Can acyclovir (antiviral medication) be used during In Vitro Fertilization (IVF)?

Acyclovir IV Administration Rate

For severe herpes infections requiring intravenous acyclovir, the medication should be administered at 5 mg/kg IV every 8 hours, infused over 1 hour to prevent renal precipitation and toxicity. 1, 2

Dosing and Administration Guidelines

Standard IV Dosing

• For severe HSV infections: 5 mg/kg IV every 8 hours 1
• For life-threatening infections: May increase to 10 mg/kg IV every 8 hours 1
• Duration: 5-7 days or until clinical resolution is attained 1

Administration Technique

• Must be administered by slow intravenous infusion over at least 1 hour
• Never administer as a bolus injection due to risk of renal precipitation 2
• Ensure adequate hydration during treatment

Special Considerations

Renal Function

• Acyclovir is primarily excreted by the kidneys
• Dose adjustment required for patients with renal impairment
• Monitor renal function during treatment, especially in:
  • Elderly patients
  • Patients with pre-existing renal dysfunction
  • Patients receiving other nephrotoxic medications

Neurological Monitoring

• Approximately 1% of patients receiving IV acyclovir develop encephalopathic changes 2
• Monitor for signs of neurological adverse effects:
  • Lethargy
  • Confusion
  • Tremors
  • Hallucinations
  • Seizures

Pregnancy Considerations

• IV acyclovir is indicated in pregnancy only for life-threatening HSV infections (disseminated infection, encephalitis, pneumonitis, or hepatitis) 1
• Current registry findings do not indicate increased risk for major birth defects after acyclovir treatment compared to the general population 1
• However, safety data remains limited for systemic use during pregnancy 1

Potential Adverse Effects

• Inflammation and phlebitis at injection site (most common) 3
• Transient serum creatinine elevations during high-dose IV use 4
• Encephalopathic changes (rare but serious) 2, 3
• Nausea and vomiting 3

Treatment of Acyclovir-Resistant Infections

If lesions persist during acyclovir treatment, resistance should be suspected. In such cases:

• Consult with an infectious disease specialist
• Consider alternative therapy with foscarnet (40 mg/kg IV every 8 hours) 1
• Note that acyclovir-resistant strains are also resistant to valacyclovir and most are resistant to famciclovir 1

Common Pitfalls to Avoid

1. Administering acyclovir as a rapid bolus injection (can cause renal precipitation)
2. Inadequate dose adjustment in patients with renal impairment
3. Failure to monitor for neurological adverse effects, especially in patients with underlying neurological conditions
4. Insufficient duration of therapy (should continue until clinical resolution)

Remember that IV acyclovir should be reserved for severe infections requiring hospitalization, such as disseminated infection, encephalitis, pneumonitis, or hepatitis, and should be administered with careful monitoring of renal function and neurological status.