What is the total daily dose of Acyclovir (antiviral medication) for Varicella (chickenpox)?

From the Guidelines

The total daily dose of Acyclovir for Varicella (chickenpox) is 20 mg/kg body weight orally per dose (max 800 mg/dose) 4 times daily, which translates to a maximum of 3200 mg daily for 7-10 days or until no new lesions for 48 hrs. This recommendation is based on the guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children, as outlined in the study published in 2009 1. The key points to consider when prescribing Acyclovir for Varicella include:

• The dose is weight-based, with a maximum dose of 800 mg per administration
• The medication should be taken four times daily
• Treatment duration is typically 7-10 days or until no new lesions appear for 48 hours
• It is essential to start treatment as soon as possible after symptom onset for maximum effectiveness
• For patients with severe immune suppression, intravenous administration may be necessary, as outlined in the guidelines 1. Some important considerations for the use of Acyclovir in clinical practice include:
• The importance of adequate hydration during treatment
• The potential need for alternative therapies, such as Famciclovir, in certain cases, although data on pediatric dosing is limited 1
• The recommendation for involvement of an experienced ophthalmologist in the management of children with varicella zoster virus retinitis 1.

From the FDA Drug Label

Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. The total daily dose of Acyclovir for Varicella (chickenpox) is:

• For children (2 years of age and older) weighing less than 40 kg: 80 mg/kg/day
• For adults and children over 40 kg: 3200 mg/day 2

From the Research

Total Daily Dose of Acyclovir for Varicella

The total daily dose of Acyclovir for Varicella (chickenpox) can be determined from the following studies:

• In the study 3, the total daily dose of Acyclovir was 80 mg/kg/day up to a maximum of 3,200 mg/day in four divided doses.
• In the study 4, the total daily dose of Acyclovir was 20 mg per kilogram of body weight four times daily for five days.
• In the study 5, the total daily dose of Acyclovir was 80 mg/kg/daily in 4 divided doses.
• In the study 6, the recommended oral dose of Acyclovir was 800 mg five times a day.

Key Points

• The dose of Acyclovir varies depending on the study, with a range of 20-80 mg/kg/day.
• The maximum daily dose of Acyclovir was 3,200 mg/day in the study 3.
• The dose of Acyclovir should be adjusted based on the patient's weight and age.
• Acyclovir should be administered in divided doses, typically 4 times a day.

Dosage Recommendations

• For immunocompetent children, the recommended dose is 20 mg/kg/day in 4 divided doses 4 or 80 mg/kg/day in 4 divided doses 3, 5.
• For immunocompromised children, the recommended dose is 1500 mg/m2/day in 3 divided doses 7.
• For adults, the recommended dose is 800 mg five times a day 6.