.
Prior to treatment, patients should be assessed for any complications or serious underlying diseases.
This includes individuals with red flag symptoms suggestive of oral cancer.
Aciclovir is eliminated primarily unchanged in the urine via active renal tubular secretion. Any drugs administered concurrently that compete with this mechanism may increase aciclovir plasma concentrations. • The risk of renal impairment is increased by the concomitant use of other nephrotoxic drugs.
• Cimetidine and probenecid increase the AUC of aciclovir by competing for active secretion by the renal tubules and reduce aciclovir renal clearance. However, dosage adjustment is usually not necessary because of the wide therapeutic index of aciclovir.
• Fatigue has been associated with the combined use of aciclovir and zidovudine.
Caution should be taken when supplying to elderly patients, as they are likely to have reduced renal function. If dose reduction is required, the patient should be referred appropriately.
• Elderly patients are at an increased risk of developing neurological side effects and should be closely monitored for evidence of these effects.
People with particularly severe recurrent herpes labialis should be encouraged to seek medical advice. • Care should be taken to maintain adequate hydration during treatment with aciclovir. • Oral suspension may contain ethanol or parahydroxybenzoates (which may cause an allergic reaction). For a full list of excipients, refer to section 6.1 of the SPC
Discuss with patient and document the reasons for exclusion from treatment under the PGD. • If a serious complication or underlying pathology is suspected (e.g. oral cancer), the patient should be urgently referred for further investigations. • Record any advice given and actions/decisions in notes • Reschedule or refer to General Practitioner or appropriate clinic as clinically indicated.
Record refusal, advice given, actions/decisions in notes • Ensure patient/parent/guardian fully understands the risks of declining treatment. • Inform or refer to doctor as appropriate if the patient has consented. • If appropriate, reassure the patient that oral herpes simplex infections are usually self-limiting, and that lesions should heal without scarring.
Topical aciclovir should be supplied as 1st line for the treatment of herpes simplex labialis, to be used from onset of prodromal symptoms before vesicles appear.
Patients must avoid transmitting the virus particularly when active lesions are present. This includes avoiding kissing, oral sex and sharing items that come into contact with the lesions until they have fully healed.
• Patients with contact lenses should take care to avoid contaminating them, as there is a risk of transmission to the eye if lenses become contaminated.
• Patients should be advised on how to use the medication and the frequency of administration/application (see description of treatment). • Advise the person/carer to seek medical advice if symptoms worsen or there is no significant improvement after 5-7 days. • Advise on possible side effects and their management. If they are concerned about any unwanted effects, they need to seek medical advice as soon as possible and before their next dose. If the symptoms do not disappear, or the patient experiences other severe symptoms, they should be advised to contact their General Practitioner, call NHS 111 or visit A&E.• Reassure the patient/carer that oral herpes simplex infections are usually selflimiting, and that lesions should heal without scarring.• Advise on measures for symptom relief. • Give advice to minimise the risk of transmission to other people and autoinoculation. • Advise the person to try to avoid trigger factors, if possible.• If appropriate, advise patients not to drive or operate machinery if they feel drowsy or sleepy during treatment.• If using aciclovir cream, patients should rinse their mouth with water immediately if any goes into the mouth. If the cream is accidently swallowed, patients should seek advice from their GP
Click to view pharmadoctor terms & conditions.
