritant, remembering also to avoid direct exposure to ultraviolet rays, given the photosensitising power of Acyclovir.

PREGNANCY AND BREASTFEEDING

The aforementioned contraindications inevitably extend also to pregnancy and the subsequent breastfeeding period, given Aciclovir's ability to cross both the hematoplacental barrier and the mammary filter exposing itself to both the fetus and the infant in pharmacologically active concentrations, despite the effects of such exposure is not yet completely clear.

Interactions

Although there are no drug interactions between Aciclovir and other clinically relevant active ingredients, it would be advisable to avoid the simultaneous intake of drugs capable of altering the glomerular filtration capacity in order to preserve the pharmacokinetic characteristics of the active ingredient.

Contraindications ACICLIN ® Aciclovir

The use of ACICLIN ® is contraindicated in patients hypersensitive to acyclovir or to structurally related active ingredients rather than to excipients present in the drug.

ACICLIN ® is generally contraindicated also during pregnancy and in the subsequent period of breastfeeding.

Undesirable effects - Side effects

The use of ACICLIN ®, especially when prolonged for a long time, could determine, even with a certain frequency, the appearance of nausea, diarrhea, rash and headache.

Fortunately, the clinically relevant side effects such as renal failure, abnormal liver function and haematological disorders are rarer.