Acyclovir topical

Name: Acyclovir topical


Antiviral; purine nucleoside analog derived from guanine.101 112

Advice to Patients

  • Importance of using only for condition prescribed.112 Advise patient that 5% cream is only for treatment of herpes labialis (perioral herpes, cold sores, fever blisters) and should not be used to treat genital herpes.112

  • Ensure that the affected areas are clean and dry before application.112

  • Do not apply to unaffected skin or inside the mouth or nose.101 112 For external use only.101 112

  • Importance of avoiding contact with eyes.101 112

  • Importance of avoiding use of occlusive dressings unless otherwise directed by clinician.112

  • Importance of washing hands before and after application.112 Advise patients not to bathe, shower, or swim immediately after application.112

  • Advise patients not to apply other topical products (e.g., cosmetics, lip balms, sunscreens, other topical medications) to treated areas unless otherwise directed by clinician.112

  • For treatment of herpes labialis, importance of applying to affected areas as directed and at the first sign or symptom (e.g., tingling, redness, bump, itching).112

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.101

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.101

  • Importance of advising patients of other important precautionary information. (See Cautions.)

Proper Use of acyclovir

Acyclovir may come with patient information about herpes simplex infections. Read this information carefully. If you have any questions, check with your health care professional.

Do not use acyclovir in the eyes.

Acyclovir is best used as soon as possible after the signs and symptoms of herpes infection (for example, pain, burning, or blisters) begin to appear.

Use a finger cot or rubber glove when applying acyclovir. This will help keep you from spreading the infection to other areas of your body and will prevent the transmission of the infection to other persons . Apply enough medicine to completely cover all the sores (blisters). A 1.25-centimeter (approximately ½-inch) strip of ointment applied to each area of the affected skin measuring 5 × 5 centimeters (approximately 2 × 2 inches) is usually enough, unless otherwise directed by your doctor.

To help clear up your herpes infection, continue using acyclovir for the full time of treatment, even if your symptoms begin to clear up after a few days. Do not miss any doses. However, do not use acyclovir more often or for a longer time than your doctor ordered.


The dose of acyclovir will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of acyclovir. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For topical dosage form (cream):
    • For herpes simplex infection:
      • Adults—Apply to the affected area(s), four to six times a day, for up to ten days.
      • Children—Use and dose must be determined by your doctor.
  • For topical dosage form (ointment):
    • For herpes simplex infection:
        In the U.S.
      • Adults—Apply to the affected area(s), every three hours, for a total of six times a day, for seven days.
      • Children—Use and dose must be determined by your doctor.
        In Canada
      • Adults—Apply to the affected area(s), four to six times a day, for up to ten days.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of acyclovir, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.


Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Index Terms

  • Aciclovir
  • ACV
  • Acycloguanosine

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Zovirax: 5% (5 g) [contains cetostearyl alcohol, propylene glycol]

Ointment, External:

Zovirax: 5% (30 g)

Generic: 5% (5 g, 15 g, 30 g)

Tablet, Buccal:

Sitavig: 50 mg [contains milk protein concentrate]

Dosing Pediatric

Herpes labialis (cold sores): Children ≥12 years and Adolescents: Topical cream: Refer to adult dosing.

Drug Interactions

Talimogene Laherparepvec: Antiherpetic Antivirals may diminish the therapeutic effect of Talimogene Laherparepvec. Monitor therapy


Concerns related to adverse effects:

• Dermatologic toxicity: Cream may be irritating and cause contact sensitization. The sensitizing ingredient has not been identified.

Disease-related concerns:

• Appropriate use: Genital herpes: Physical contact should be avoided when lesions are present; transmission may also occur in the absence of symptoms. Treatment should begin with the first signs or symptoms. There are no data to support the use of acyclovir ointment to prevent transmission of infection to other persons or prevent recurrent infections if no signs or symptoms are present.

• Appropriate use: Herpes labialis: Treatment should begin with the first signs or symptoms.

Special populations:

• Immunocompromised patients: Buccal tablet, cream: Use and safety has not been studied; use with caution.

Dosage form specific issues:

• Buccal tablet: Apply to the area of the upper gum above the incisor tooth on the same side as the symptoms; do not apply to the inside of the lip or cheek.

• Cream: For external use only to the lips and face; do not apply to eye or inside the mouth or nose, or to any mucous membranes.

• Ingredient precaution: Some products may contain milk protein concentrate.

• Ointment: For cutaneous use only; do not use in the eye.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience burning, stinging, dry skin, itching, dry lips, application site pain, or headache. Have patient report immediately to prescriber severe application site irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

How should I use acyclovir topical?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Treatment with acyclovir topical should be started as soon as possible after the first appearance of symptoms (such as tingling, burning, blisters).

Wash your hands before and after applying acyclovir topical cream.

Apply only enough cream to cover the cold sore or tingly area. Rub in gently until the cream disappears. Acyclovir topical cream may be applied 5 times daily for 4 days. Follow your doctor's instructions.

Wear a glove or a finger cot or use a cotton swab when applying acyclovir topical ointment to avoid spreading the virus to other body parts and to other people.

Apply only enough ointment to cover the genital lesion(s) completely. This medication may be applied every 3 hours up to 6 times daily. Acyclovir topical ointment may be applied every 3 hours, up to 6 times daily for 7 days. Follow your doctor's instructions.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.

Lesions caused by herpes viruses should be kept as clean and dry as possible. Wearing loose clothing may help to prevent irritation of the lesions.

Store at room temperature away from moisture and heat.

Pregnancy & Lactation

Pregnancy category: B

Lactation: Excretion in milk unknown; systemic exposure is minimal after topical application

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.


This medication is used to treat "cold sores/fever blisters" (herpes labialis). It can speed up healing of the sores and decrease symptoms (such as tingling, pain, burning, itching). Acyclovir belongs to a class of medications known as antivirals. It works by stopping the growth of the virus. This medication does not cure herpes, and it does not prevent passing the infection to someone else. It does not prevent a future occurrence.

How to use Acyclovir Cream

Read the Patient Information Leaflet available from your pharmacist. Consult your doctor or pharmacist if you have any questions.

Use this medication at the first sign of infection (such as tingling, burning, redness). Wash your hands with soap and water before and after applying this medication. Clean and dry the affected areas before applying the medication. Apply to the affected area and rub in gently, usually 5 times a day (every 3 to 4 hours) for 4 days for cold sores, or as directed by your doctor. Apply enough cream to cover all affected areas (red/tingling/burning areas, sores).

Apply to skin only. Do not apply this medication in the eyes or nose, inside the mouth, or inside the vagina. If you do get medication in those areas, flush with plenty of water.

Dosage is based on your medical condition, type of infection, and response to treatment. Do not use this drug more often or for longer than prescribed.

Use this medication regularly to get the most benefit from it. This medication works best when the amount of drug absorbed by the skin stays at a constant level. Therefore, use this drug at evenly spaced intervals. To help you remember, use it at the same times each day.

To prevent washing off the medication, do not bathe, shower, or swim right after applying it.

If applying to genital herpes sores, use a finger cot or rubber gloves to avoid spreading the infection.

Do not apply other skin products (such as drugs, cosmetics, sun screens, or lip balms) unless told to do so by your doctor. Do not cover the area with plastic or waterproof bandages unless told to do so by your doctor.

Cold sores (herpes) can spread easily. Acyclovir cream does not prevent the spread of herpes. Avoid close physical contact with others (such as kissing) during an outbreak until the cold sores have completely healed. Also, try not to touch the cold sore, and wash your hands if you do touch the cold sore.

If you are using acyclovir for treatment of genital herpes, it is important to follow safe sex practices to reduce the risk of giving herpes to your partner, even if there are no symptoms present. Always use a condom made of latex or polyurethane. When you have symptoms or are experiencing an outbreak, do not have sexual contact with your partner.

Tell your doctor if your condition persists or worsens after treatment is finished.


Before using acyclovir, tell your doctor or pharmacist if you are allergic to it; or to valacyclovir; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history.

Tell your doctor if you are pregnant before using this medication. Discuss the risks and benefits with your doctor.

Acyclovir may pass into breast milk in small amounts. However, the drug is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. Avoid breastfeeding if you have herpes sores on or near your breast.

Usual Pediatric Dose for Herpes Simplex Labialis

12 years or older: Apply to the affected area 5 times a day for 4 days. Therapy should be started as early as possible following onset of signs and symptoms (i.e., during the prodromal phase or when lesions appear).

Other Comments

Patients should wash their hands before and after applying acyclovir topical cream to the affected area. A finger cot or rubber glove should be used when applying acyclovir topical ointment to the affected area.