The spectrum of clinical manifestations of herpes viral infection (HVI) is significantly diverse. They depend on the localization of the pathological process, its prevalence, and the state of the antiviral component of the immune response. Herpes simplex viruses types 1 and 2 most often affect the skin, mucous membranes, and central nervous system. In addition, the clinical manifestations of GVI are determined by:
1) features of the herpes simplex virus (HSV): its type, antigenicity and virulence;
2) localization of the lesion (tissue or organ);
3) stage and phase of the disease (exacerbation or remission);
4) severity and duration of the infectious process;
5) gender, age and degree of immunocompetence of the patient;
6) ongoing therapy.
One of the most common sites of HSV infection is the urogenital tract. Genital herpes occurs in all population groups, and the highest incidence is recorded at the age of 20-29 years, and the second peak occurs at the age of 35-40 years [1-3].
HSV enters the body through the skin or mucous membranes through direct contact with the natural barriers and/or body fluids of an infected person. It has been shown that infection can occur from an infected patient, regardless of the presence or absence of symptoms of the disease. Only 10–25% of people seropositive for HSV have a history of genital herpes, suggesting that most people have an unrecognized atypical or asymptomatic infection. In 70% of cases, infection with genital herpes occurs through contact with a partner who has an asymptomatic form of GVI [1, 3].
There are several classifications of GVI, which reflect different variants of the course and forms of the disease. All of them take into account the main types of clinical manifestations of genital herpes (N.V. Shperling et al., 2010) [4]:
- primary;
- recurrent:
- mild course - relapse rate 1-2 times a year, remission for at least 6 months;
- moderate severity - relapse rate 3-5 times a year, remission for at least 3 months;
- severe course - relapse rate more than 6 times a year, remission from several days to 6 weeks;
- asymptomatic.
During primary infection, the lesions often have multiple localizations and are accompanied by enlargement and tenderness of the inguinal lymph nodes. It should be noted that the first clinical episode of genital herpes is a true manifestation of primary GVI if the patient has never previously experienced symptoms of the disease and there are no antibodies to HSV in his blood. The incubation period of primary genital herpes ranges from 2 to 12 days (on average 6 days). A typical picture of manifestations of genital herpes is characterized by the appearance on the mucous membranes of the genital organs and adjacent areas of the skin of single or multiple vesicular elements that appear on an erythematous background. After 1-2 days, the vesicles open, forming weeping erosions, less often ulcers, epithelializing under the crust or without its formation. In people of both sexes, the primary attack is usually severe, with severe symptoms of general intoxication: most patients experience fever, malaise, aching muscles, and headache. Viral particles are released from infected tissues within 10-12 days. The duration of the acute period for primary genital herpes can reach 10 days. However, in most cases, infection occurs covertly, immediately moving into the latent period [1, 3, 5].
Typical lesions in men are located on the skin of the pubic area, the shaft of the penis, or in the perianal area. Less commonly, rashes appear on the glans penis, coronary sulcus, scrotum, perineum, thighs or buttocks. Herpetic lesions in women can be located on the labia, perineal skin, perianal and buttock areas. When a secondary bacterial infection is attached, lesions of the cervix are possible in the form of diffuse inflammation with erosions, large isolated ulcers and sometimes severe necrotic ulcerations.
Most women and men with primary genital herpes experience dysuric disorders. Severe pain and tissue destruction can cause urinary retention (Eleberg syndrome) [3, 5].
In addition to what is described, the primary episode includes those cases of the disease in which the first clinical manifestations develop against the background of seropositivity for HSV infection. Symptoms in this case, as a rule, are less intense than with true primary herpes, but more pronounced than with the recurrent form of the disease [3].
Secondary herpes viral infection occurs in patients of any age who have had primary herpes. HSV reactivation usually occurs in the first few months after the initial episode of the disease. Manifestations of recurrent genital herpes can vary: from asymptomatic viral shedding or mild symptoms to very painful confluent ulcerations with clear boundaries. In most cases of recurrent genital herpes, the clinical symptoms of subsequent exacerbations are less severe and lasting compared to the initial episode. The prodromal phase, including itching, burning or skin hypersensitivity at the sites of subsequent lesions, is observed in approximately half of patients with recurrent genital herpes. The frequency of relapses in men and women is usually the same, but their manifestations are different. In men, relapses last longer and are characterized by the presence of a larger number of lesions than in women, while in women the clinical symptoms are more acute than in men [1, 3].
With increasing duration of the disease and under the influence of local therapy, the clinical picture of genital herpes often changes. Rashes in the affected area may bypass certain stages of development. Only erosions, papular elements and edematous spots against the background of erythema are preserved. In atypical forms of genital herpes, characteristic lesions on the mucous membranes and skin of the genitals may be absent, only hyperemia and diffuse swelling of the mucous membrane are noted, and recurrent painful cracks rarely occur. A recurrent form of genital herpes has also been described, which is characterized only by itching, and in some cases there are no subjective sensations.
The asymptomatic form of genital herpes is also common (60% of all cases), which is characterized by reactivation of HSV without the development of classic symptoms of the disease. It is important that it is patients with asymptomatic genital herpes who most often become a source of infection for their sexual partners [1, 3, 5].
If GVI recurs during pregnancy, the risk of transmitting the virus to the newborn and developing the disease is low. A primary episode of genital herpes in a pregnant woman can cause transplacental transmission of the virus to the fetus, while the outcome of primary GVI is largely determined by the gestational age at which the infection occurred [2].
Frequent relapses, causing discomfort in the genital area, and the low effectiveness of many prescribed treatment regimens often lead to a significant deterioration in the physical and mental condition of patients. Patients with genital herpes often experience depression, anger, decreased self-esteem, and hostility toward the person who was the likely source of infection. Thus, patients with genital herpes show an increase in psychosexual and social mental disorders [3].
The goals of treating recurrent GVI are to reduce the frequency of exacerbations, reduce their severity and duration, improve the quality of life of patients, as well as prevent infection of sexual partners and the newborn.
The main direction of treatment is the use of highly specific antiviral drugs - acyclic nucleosides, which block HSV replication. Currently, according to international standards for the treatment of herpes viral infections, the drugs of choice are acyclovir, valacyclovir and famciclovir [6–8].
Acyclovir, the first systemic antiviral drug, exhibits activity against cells infected with HSV. Since acyclovir is an analogue of 2'-deoxyguanosine, to function it requires activation by cellular thymidine kinase modified by the virus, followed by its conversion to acyclovir triphosphate. This form of acyclovir irreversibly, competitively with deoxyguanosine triphosphate, inhibits the viral DNA polymerase, which prevents the possibility of elongation of the viral DNA chain. The absence in a healthy cell of specific changes caused by the viral enzyme that converts the original form of acyclovir into acyclovir triphosphate determines the specificity of the action of acyclovir.
Unfortunately, despite the high selectivity of acyclovir, its oral bioavailability remains very low. In this regard, to achieve the desired effect in clinical practice, it is often necessary to prescribe rather high doses of this drug. That is why oral use of acyclovir is limited in the treatment of severe stages of diseases caused by herpes viruses.
Unlike the first-generation antiviral drug acyclovir, valacyclovir has exceptionally high bioavailability, exceeding that of acyclovir by 3-5 times. In addition, even with oral administration of the drug, its level in the blood plasma reaches high values, comparable to the values obtained when acyclovir is administered into a vein. This property of valacyclovir is due to its chemical structure. Its uniqueness lies in the fact that valacyclovir is a compound of L-valine and acyclovir via an ester bond. This feature allows proacyclovir to be delivered unchanged into the blood plasma. Metabolized in the liver by hydrolase, valacyclovir breaks down into valine and acyclovir, which in turn already has an antiviral effect. In addition, some valacyclovir is hydrolyzed in the small intestine to release the active form of acyclovir. The pharmacokinetics of this drug make it possible to prescribe it regardless of food intake.
There are two main ways to use antiviral chemotherapy drugs: episodic administration (as needed, during exacerbations of GVI) and prolonged therapy. In the first case, the drug is prescribed in a short course for 5-10 days, in the second, patients take the drug daily for several months or years, not only to stop this relapse, but also to prevent subsequent exacerbations [7-9].
Episodic therapy is preferable for patients with mild and rare exacerbations of an infectious disease. The goal of treatment in this case is to reduce the severity of symptoms of relapse. For maximum effectiveness, the drug should be started during the prodromal period or the 1st day of clinical manifestations. According to Russian clinical guidelines, for relapses of genital herpes, acyclovir is prescribed 200 mg 5 times a day (or 400 mg 3 times a day) for 5 days, or valacyclovir 500 mg 2 times a day for 5 days, or famciclovir 125 mg 2 times a day for 5 days [6] (Table 1).
Table 1. Recommended regimens for the use of acyclic nucleosides for recurrent herpes simplex (European standards for the diagnosis and treatment of sexually transmitted infections, 2010) [8-10] Note. * — level of evidence A.
Timely administration of acyclic nucleosides makes it possible to interrupt the replication of the virus, and in this case the relapse occurs in an abortive form. To start taking medications in a timely manner, patients are advised to always carry a small amount of acyclic nucleoside tablets with them, and in case of relapse, at the stage of precursors of the disease, take the drug.
For patients with a relapse rate of more than 6 times a year, a prolonged regimen of antiviral drugs is recommended. According to the literature, it is effective in 70-80% of patients. For such therapy, an individualized approach is required, which includes an assessment of the frequency and severity of exacerbations in a given patient, as well as his individual needs for controlling relapses of the disease [7-9].
Suppressive therapy is preferable in cases of frequent recurrence of genital herpes, especially in severe exacerbations. The advisability of using a suppressive treatment regimen is also emphasized in case of pronounced emotional reactions of the patient to the resumption of symptoms of the disease. The dosages used when using a suppressive treatment regimen depend on the clinical course of relapses of genital herpes. If a patient with this disease has no more than 10 relapses per year, the daily dose of valacyclovir should be 500 mg. If the number of relapses is more than 10 per year, a daily dosage of valacyclovir 1000 mg is used [7-9].
Benefits of using valacyclovir:
— unlike other antiviral drugs, valacyclovir does not stop, but blocks the reproduction of the herpes simplex virus;
— a smaller number of pills per day improves the patient’s compliance with therapy and reduces the risk of missing a drug dose, which means it increases the effectiveness of treatment and reduces the drug burden on the body;
— valacyclovir is combined with most medications and does not affect memory, attention and reaction speed;
- does not have teratogenic or mutagenic effects.
Recently, a large number of valacyclovir drugs have appeared on the Russian market. One of these drugs is the European analogue of valacylovir - Valvir
. Release form: film-coated tablets in a standard dose of 500 mg (valaciclovir hydrochloride hydrate 611, 70 mg), as well as in a dose of 1000 mg (valaciclovir hydrochloride hydrate 1223, 40 mg). To study the drug, a study of its clinical effectiveness in patients with chronic recurrent herpesvirus infection (CRHVI) was conducted.
Material and methods
The study was conducted on patients who applied to the clinic of the Institute of Immunology of the Federal Medical and Biological Agency of Russia in 2014. The main group included immunocompetent patients (without established primary immunodeficiency and HIV infection), men and women over 18 years of age with a clinical picture of exacerbation of genital herpetic infection . Exclusion criteria were: pregnancy, lactation, use of other antiviral or immunotropic therapy, presence of decompensated diseases or acute conditions that could significantly affect the results of the study.
At the screening visit, specialists collected an anamnesis of the disease, noting the frequency and duration of exacerbations of infection, and previously used treatment. All patients were given recommendations for timely initiation of the drug valacyclovir ( Valvir
) during the first 6 hours from the onset of symptoms of exacerbation or during the period of prodromal symptoms.
In the process of monitoring patients who received therapy at the time of exacerbation of genital herpes, attention was paid to the duration and severity of local symptoms (itching, pain, burning at the site of the lesion), the nature of the elements of the rash, the area of the lesion, healing time and the duration of symptoms of intoxication.
The severity of subjective symptoms (itching, pain, burning) during an exacerbation was assessed in points on the following scale: 0 points - no complaints, 1 point - slight sensations of itching, burning or pain at the site of the rash that do not interfere with everyday life, 2 points - moderately severe symptoms that create daily discomfort, 3 points - complaints of pronounced subjective sensations in the area of the rash with irradiation to other anatomical areas (hips, sacrum, perineum, etc.).
Patients of the main group (20 men and women with genital CHVI) received the drug valacyclovir ( Valvir
) according to the regimen of 500 mg 2 times a day for 5 days. To assess the effectiveness and safety of therapy, patients were examined in the clinic on the 1st, 3rd, 5th day of treatment, as well as 14 days after completion of therapy. If new rashes appeared, the patient came to the clinic for an unscheduled visit. The comparison group included 20 patients who received therapy with acyclovir (manufactured in Russia) according to the standard regimen - 400 mg 3 times a day for 5 days.
All patients underwent an objective examination during each visit, including registration of the following parameters: localization of the lesion; area of the lesion (cm2); characteristics of the elements of the rash indicating the time of appearance (hyperemia, vesicles, erosions, beginning of epithelization, complete re-epithelialization).
The effectiveness of the study drug was assessed based on the following criteria:
— reducing the severity of the clinical course of relapse;
- duration of local symptoms (itching, pain, burning in the affected area);
— time required for epithelialization to begin;
— time to achieve complete recovery (complete epithelization).
In addition to objective data, the effectiveness of therapy was assessed according to the patient’s subjective feelings in points: 5 points - very good; 4 points – good; 3 points - satisfactory; 2 points - unsatisfactory; 1 point – extremely unsatisfactory.
Adverse reactions from taking the drug were assessed according to objective data and subjective feelings of the patient. The severity of adverse reactions of the study drug was assessed on the following scale in points: 5 points - no side effects noted; 4 points - minor side effects are observed that do not cause serious problems for the patient and do not require discontinuation of the drug; 3 points - side effects are noted that affect the patient’s condition, but do not require discontinuation of the drug; 2 points - there is an undesirable side effect that has a significant negative impact on the patient’s condition, requiring discontinuation of the drug; 1 point - side effect requiring discontinuation of the drug and the use of additional medical measures.
Tolerability of the drug was assessed both by the attending physician and by the patients themselves according to the following scale: 5 - very good, 4 - good, 3 - satisfactory, 2 - bad, 1 - very bad.
The results obtained were statistically processed by methods of variation statistics using Student's tests and presented in the form of tables.
Acyclovir
Acyclovir is an antiviral drug. Used to combat Herpes simplex - the herpes simplex virus. The widespread prevalence of this virus is due to its resistance to damaging environmental factors, a long incubation period and the presence of multiple routes of infection. Suffice it to say that about 95% of the world's population are carriers of the herpes virus. However, such threatening statistics are not a reason to declare an emergency, because Herpes infection manifests itself clinically only under certain conditions, in particular when the immune status of the virus carrier is reduced. After activation, the infection can acquire the features of an acute or chronic disease. With a significant decrease in immunity, there is a risk of developing a generalized (systemic) infection. Acyclovir is an effective remedy in the fight against herpes infection. Its active metabolite, acyclovir triphosphate, is installed in the DNA chain of the virus, damaging it and blocking the replication (multiplication) of the virus. Acyclovir demonstrates high efficiency, safety and selectivity of specific action. Today, this drug can be called a first-line drug for antiherpetic therapy, the so-called. "gold standard". The use of the drug in infants who are carriers of the herpes virus reduces the duration and severity of infection and increases the immunostimulating properties of immunotropic drugs. Penetrating into an infected cell, Acyclovir, under the action of the enzyme thymidine kinase, is converted into acyclovir triphosphate, which suppresses the biosynthesis of viral DNA. Thymidine kinase is present in both human cells and viruses, but in the latter it binds more actively to Acyclovir, forming its active form much faster.
This explains the selectivity of the drug and its high safety profile. Tablet Acyclovir is effective against herpes virus types 1 and 2, herpes zoster. It is used for both therapeutic and preventive purposes. Acyclovir tablets are indicated for systemic lesions when local forms of the drug (ointment, cream) have not shown their effectiveness within 10 days. When taken orally, about 15-30% of the active substance entering the body is absorbed into the systemic bloodstream. The half-life of the drug is 3.3 hours. Excretion is carried out by the kidneys and, to a lesser extent, by the intestines. In severe renal failure, taking Acyclovir is not recommended. When taking the drug, it is necessary to monitor the functional state of the kidneys and monitor indicators characterizing it. Acyclovir is not a means of preventing the transmission of genital herpes from one sexual partner to another, so persons carrying an active form of the virus should avoid unprotected sex. External forms of Acyclovir are not intended for application to the mucous membranes of the mouth, eyes, and genitals.
The high incidence of herpetic infection, the wide range of its clinical manifestations, and the aesthetic damage caused make it urgent to choose an antiviral drug with a favorable safety profile, high selectivity of action and an adequate price. Acyclovir, which is produced mainly by domestic pharmaceutical companies (Sintez, Vertex, Tatkhimpharmpreparaty, Atoll, etc.) fully meets these criteria and provides rational drug therapy for a particular patient with a certain form of infection, while demonstrating high efficiency with a minimum of side effects effects.
Results and discussion
The main group included 20 patients (7 men and 13 women) aged from 18 to 65 years with a clinical picture of recurrent genital herpes (Table 2). The clinical course of genital GVI in patients of the main group was characterized by a high frequency of exacerbations (up to 1 time in 1-1.5 months), pronounced local symptoms of exacerbation (itching, burning, pain in the affected area). The comparison group consisted of 20 patients with a similar form of GVI, comparable in gender, age and nature of the disease. Over the past 3-6 months, more than 50% of patients included in the study used only local therapy (ointment with acyclovir, interferon, antiseptic solutions) for herpetic lesions during relapse.
Table 2. Characteristics of patients included in the study
All patients participating in the study complained of the appearance of local hyperemia, edema, vesicular or erosive rashes, accompanied by itching, burning, and pain. Before treatment, all patients were examined to identify the type of HSV (1st or 2nd) using the polymerase chain reaction method. A positive result was obtained in 100% of cases. Approximately 1/3 of patients (27.5-37.5%) had symptoms of general intoxication during an exacerbation (headache, low-grade fever, weakness). In 45-50% of patients there was pain along the affected nerves (Table 3).
Table 3. Frequency of registration of GVI symptoms before treatment, abs. (%)
During the treatment of patients with the genital form of CHVI with Valvir
the duration of relapse and the period of complete epithelization decreased on average from 6.4 to 3.8 days, which is significantly different from similar indicators in patients who were prescribed acyclovir (
p
<0.05).
More effective relief of local symptoms (itching, pain, burning) was also noted. The duration of local symptoms in people with exacerbation of genital herpes who took Valvir
was 2.5±0.3 days, while in the group of patients taking acyclovir it was 3.9±0.2 days (
p
<0.05).
There was a reduction in the period of onset of epithelization of herpetic lesions in patients treated with Valvir
to 1.9 days (
p
<0.05 compared to the indicators of the group of patients taking acyclovir) (Table 4).
Table 4. Efficacy of the study regimen of Valvir, days Note.
*—differences are significant compared to the comparison group (p<0.05). It is well known that exacerbation of CHRGVI causes physical pain, discomfort in the affected area and, as a consequence, psychological stress of the patient. Significant reduction in the period of epithelization (complete healing) from 6.4 to 3.8 days while taking valacyclovir ( Valvira
) at a dose of 500 mg 2 times a day made it possible to reduce the severity of local symptoms of relapse and improve the psychological background in patients during an exacerbation of herpes simplex.
When treated with acyclovir, these indicators change less significantly from 6.7 to 4.6 days, which constitutes a significantly longer period of physical and psychological discomfort in the examined individuals during relapse of infection. A positive point is a significant reduction in the duration of local symptoms (itching, pain, burning) to 2.5 days when taking valacyclovir ( Valvira
) (
p
<0.05 versus acyclovir).
In addition, some patients taking valacyclovir ( Valvir
) noted a weakening of local symptoms after the 1st day of taking the drug, while for patients taking acyclovir, this occurs on the 3rd day of taking the drug.
Rapid relief of the symptoms of the disease significantly increases patient satisfaction from the treatment, therefore, the relief of clinical manifestations and symptoms of relapse of HSV when taking valacyclovir ( Valvira
) allows increasing patient adherence to therapy at the time of relapse.
Also, patients taking Valvir
strictly followed the doctor’s recommendations and did not miss doses of the drug, while patients taking acyclovir took the drug irregularly, starting from the 3-4th day of use.
Thus, adherence to treatment and, consequently, its effectiveness in patients in the Valvira
was higher.
During the study, there were no adverse events associated with the administration of the drug Valvir.
requiring interruption or cessation of therapy. Most patients rated the drug's tolerability as “good” or “very good.”
Thus, Valvir
showed good tolerability in patients with CHVI.
The clinical effectiveness of Valvir
in the form of a pronounced reduction in the duration of local symptoms of relapse
.
Herpes in the nose
25.07.2018
Any case of herpes simplex infection is transmitted from an infected person to another. Common ways to spread the herpes virus are through kissing and direct contact with blisters. Once the sores break out and heal completely, they are no longer contagious. However, once a person becomes infected with the herpes simplex virus (either of the two strains), it cannot be eliminated from the body. The virus progresses to the nerve roots and lies dormant until favorable conditions arise to cause infection. Thus, the likelihood of repeated outbreaks is very high.
Treatment of herpes
To date, no cure for herpes has been formulated. Therefore, herpetic sores in the nose are treated to combat painful symptoms and shorten the healing period. Treatment options for herpes remain the same no matter where the painful lesions occur. So, no matter who is dealing with cold sores on the nose or typical cold sores on the lips, the suggested treatments, self-care tips and home remedies are the same. Below is a quick guide to treating nasal .
Since the cause of the pathogen is a virus, the obvious treatment for nasal is the administration of antiviral drugs. Based on the pathology and overall illness, your doctor may recommend one of the oral medications that is right for you. In addition, topical ointments are prescribed nasal
ulcers under any circumstances ! When using medications, it is recommended to wash your hands before and after use.
Maintaining personal hygiene and cleaning the areas affected by herpes is critical to preventing the sores from spreading to the rest of the body. Make sure the fluid-filled blisters are washed with antimicrobial soap and water. After this, wipe your nose dry with a clean towel.
To get quick results, doctors may recommend supplements of zinc, vitamin C, and lysine. They help directly or indirectly activate the body's defense mechanism to reduce the healing period. In addition, these additional treatments help reduce patients' risk of relapse.
Avoiding acidic foods and those containing arginine is an effective home remedy for treating nasal herpes . HSV has been found to require arginine and an acidic environment for replication. Thus, by depriving pathogens of their essential growth factors, the intensity of symptoms can be reduced.
nasal herpes requires maintaining a safe distance from people who carry the herpes simplex virus. And for those who have gone through painful flare-ups, avoiding triggers is an effective way to prevent a recurrence. Triggers for blisters include stress, skin trauma, prolonged sun exposure, hormonal fluctuations, alcohol consumption, a weakened immune system and illness.
If you find strange sores in nose , immediately contact a specialist so that you can be prescribed timely and correct treatment!
Published in Dermatology Premium Clinic
conclusions
1. Standard treatment regimen with Valvir
is effective for the treatment of recurrent genital GVI.
2. During treatment with Valvir
in patients with CHRGVI, there is a reduction in the duration of local symptoms of relapse.
3. Valvir's
in the first 6 hours from the onset of exacerbation of GVI significantly improves the quality of life of patients.
4. Drug Valvir
It is well tolerated and safe in both young and older patients.
Acyclovir cream 5% 5g (Tula Pharmaceutical Factory)
Registration Certificate Holder
TULA PHARMACEUTICAL FACTORY (Russia)
Dosage form
Medicine - Acyclovir (Aciclovir)
Description
Cream for external use
white or almost white, uniform.
100 g
acyclovir 5 g
Excipients
: propylene glycol - 8 g, liquid paraffin (vaseline oil) - 12 g, cetyl alcohol - 6 mg, macrogol 6 cetostearyl ether - 1.5 g, macrogol 25 cetostearyl ether - 1.5 g, methyl parahydroxybenzoate - 0.15 g, propyl parahydroxybenzoate - 0.05 g, water - up to 100 g
1 g - aluminum tubes (1) - cardboard packs. 2 g - aluminum tubes (1) - cardboard packs. 3 g - aluminum tubes (1) - cardboard packs. 4 g - aluminum tubes (1) - cardboard packs. 5 g - aluminum tubes (1) - cardboard packs. 10 g - aluminum tubes (1) - cardboard packs. 15 g - aluminum tubes (1) - cardboard packs. 20 g - aluminum tubes (1) - cardboard packs. 25 g - aluminum tubes (1) - cardboard packs. 30 g - aluminum tubes (1) - cardboard packs. 40 g - aluminum tubes (1) - cardboard packs. 50 g - aluminum tubes (1) - cardboard packs. 60 g - aluminum tubes (1) - cardboard packs. 70 g - aluminum tubes (1) - cardboard packs. 80 g - aluminum tubes (1) - cardboard packs. 90 g - aluminum tubes (1) - cardboard packs. 100 g - aluminum tubes (1) - cardboard packs. 5 g - cans (1) - cardboard packs. 10 g - cans (1) - cardboard packs. 15 g - cans (1) - cardboard packs. 20 g - cans (1) - cardboard packs. 25 g - cans (1) - cardboard packs. 30 g - cans (1) - cardboard packs. 35 g - cans (1) - cardboard packs. 40 g - cans (1) - cardboard packs. 50 g - cans (1) - cardboard packs. 60 g - cans (1) - cardboard packs. 70 g - cans (1) - cardboard packs. 80 g - cans (1) - cardboard packs. 90 g - cans (1) - cardboard packs. 100 g - cans (1) - cardboard packs.
Indications
Skin infections caused by Herpes simplex virus types 1 and 2, including genital herpes and herpes labialis; shingles; chicken pox.
Contraindications for use
Hypersensitivity to acyclovir and valacyclovir; children and adolescents up to 18 years of age.
Carefully:
pregnancy; lactation period (breastfeeding); dehydration; renal failure.
pharmachologic effect
Antiviral agent for external use, a synthetic analogue of purine nucleoside. Thymidine kinase in virus-infected cells actively converts acyclovir through a series of sequential reactions into acyclovir mono-, di- and triphosphate. The latter interacts with the viral DNA polymerase and is integrated into the DNA that is synthesized for new viruses. Thus, “defective” viral DNA is formed, which leads to the suppression of the replication of new generations of viruses.
Acyclovir is active against Herpes simplex virus types 1 and 2, Varicella zoster virus, Epstein-Barr virus and cytomegalovirus.
Drug interactions
When acyclovir was used externally, no clinically significant drug interactions were observed.
Immunostimulants
- the effect of acyclovir may be enhanced.
Dosage regimen
Externally. Apply 4-6 times a day (every 4 hours) in a thin layer to the affected and adjacent areas of the skin. The drug is applied either with a cotton swab or with clean hands to avoid additional infection of the affected areas. Therapy should be continued until a crust forms on the blisters or until they are completely healed. The duration of therapy is on average 5 days and should not exceed 10 days.
It is important to begin treatment for a recurrent infection during the prodromal phase or at the very beginning of the infection.
The duration of treatment is at least 5 days. If there is no healing, treatment can be continued for up to 10 days. If symptoms persist for more than 10 days, you should consult your doctor.
Side effect
Determination of the frequency of adverse reactions: very often (≥1/10), often (≥1/100, <1/10), infrequently (≥1/1000, <1/100), rarely (≥1/10,000, <1 /1000) and very rare (<10,000), frequency unknown (incidence cannot be determined from available data).
Local reactions:
uncommon - at the site of application there may be a burning sensation that goes away over time, dry skin, itching; rarely - erythema, contact dermatitis at the site of application. In case of contact with mucous membranes, inflammation may occur.
From the immune system:
very rarely - anaphylactic reactions, including angioedema and urticaria.
special instructions
Acyclovir in the form of dosage forms for external use should not be applied to the mucous membranes of the mouth, eyes, or vagina.
Use during pregnancy and breastfeeding
Restrictions during pregnancy - With caution. Restrictions when breastfeeding - Contraindicated.
The use of acyclovir during pregnancy is possible in cases where the expected benefit to the mother outweighs the potential risk to the fetus.
If it is necessary to use it during lactation, the issue of stopping breastfeeding should be decided.
Use for renal impairment
Restrictions for impaired renal function - Contraindicated.
Use is not recommended for severe renal impairment.
In case of renal failure, adjustment of the dosage regimen is necessary.
It should be taken into account that when using acyclovir, acute renal failure may develop due to the formation of sediment from acyclovir crystals, which is especially likely with rapid intravenous administration, simultaneous use of nephrotoxic drugs, in patients with impaired renal function and with insufficient water load.
When using acyclovir, it is necessary to monitor renal function (determining the level of urea nitrogen in the blood and creatinine in the blood plasma).
Use in elderly patients
Restrictions for elderly patients - Use with caution.
Treatment of elderly patients should be carried out with a sufficient increase in water load and under the supervision of a physician, because in this category of patients, the half-life of acyclovir increases.
Use in children
Restrictions for children - No restrictions.
Orally for children over 2 years old - 200-400 mg 3-5 times a day, if necessary - 20 mg/kg (up to 800 mg per dose) 4 times a day. In children under 2 years of age, use a dose equal to half the dose for adults. The duration of treatment is 5-10 days.
