ZORVIRAX

Zovirax is a prescription cream medication that is effective in the initial phases of genital herpes and in the treatment of mouth ulcers and lip blisters caused by the herpes simplex virus.

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Brand Name(s): Zovirax
Generic Name Acyclovir
Phonetic: (ay sye' kloe veer)

Who is this for?
Acyclovir is used to treat herpes infections of the skin, lip, and genitals; herpes zoster (shingles); and chickenpox. It does not cure herpes infections but decreases pain and itching and promotes healing. Topical acyclovir does not prevent the recurrence of sores but may decrease pain and itching if applied when the earliest symptoms first appear. Oral acyclovir decreases the frequency and severity of recurrent sores, but it is used only by people with severe herpes infections because of possible adverse effects. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

When should I be careful taking it?
Before taking acyclovir,

tell your doctor and pharmacist if you are allergic to acyclovir or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially probenecid (Benemid), zidovudine (Retrovir, AZT), and vitamins.
tell your doctor if you have or have ever had kidney disease, problems with your immune system, human immunodeficiency virus infection (HIV), or acquired immunodeficiency syndrome (AIDS).
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking acyclovir, call your doctor.
What side effects should I watch for?
Although side effects from acyclovir are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

burning, stinging, itching, or rash when ointment is applied
headache
upset stomach
vomiting
diarrhea or loose stools
If you experience any of the following symptoms, call your doctor immediately:
severe rash
severe itching
How should I take it?
Acyclovir comes as an ointment for use on the skin and as a tablet, capsule, and liquid to take by mouth. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take acyclovir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Use this medication as soon as possible after symptoms appear. Clean and dry the skin area before applying the ointment. Wear protective gloves when applying it to prevent the spread of infection. Rub the ointment in gently. Use enough ointment to cover all sores completely. Do not apply acyclovir ointment to the eyes. Shake the liquid well before each use to mix the medication evenly. Continue to take acyclovir even if you feel well. Do not stop taking acyclovir without talking to your doctor.

Dietary Considerations
Acyclovir may cause an upset stomach. Take acyclovir with food or milk.

What happens if I miss a dose?
If you are using tablets, capsules, or liquid, take the missed dose as soon as you remember it and take any remaining doses for that day at evenly spaced intervals. If you are using ointment, apply it as soon as you remember and apply further doses at your regular interval (e.g., every 3 hours) until you go to bed. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose of either the ointment or oral medication to make up for a missed one.

Where should I keep it?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

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Information for the Patient: Herpes Zoster (shingles) and Genital Herpes: Treatment: If your physician has prescribed a course of Zovirax for the treatment of a herpes zoster (shingles) infection, it is important to understand that the drug must be taken as early as possible after the onset of the disease. This is because the herpes virus multiplies in and eventually destroys affected skin cells. Zovirax stops the virus multiplying and therefore from spreading to neighbouring healthy cells. It cannot replace a cell which has been damaged by the multiplying virus, but it will facilitate the process of healing.

Suppression of Recurrences: If your physician suggested continuous use of Zovirax to prevent frequent recurrences of genital herpes infections, you should follow dosing instructions carefully. The objective is to keep enough of the drug in the body at all times to prevent the herpes virus from multiplying. Your physician will try to prescribe the minimum dose required to do this in your case and may therefore increase or decrease your dose during the first few weeks. Follow your physician's instruction carefully to ensure that you get the best possible response to treatment.

Safety: Short-Term: The safety of Zovirax in short-term use has been well studied. As with any widely prescribed medication, adverse events in association with its use are reported from time to time. The common ones are listed below; they have rarely been severe enough to make it necessary to stop taking the drug.

Headache, nausea, diarrhea, skin rash and upset stomach.

If you experience anything unusual while you are receiving treatment with Zovirax, you should report it to your physician.

A complete listing of adverse events so far reported is contained in the Product Monograph supplied to your physician.

Long-Term: Your physician may periodically stop your drug therapy in order to reassess your need for continuous treatment. As with any new drug, the effect of long-term use in humans has not been fully assessed. Prudence is therefore suggested when choosing continuous, long-term therapy with Zovirax. Suppression of recurrent genital herpes is therefore only recommended in those who are severely affected.

Pregnancy: You should consult your doctor if you become pregnant or intend to become pregnant or intend to breast-feed while taking Zovirax.

Reproductive Toxicity: Although decreased sperm counts in animals treated with high doses, and breaks in chromosomes in high concentrations of acyclovir in the test tube, have been seen, these effects did not occur in humans given doses of 800 to 1000 mg/day for at least 6 months.

General Information: Herpes infections cause painful blisters on the skin and mucous membranes. The fluid in these blisters contains the virus which causes the disease. The infection is easily spread either to yourself or other people. If you touch your skin sores, wash your hands immediately and do not touch other parts of your body until you have done so. Especially avoid intimate contact with others when the disease is visible. Medication should not be shared with others. The prescribed dosage should not be exceeded. Zovirax does not eliminate dormant viruses. Some patients experience increased severity of the first episode of genital herpes after stopping treatment.

For more information about Zovirax and herpes infections, please consult your physician or pharmacist.

Chickenpox--Information for Parents: Common in childhood and contagious: Chickenpox is one of the most common infections in otherwise healthy children. It usually occurs in children before the age of 10, but anyone who has never had chickenpox can become infected--irrespective of age.

Chickenpox is caused by a virus called "varicella zoster" and it is highly contagious. Family members often give the disease to each other. For reasons that are not known, often the second or third child who catches it from a brother or sister will be sicker than the first child. Also, the disease tends to be more severe in teenagers than in younger children.

The disease can be mild with few pox or mild symptoms--alternatively,could be severe with hundreds of pox. The pox can occur both outside and inside the body. There is no way to predict the severity of chickenpox.

Recognizing the Disease: The early symptoms of chickenpox may be vague and could include fever, itching, headache, aching joints and muscles, sore throat, general malaise: loss of appetite, listlessness and irritability. After that, itchy, small, red spots (the "pox") appears, and become blisters within a few hours. New spots and blisters continue to appear for about 5 days. The blisters start to dry up and within 6 or 7 days turn into scabs.

Incubation: Not all who are exposed come down with the disease. The incubation period may extend from 1 to 3 weeks after exposure. The virus is spread through the air when: (1) a person with chickenpox scratches the blisters, allowing the virus to become airborne: or (2) a person with chickenpox coughs or sneezes within close contact of others. The disease is most contagious shortly before the rash appears, through the early stages of the rash, until all the blisters have dried. A patient is not contagious once all the blisters have become scabs.

Early Consultation With Your Physician: If you think your child has been exposed to chickenpox, be on the lookout for symptoms described above. At the first sign of rash, call your physician . There are more treatment options available when the infection is caught this early. Your physician may prescribe a medication which could offer the child less discomfort, and possibly a faster recovery.

Tips to Bear in Mind: It is important to follow the physician's orders with all medications prescribed--even if the patient seems to feel better. Never use medications containing acetylsalicylic acid (ASA) in children with fever and chickenpox. Acetaminophen may be given to reduce fever.

The rash can be soothed by coating with an anti-itch product such as calamine, or other medications that your physician recommends. The discomfort of itching can be relieved temporarily by baths and wet compresses. Bathing daily with soap and water can also help prevent infection. Do not use antiseptics on the sores; rather consult your physician , who might prescribe an antibiotic if necessary. Since infection or scarring can occur at scratch sites, it is important to discourage scratching and spreading of virus particles through the air. Keep the rash clean and dry. If possible keep the nails cut short, cover the hands and feet with cotton gloves, mitts or socks to discourage children scratching at sleep time.

Possible Complications: Complications are rare in the healthy child. The people who are at greatest risk of complications are: pregnant women, newborn babies, or people being treated for cancer, arthritis, asthma, or after organ transplants--where medicine is suppressing their immune systems. If anyone in your family falls within these groups inform your physician so that the preventive measures can be taken.

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Zovirax Patient Monograph

This medication is used in the treatment of chickenpox, genital or systemic herpes infections, and shingles. Zovirax (acyclovir) does not cure herpes, but decreases the number of outbreaks and helps sores heal faster. It may be used to prevent recurrent herpes simplex infections in patients with compromised immune systems. This antiviral medication may treat certain other viral infections, but is ineffective against the cold virus.

Zovirax treatment should begin within 24 hours of chickenpox outbreak, and within 48 hours of a shingles outbreak for maximum effectiveness. Individuals with recurrent genital herpes should begin treatment at the first symptom of an outbreak, and are sometimes prescribed daily doses to decrease the number of outbreaks. If daily treatment is undertaken for recurrent outbreak, treatment should be re-evaluated after a year.

Acyclovir is only available by prescription. Under the brand name Zovirax, it is available in capsule, ointment, oral suspension, and tablet form.

Zovirax Side Effects
Most Common Side Effects (less than 5%): Diarrhea, general discomfort or feeling of illness (high doses), headache, itching (ointment), nausea, skin rash or discomfort (usually ointment). Treatment with Zovirax ointment is unlikely to produce systemic side effects, as it is poorly absorbed through the skin.

Less Common or Rare: Anaphylactic (acute allergic) reaction, aggression, agitation, altered vision, anemia, bloody urine, coma, confusion, delirium, dizziness, drowsiness, fever, hear loss, hallucinations, hives, kidney failure, psychosis, seizures, skin peeling, light sensitive rash, swelling in the extremities, swollen lymph nodes, tremors, yellowed skin and eyes (indicative of serious liver problems). If any of these symptoms occur, contact your doctor or a hospital immediately, and go in for an examination. Particularly severe symptoms may require emergency medical services.

Cautions:

Dehydration: Reduces your body's ability to clear this medication from the blood, increases the risk of unwanted side effects.
Kidney Damage or Disease: Reduces your body's ability to clear this medication from the blood, increases the risk of unwanted side effects.
Nervous System Disorders: Acyclovir may worsen these conditions.
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Zovirax Interactions
The use of the following medications can increase the risk of side effects during acyclovir treatment, particularly if there is kidney damage or disease present. Your doctor may still prescribe certain medications together even if there is a potential for reaction, but with an adjusted dosage to ensure minimum likelihood of side effects.

Acetaminophen (Tylenol) - or any combination pain medication containing acetaminophen, like Percocet (oxycodone, acetaminophen), or Vicodin (hydrocodone, acetaminophen).
Aspirin - or an combination pain medication containing it, like Fioricet (butalbital, acetaminophen, and caffeine), Fiorinal (butalbital, aspirin, and caffeine), or Talwin Compound (aspirin, pentazocine).
Anti-inflammatories like Celebrex (celecoxib) and Vioxx (rofecoxib), or combination medications containing non-steroidal anti-inflammatories like Vicoprofen (hydrocodone, ibuprofen).
Benemid (probenecid)
BiCNU (carmustine)
Cuprimine (penicillamine)
Cyclosporine (Neoral, Sandimmune)
Desferal (deferoxamine)
Gold salts
Interferon (Roferon-A)
Lithium (Lithane, Lithobid)
Mexate (methotrexate)
Mithracin (plicamycin)
Narcotic pain medications - These are safe to mix with Zovirax, but often they come as combination products containing aspirin or anti-inflammatories. Speak to your doctor about safer dosages or alternate treatments.
Platinol (cisplatin)
Retrovir (zidovudine)
Thiola (tiopronin)
Zanosar (streptozocin)

Zovirax Dosages
The dosages below are for the Zovirax brand of acyclovir, the dosages of other products may differ.

Capsules: 200 mg blue capsules printed with 'Wellcome ZOVIRAX 200'
Liquid Suspension: 200 mg/ 5 mL, off-white, banana flavored liquid
Ointment: 50 mg/1 g in 3 gram and 15 gram tubes
Tablets: 400 mg shield shaped tablets, white, marked with 'ZOVIRAX' on one side and a triangle on the other; 800 mg oval tablets, pale blue, marked 'ZOVIRAX 800'
The general guidelines for adults are as follows:

Herpes Zoster; 800 mg by mouth every 4 hours, 5 times daily, up to 7-10 days.
Genital Herpes Outbreak; 200 mg by mouth every 4 hours, 5 times daily, for 10 days. Alternately, apply ointment every 3 hours, 6 times daily, for 7 days.
Suppressive Therapy; 400 mg by mouth twice daily, up to 1 year followed by re-evaluation.
Intermittent Suppression; 200 mg by mouth every 4 hours, 5 times daily, for 5 days at the first sign of recurrence.
Chickenpox; 800 mg by mouth 4 times daily, for 5 days. Children who weigh more than 40 kg. should take the adult dosage.
Your doctor may suggest a different dosage or frequency of use. Always follow the instructions on your prescription, taking your medication as often, and for as long, as suggested by the prescribing physician.

Zovirax Directions
Start treatment as soon as possible, preferably within one day, of a herpes or shingles outbreak or onset of chickenpox symptoms. Take this medication with a full glass of water for best results. If you are taking the liquid form of the medication, use a marked measuring spoon to measure dosage, as regular teaspoons may be inaccurate. Apply ointment as often as directed, using a rubber or latex glove to prevent spreading the infection.

Take this medication for as long as your doctor recommends, even if you begin to feel better. Viral infections may still linger even if the obvious symptoms have gone away. Still, you should not continue treatment for any longer than your doctor suggests. If you see no improvement towards the end of your treatment, contact your doctor for further instructions.

Store Zovirax away from direct light and heat. Do not freeze the liquid form of this medication. Store tablets and capsules in a dry location; avoid storing them in the bathroom, near sinks, or other areas where the container may become damp. Do not use after the expiration date.

Keep Zovirax away from children; both when storing it, and when discarding any unused medication.

Zovirax and Pregnancy
Zovirax has been partly studied in pregnant women and animals, and does not appear to cause birth defects. However, the manufacturer notes that these studies were neither large, nor conclusive. The use of this medication during pregnancy should be discussed with a doctor, and only undertaken if the benefits of treatment outweight the possible risks to the infant.

This medication does not seem to cause difficulties in nursing infants, but it is still advisable to discuss the matter with your doctor.

Zovirax and Children
In infants with herpes simplex outbreaks, this medication has been used intravenously in hospital settings, but is not generally recommended for use in children under 2 years of age.

In children aged 2-18 years, Zovirax has been used to treat chickenpox with the results of faster healing and fewer lesions. This medication does not seem to cause different symptoms in children than it does in adults.

Children over 2 years of age and under 40 kg should take a dose of 20 mg/kg by mouth 4 times daily, for 5 days. If the child weighs more than 40 kg, they should take the adult dose of 800 mg by mouth 4 times daily, for 5 days.

Dosage for children must always be determined individually by a doctor based on the current age, weight, and medical history of the child. Children must only use prescriptions that were filled out specifically for them.

Zovirax and Seniors
This medication has not been studied for specific effects in the senior population. Dosages starting on the low end of the range are recommended to take possible decreases in kidney function and the likelihood of multiple prescription use into account.

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