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According to the manufacturer, valacyclovir should be administered to a nursing mother with caution and only when indicated. Although the American Academy of Pediatrics AAP has not specifically evaluated valacyclovir, systemic maternal acyclovir is considered to be usually compatible with breast-feeding. In a small study of 5 lactating women, valacyclovir was administered orally as a single mg dose. Peak acyclovir concentrations in breast milk ranged from 0. The administration of valacyclovir mg twice daily to a breast-feeding woman would provide the nursing infant with an oral acyclovir dosage of approximately 0.
In the study, unchanged valacyclovir was not detected in maternal serum, breast milk, or infant urine. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition.
If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, health care providers are encouraged to report the adverse effect to the FDA. Aprotinin: Moderate The manufacturer recommends using aprotinin cautiously in patients that are receiving drugs that can affect renal function, such as valacyclovir, as the risk of renal impairment may be increased.
Bictegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Consider the potential for drug interaction prior to and during concurrent use of these medications. Both emtricitabine and valacyclovir are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs.
Moderate Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Drugs that decrease renal function may also increase concentrations of tenofovir.
Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir, with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as valacyclovir.
Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. Cimetidine: Minor Cimetidine may cause a reduction in the clearance of acyclovir. The clinical significance of these pharmacokinetic interactions is unknown; however, no dosage adjustments are recommended for patients with normal renal function.
Colchicine; Probenecid: Moderate Probenecid can reduce the renal tubular secretion of valacyclovir when these agents are coadministered, causing an increase in the serum concentration and elimination half-life of valacyclovir.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Doravirine; Lamivudine; Tenofovir disoproxil fumarate: Moderate Since tenofovir is primarily eliminated by the kidneys, concurrent administration of tenofovir disoproxil with valacyclovir may increase serum concentrations of tenofovir via competition for renal tubular secretion.
Efavirenz; Emtricitabine; Tenofovir: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Moderate Since tenofovir is primarily eliminated by the kidneys, concurrent administration of tenofovir disoproxil with valacyclovir may increase serum concentrations of tenofovir via competition for renal tubular secretion.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Since tenofovir is primarily eliminated by the kidneys, concurrent administration of tenofovir disoproxil with valacyclovir may increase serum concentrations of tenofovir via competition for renal tubular secretion. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir. Emtricitabine: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Emtricitabine; Rilpivirine; Tenofovir alafenamide: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Emtricitabine; Tenofovir alafenamide: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir. Emtricitabine; Tenofovir disoproxil fumarate: Moderate Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as valacyclovir.
Entecavir: Moderate Entecavir may affect renal function and should be used cautiously in combination with other drugs that may also affect renal function including valacyclovir. Fosphenytoin: Minor The addition of valacyclovir to phenytoin may lead to a clinically significant decrease in phenytoin serum concentrations and loss of seizure control. Clinicians should be prepared to make adjustments in phenytoin or fosphenytoin dosing if valacyclovir therapy is added or discontinued.
Hyaluronidase, Recombinant; Immune Globulin: Moderate Immune Globulin IG products have been reported to be associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death. Patients predisposed to acute renal failure include patients receiving known nephrotoxic drugs like valacyclovir. Coadminister IG products at the minimum concentration available and the minimum rate of infusion practicable.
Also, closely monitor renal function. Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Since tenofovir is primarily eliminated by the kidneys, concurrent administration of tenofovir disoproxil with valacyclovir may increase serum concentrations of tenofovir via competition for renal tubular secretion.
Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live: Major If possible, discontinue valacyclovir at least 24 hours before administration of the varicella-zoster virus vaccine, live. Also, do not administer valacyclovir for at least 14 days after vaccination. Concurrent administration of any of the varicella-zoster virus vaccines Zostavax, Varivax, ProQuad with antiviral medications known to be effective against varicella zoster virus has not been evaluated.
Therefore, when possible, a washout period between the use of the antiviral medication and the vaccines is recommended. Valacyclovir has a relatively short serum half-life and is quickly cleared from the body. Refer to the most recent Center for Disease control guidance if concurrent use is necessary. Mycophenolate: Moderate Valacyclovir, a prodrug of acyclovir, when added to a regimen of MMF, cyclosporine, and prednisolone caused neutropenia.
The acyclovir trough concentration was 4. Cessation of valacyclovir led to immediate recovery of the neutrophil count and an increased concentration of mycophenolic acid from 0. Coadministration of mycophenolate mofetil MMF and acyclovir to healthy volunteers resulted in no significant change in mycophenolic acid concentrations or AUC.
However, the systemic exposure of the glucuronide metabolite of mycophenolate MPAG and of acyclovir was increased Blood cell count monitoring is recommended. The risk of adverse effects e. The potential exists for the two drugs to compete for tubular secretion, which could further increase the concentration of both drugs in patients with renal dysfunction.
Phenytoin: Minor The addition of valacyclovir to phenytoin may lead to a clinically significant decrease in phenytoin serum concentrations and loss of seizure control.
Clinicians should be prepared to make adjustments in phenytoin dosing if valacyclovir therapy is added or discontinued. Probenecid: Moderate Probenecid can reduce the renal tubular secretion of valacyclovir when these agents are coadministered, causing an increase in the serum concentration and elimination half-life of valacyclovir.
Talimogene Laherparepvec: Major Consider the risks and benefits of treatment with talimogene laherparepvec before administering acyclovir or other antivirals to prevent or manage herpetic infection.
Talimogene laherparepvec is a live, attenuated herpes simplex virus that is sensitive to acyclovir; coadministration with antiviral agents may cause a decrease in efficacy.
Telbivudine: Moderate Drugs that alter renal function such as valacyclovir may alter telbivudine plasma concentrations because telbivudine is eliminated primarily by renal excretion.
Monitor renal function before and during telbivudine treatment. Can you have an outbreak while taking Valtrex? However, the frequency of outbreaks tends to go down over time for a lot of people.
It can take up to 10 days or, in some cases, even longer for herpes blisters to heal even with valacyclovir treatment. In Closing. Valacyclovir is not considered a liver toxic drug.
When taken at a normal dose, valacyclovir is highly unlikely to cause liver damage in individuals with normal liver health. However, because they suppress the immune system, these medicines also suppress the ability of the body to fight infection. Valaciclovir is therefore given to people who have received an organ transplant, in order to help the body kill off any CMV virus. The inhibitory effects of antivirals on immune cells may contribute to the immune deterioration observed in patients following prolonged use of the drugs.
On its own, its half-life is approximately 30 minutes. Valacyclovir commonly sold as Valtrex is one of the most widely used and effective drugs on the market for treating and controlling cold sores, shingles and genital herpes. Valacyclovir is also commonly prescribed for chickenpox, which is caused by the varicella zoster virus VZV. The amount of time required for valacyclovir to start working can vary based on a number of factors, ranging from the type of infection you have to your valacyclovir dosage and the total amount of time that passes after you notice symptoms but before you start treatment.
The standard dosage of valacyclovir for first-time herpes outbreaks is 1, mg two times per day over a period of 10 days. It can take up to 10 days or, in some cases, even longer for herpes blisters to heal even with valacyclovir treatment. This makes it important to start treatment as soon as you notice herpes symptoms.
In some cases, your doctor might prescribe valacyclovir for a longer period than 10 days or at a different dosage. Herpes can remain dormant in the body for weeks, months or years in between outbreaks. On average, people with HSV-1 experience about one outbreak per year, while people with HSV-2 will usually experience four to five outbreaks per year.
When these outbreaks occur, valacyclovir can provide fast and effective relief, helping to control herpes outbreak symptoms. The typical valacyclovir dosage for recurrent herpes outbreaks is mg two times per day over a period of three days.
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