preloder

Acyclovir-Hydrocortisone


Acyclovir

is an

antiviral

drug. The combination of

Acyclovir

and

hydrocortisone

topical
(for the skin) is used to treat

cold sores

in people who are at least 12 years old. This medication will not cure or prevent

cold sores

caused by

herpes

, but it can lessen the symptoms of the

infection

.
Dosing
Adult dosing:
Recurrent

herpes simplex

labialis:

At first

signs and symptoms

, apply
TOPICALLY
to affected areas on

lips

or around the

mouth

, including outer margin, 5 times a day for 5 days

Pediatric dosing:
Recurrent

herpes simplex

labialis:

6 years or older:
At first

signs and symptoms

, apply
TOPICALLY
to affected areas on

lips

or around the

mouth

, including outer margin, 5 times a day for 5 days

Indications
FDA-Labeled Indications:
Recurrent

herpes

simplex labialis
Mechanism of Action

Acyclovir

is a synthetic purine nucleoside analogue with inhibitory activity against

herpes

simplex viruses type 1 (HSV-1) and type 2 (HSV-2) in
cell culture
and in vivo. The inhibitory activity of

Acyclovir

is highly selective due to its affinity for the

enzyme

thymidine kinase (TK) encoded by HSV. This

viral

enzyme

converts

Acyclovir

into

Acyclovir

monophosphate, a nucleotide analogue. The monophosphate is further converted into diphosphate by cellular guanylate kinase and into triphosphate by a number of cellular

enzymes

. In
cell culture
,

Acyclovir

triphosphate stops replication of

herpes

viral

DNA

.
This inhibition is accomplished in 3 ways:
1) competitive inhibition of

viral

DNA

polymerase

,
2) incorporation into and termination of the growing

viral

DNA

chain,
3) inactivation of the

viral

DNA

polymerase

.

hydrocortisone

is the main glucocorticoid secreted by the

adrenal cortex

. It is used
TOPICALLY
for its

anti-inflammatory

effects which suppress the clinical manifestations of the

disease

in a wide range of disorders where inflammation is a prominent feature.
Adverse Effect
Common:
Dermatologic:
Application site pigmentation changes (less than 1%)
Application site reaction (less than 1%)

Burning sensation

, Application site (less than 1%)

Dry skin

, Application site (less than 1%)

Erythema

, Application site (less than 1%)
Contraindication
Specific contraindications have not been determined
Interaction
No drug interaction studies have been performed
Precaution
Contact sensitization and irritation may occur
Failure of sore to heal; may be

bacterial

or

fungal

orofacial lesion
topical
use on

lips

and around

mouth

only; avoid contact with inside of

nose

or

mouth

,

eyes

, or genitals
Pregnancy Category
B (FDA)
Breast Feeding
Infant risk cannot be ruled out.
Monitoring
Improvement in

signs and symptoms

of

cold sores

and shorter healing time are indicative of efficacy
How to Take or Administration
Topical:
Apply a thin layer; to avoid aggravating or transferring the

infection

, do not rub affected area; do not cover area with a bandage or use other
topical
products
Do not apply in the

eyes

, inside the mouth or

nose

, or in the
genital area

Dosage Form
Topical Cream:
(

Acyclovir-Hydrocortisone

) 5%-1%

Treatment
Management of Mild to Moderate Toxicity:
Patients generally do well with supportive care.

Nausea

and

vomiting

should be treated with

antiemetics

. Rashes should be treated with supportive care, discontinuation of the offending agent, and consideration of antihistamines and corticosteroids. With massive overdose, hydrate patients and monitor

renal

function.

Management of Severe Toxicity:
Supportive care remains the mainstay of care in severe toxicity. Seizures should be treated with

benzodiazepines

as first line therapy, followed by barbiturates or propofol, if seizures persist. Hydrate patients and monitor urine output and

renal

function. Airway protection should be employed as need for patients with coma.

Toxicology
A toxic dose has not been established for these agents.
Patient Counselling or Clinical Teaching
Advise patient to use only on

lips

and around

mouth

and to avoid contact with inside of

nose

or

mouth

,

eyes

, or

genital area

.
Drug may cause application site reactions and irritation and contact sensitivity.
Instruct patient to contact healthcare professional if cold sore fails to heal within 2 weeks of starting treatment.
Tell patient to avoid excessive rubbing of affected area during
application of
cream as this may aggravate or transfer

infection

.
Instruct patient to not bathe, shower, or swim until 30 min after
application of
cream.
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