Antiviral

Antimicrobial Normal Adult Dose Dose and Interval Adjustment for Renal Impairment
Creatinine Clearance (mL/min)
>50 10 - 50 <10 (Anuric)
Acyclovir 400mg PO tid NO CHANGE NEEDED q12h
  5-10mg/kg IV q8h q8h 25-50mL/min: q12h

10-25mL/min: q24h

50% dose q24h
Amantadine 100mg PO bid or 100mg PO daily

See Prophylaxis for Influenza A

Famciclovir 500mg PO tid q8h q12-24h 250mg q24h
Ganciclovir Induction
5mg/kg IV q12h

50-69mL/min:

2.5mg/kg q12h


25-49mL/min:

2.5mg/kg q24h

10-24mL/min:
0.625mg/kg q24h


1.25mg/kg 3x/week
  Maintenance
5mg/kg IV q24h

50-69mL/min:

2.5mg/kg q24h


25-49mL/min:

1.25mg/kg q24h

10-24mL/min:
0.625mg/kg q24h


0.625mg/kg 3x/week
Oseltamivir Treatment
75mg PO bid

> 60mL/min: NO CHANGE NEEDED

> 30-60mL/min: 30mg PO bid

10-30mL/min:
30mg PO daily


USE WITH CAUTION: 75mg PO once only
  Prophylaxis
75mg PO daily

> 60mL/min: NO CHANGE NEEDED

> 30-60mL/min: 30mg PO daily

10-30mL/min:
30mg PO q2days


USE WITH CAUTION: 30mg PO once only
Valacyclovir 1g PO tid q8h q12-24h 500mg q24h
Valganciclovir Induction
900mg PO bid

q12h

450mg daily- q2days

DO NOT USE
  Maintenance
900mg PO daily

daily

450mg q2days - 2x/week

DO NOT USE
Zanamivir 10mg inhaled orally daily-bid NO CHANGE NEEDED