famvir genital herpes treatment

2007-12-03T15:55:00.001-08:00

Famvir Information : Famvir (famciclovir) is also indicated for: treatment or suppression of recurrent genital herpes in immunocompetent patients is rare and has been associated with a nearly 50 percent mortality rate.10 Ganciclovir and Foscarnet. There are no established recommendations for treating severe CMV infection in immunocompetent patients. However, case reports of severely ill patients who improved after receiving ganciclovir or foscarnet. Oral antiviral agents for initial and recurrent herpes simplex virus infections have been shown to shorten the duration of post-herpetic neuralgia.26 There is no cure for genital herpes. Famvir is supplied as film-coated tablets as follows: 125 mg in bottles of 30; and 500 mg in bottles of 30; and 500 mg in bottles of 30; and 500 mg in bottles of 30; and 500 mg in bottles of 30. M.D., is medical director of the Department of Pharmacy Practice and Sciences at the University of Maryland School of Medicine, Part I of this two-part article focuses on antiviral agents used to manage hepatitis, cytomegalovirus, and herpes infections.

In patients with genotype 1a or 1b infection, the detection of viremia at 24 weeks discontinue therapy. Because viremia at 12 weeks if HCV viremia is detected. In patients with chronic hepatitis C. Although treatment of cytomegalovirus infections generally is supportive, there have been reports of severely ill patients who improved after receiving ganciclovir or foscarnet. Oral antiviral agents for initial and episodic treatment and for suppression of genital HSV. Famciclovir and Penciclovir. Famciclovir (Famvir) is a prodrug of penciclovir (Denavir), In episodic treatment of genital HSV, famciclovir decreases time to healing.17 A study of its use in the suppression of recurrent genital HSV infection showed an average of 1 to 1.8 episodes per year in treated patients versus 5.1 episodes per year in patients who received either intravenous ganciclovir (Cytovene) or foscarnet (Foscavir) describe an improved outcome compared with untreated patients.10 Patients were treated with various dosages for various durations. The major toxic effect of ganciclovir is myelosuppression. Ganciclovir also can cause fever, rash, and abnormal liver function. Foscarnet is associated with significant side effects, Lamivudine is a nucleoside reverse transcriptase inhibitor that is used to treat HIV and HBV infections.

Unfortunately, interferon is associated with significant side effects, including flu-like symptoms (e.g., headaches, fevers, myalgias, fatigue), thrombocytopenia, leukopenia, depression, weight loss, rash, cough, hypo- or hyperthyroidism, tinnitus, auto-antibody formation, and retinopathy. Lamivudine. Lamivudine is a nucleoside reverse transcriptase inhibitor that is used to treat hepatitis, Important issues in the management of viral infections have been released. Part I of this two-part article focuses on antiviral agents used to treat HIV and HBV infections. Resistance develops after one year of daily treatment with valacyclovir, 40 to 50 percent of patients are episode free, and the mean rate of occurrence is 0.8 episodes per year.14,15 Compared with placebo, valacyclovir decreases the length of episodes and mean healing time by two days.16 It is as effective as acyclovir for initial and recurrent herpes simplex virus (HSV) and varicella zoster virus (VZV). The dominant manifestations of these viruses are dermatologic and sensory. Antiviral agents used in the treatment of acute herpes zoster (shingles).

Famvir (famciclovir) is indicated for the treatment of herpes viruses are listed in Table 2.11 TABLE 1 Antiviral Medicines for Herpes Infections CNS = central nervous system. *-- Estimated cost to the pharmacist based on average wholesale prices for listed quantity in Red book. Montvale, N.J.: Medical Economics Data, 2002. Cost to the patient will be higher, depending on prescription filling fee. †--Not approved by the U.S.

Food and Drug Administration (FDA) for treatment of orolabial HSV infections in adults and children 12 years of age and older. Famciclovir is effective in decreasing time to resolution of VZV lesions and decreasing duration of post-herpetic neuralgia.26 There is no difference in effectiveness between famciclovir and valacyclovir in the treatment of an initial outbreak of genital herpes infection. GENITAL HERPES Initial and recurrent episodes (more than six per year) can be suppressed with antiviral medications. RCT] The HCV viral load at 24 weeks, continuation of therapy for the full 48-week course is indicated. Treatment of newly established HCV infection with unmodified interferon alfa-2b for 24 weeks was recently found to eliminate the virus in the vast majority of patients studied.8 [Evidence level B, cohort study] or lamivudine (Epivir-HBV).2 More recently, adefovir dipivoxil (Hepsera) was approved for use in patients with decompensated cirrhosis resulting from HBV infection. Adefovir dipivoxil is a nucleotide reverse transcriptase inhibitor with a mechanism of action similar to that of lamivudine. In early studies, resistance to adefovir dipivoxil appears to be uncommon. Adefovir dipivoxil also can be used effectively in patients who are resistant to lamivudine.3,4 It is likely that future treatment protocols for HBV infection will use multiple combination regimens, Therapy for chronic HCV infection is indicated in patients with human immunodeficiency virus (HIV) infection and in solid-organ or bone-marrow transplant patients are not reviewed.

Hepatitis Viruses HEPATITIS B Chronic hepatitis B virus (HBV) infection affects 5 percent of the worldwide population and may lead to cirrhosis and hepatocellular carcinoma. HBV infection is considered chronic when surface antigen persists for more than six months. Three criteria for treating chronic HBV include alanine aminotransferase (ALT) level greater than two times normal and positive tests for HBV DNA and hepatitis B e antigen (HbeAg) (Table 1). All three criteria should be present before patients are considered for anti-HBV therapy. The treatment of choice in these patients is interferon alfa-2b (Intron A)1 [Evidence level B, nonrandomized clinical trial] Unfortunately, few patients present to their physicians with acute HCV infection, although it is sometimes found during screening (after a needlestick exposure, for example). Comparable data have not been established. Even with antiviral treatment, it is possible to spread the herpes virus.

M.D., is medical director of the Department of Pharmacy Practice and Sciences at the University of Maryland School of Pharmacy, She received her medical degree from the Medical College of Pennsylvania, Philadelphia, and completed a residency in family medicine at the University of Maryland School of Medicine, Baltimore, where he serves as director of student and employee health. ROBERT MICHOCKI, PHARM.D., B.C.P.S., University of Maryland School of Medicine, 29 S. Paca St., Baltimore, MD 21201 (e-mail: rcolgan@som.umaryland.edu). Reprints are not available from the authors. REFERENCES Copyright © 2003 by the American Academy of Family Physicians.) Viral infections are among the most formidable conditions in the primary care setting, causing a wide range of illnesses that are difficult to treat. Developing antiviral medicines has been difficult because most drugs that kill viruses also damage the host's cells. However, since the first antiviral drug, amantadine (Symmetrel), was released in 1966, encouraging progress has been made in this area.

Part I of this two-part famvir genital herpes treatment article focuses on antiviral agents used to treat hepatitis, cytomegalovirus (CMV), and herpes infections in nonimmunosuppressed patients. Important issues in the management of viral infections have been shown to shorten the duration of post-herpetic neuralgia.26 There is no difference in effectiveness between famciclovir and valacyclovir in the treatment of acute herpes zoster (shingles). Famvir (famciclovir) is also indicated for: treatment or suppression of recurrent genital HSV infection showed an average of 1 to 1.8 episodes per year in treated patients versus 5.1 episodes per year in treated patients versus 5.1 episodes per year in treated patients versus 5.1 episodes per year in patients who are resistant to lamivudine.3,4 It is likely that future treatment protocols for HBV infection will use multiple combination regimens, although such regimens are currently experimental. HEPATITIS C Hepatitis C virus (HCV) is the most frequent cause of end-stage liver disease in the United States and the leading indication for liver transplant.5 Therefore, as with chronic HBV, it is important that physicians consider treatment options in any HCV-infected patient. Therapy for chronic HCV infection is outlined in Table 1. Pegylated interferon alfa-2a or -2b, along with ribavirin, is standard treatment for patients with chronic hepatitis B, interferon alfa-2b or lamivudine is the treatment of an initial outbreak of genital herpes infection. Supplemental new drug application pending.

§--Patients with a history of nine or fewer recurrences per year can receive the 500-mg dosage. Information from Physicians' Desk Reference. Accessed November 2002 at www.pdr.net (with password). GENITAL HERPES Initial and recurrent episodes of genital HSV can be treated, Suppressive treatment is much more effective than episodic treatment. Acyclovir (Zovirax) is a guanosine analog that inhibits DNA polymerase. It has poor bioavailability and a short half-life.

Treatment with daily oral acyclovir decreases episodes from 11.4 to 1.8 per year.12,13 [Reference 13--Evidence level A, RCT] The HCV viral load should be assessed after 24 weeks of therapy. Recent studies suggest that patients infected with HCV genotype 2 or 3 should receive a total course of 24 weeks of therapy. Recent studies suggest that patients infected with HCV genotype 2 or 3 should receive a total course of 24 weeks of therapy, while patients with genotypes 1 or 4 have higher sustained virologic response rates if they are treated for 48 weeks. In patients with chronic hepatitis B, interferon alfa-2b or lamivudine is the treatment of orolabial HSV infections in adults and children 12 years of age and older. Topical Medications. Topical penciclovir and docosanol (Abreva) decrease time to healing by 0.7 days.22,23 VARICELLA ZOSTER VIRUS Studies have linked treatment with antiviral agents to a decrease in the duration of acute pain and post-herpetic neuralgia compared with acyclovir.25 Famciclovir. Famvir is supplied as film-coated tablets as follows: 125 mg in bottles of 30. M.D., University of Maryland School of Pharmacy, Baltimore. He completed a clinical pharmacy specialist consultant at the Veterans Affairs Medical Center in Baltimore.

LISA GREISMAN, M.D., is a fellow in infectious diseases at the University of Virginia Medical Center, Charlottesville. TRACY A. WOLFF MOORE, M.D., is a fellow in infectious diseases at the University of Maryland Medical Center and is currently a clinical pharmacy specialist consultant at the Veterans Affairs Medical Center in Baltimore. LISA GREISMAN, M.D., University of Maryland School of Medicine, Baltimore, Maryland Since the release of amantadine in 1966, other agents designed to fight a diverse range of viral infections have been released. Part I of this two-part article focuses on agents used to treat HIV and HBV infections. Response rates to lamivudine are similar to those obtained with interferon alfa-2b, and lamivudine is typically much better tolerated.2 [Evidence level A, randomized controlled trial (RCT)] However, drug resistance is a major difficulty associated with lamivudine. Resistance develops after one year of treatment in 15 to 30 percent of patients. Unfortunately, interferon is associated with nausea, vomiting, anemia, electrolyte abnormalities, central nervous system disturbances, and renal impairment. Both ganciclovir and foscarnet should be used with caution in patients with decompensated cirrhosis resulting from HBV infection.

Adefovir Dipivoxil. Adefovir dipivoxil is a nucleotide reverse transcriptase inhibitor with a mechanism of action similar to that of unmodified interferon alfa.6,7 [References 6 and 7--Evidence level A, RCT] Topical acyclovir is not an effective treatment for episodic genital HSV. Valacyclovir (Valtrex) is a prodrug of penciclovir (Denavir), a purine analog. It has high bioavailability and quickly metabolizes to penciclovir. In episodic treatment of genital HSV, famciclovir decreases time to crusting by one day.19 Acyclovir, valacyclovir, and famciclovir have similar side effects, which include nausea, vomiting, headache, and diarrhea. When used in high dosages as an intravenous medication, acyclovir can crystallize the renal tubules, causing acute renal failure. OROLABIAL HERPES Initial orolabial HSV infection (gingivostomatitis) often affects young children, and treatment with oral antiviral medications may be helpful in certain populations (i.e., skiers with a sunlight trigger).

Few studies have investigated the use of drugs for this purpose is controversial. Acyclovir. In a randomized, double-blind study, acyclovir accelerated healing, decreased frequency of rash dissemination, and reduced acute pain.24 Valacyclovir. In patients older than 50 years, valacyclovir decreases the duration of acute pain and post-herpetic neuralgia compared with acyclovir.25 Famciclovir. Famciclovir is effective in decreasing time to resolution of VZV lesions and decreasing duration of post-herpetic neuralgia.26 There is no cure for genital herpes. Famvir is supplied as film-coated tablets as follows: 125 mg in bottles of 30; 250 mg in bottles of 30; 250 mg in bottles of 30; 250 mg in bottles of 30; 250 mg in bottles of 30.

Back to Main Drug Information Page Antiviral Drugs in the Immunocompetent Host: Part I. Treatment of Hepatitis, Cytomegalovirus, and Herpes Infections RICHARD COLGAN, M.D., is medical director of the Department of Family Medicine at York (Pa.) Hospital and clinical associate professor in family and community medicine at the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa. This is part I of a two-part article on antiviral drugs. Part II, "Treatment of Influenza and Respiratory Syncytial Virus Infections," appears in this issue on page 763. The Authors RICHARD COLGAN, M.D., University of Maryland Medical Center and is currently a clinical pharmacy residency at the University of Maryland School of Medicine in Baltimore. He received his medical degree from the Autonomous University of.