Penciclovir Cream is a nucleoside analog HSV
Herpes Simplex Virus Infection
An infection caused by the virus HSV.
Full Answer
How is penciclovir used to treat herpes labialis (cold sores)?
When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include: 1. Spread penciclovir liberally all over lips and the area surrounding lips. 2. Penciclovir therapy is started at the first sign of a cold sore outbreak. 3.
What is penciclovir cream used for?
Penciclovir Cream, 1% contains Penciclovir, an antiviral agent active against herpes viruses. Penciclovir Cream is available for topical administration as a 1% white cream.
When is penciclovir indicated for the treatment of impetigo?
Penciclovir should be used a minimum of two weeks to prevent recurrence. 2. Penciclovir therapy is started at the first sign of a cold sore outbreak. 1. A child presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo.
How often should you apply penciclovir cream?
Penciclovir Cream should be applied every 2 hours during waking hours for a period of 4 days. Treatment should be started as early as possible (i.e., during the prodrome or when lesions appear). 3. DOSAGE FORMS AND STRENGTHS Each gram of Penciclovir Cream contains 10 mg of Penciclovir in a cream base, which is equivalent to 1% (w/w). 4.
When should penciclovir be used?
Penciclovir is best used as soon as possible after the symptoms of herpes infection (for example, pain, burning, or blisters) begin to appear. Do not use this medicine in or near the eyes. Do not use this medicine inside the mouth or nose or on other internal parts of the body.
How do you use penciclovir cream?
Apply a thin layer of penciclovir cream to completely cover the area of the cold sore or the area of tingling/itching/redness/swelling, and rub in gently. Apply the cream every 2 hours (except during sleep) for 4 days or as directed by your doctor. Apply to skin only.
Which is better acyclovir or penciclovir?
Two of the studies compared penciclovir to acyclovir and one study showed that penciclovir was superior to acyclovir; however, the other trial showed no difference in effectiveness. The two other studies regarding penciclovir showed modestly improved healing and pain outcomes when compared to placebo.
What is the mechanism of action of penciclovir?
Mechanism of Action: Penciclovir triphosphate inhibits HSV polymerase competitively with deoxyguanosine triphosphate. Consequently, herpes viral DNA synthesis and, therefore, replication are selectively inhibited.
Do I need prescription for penciclovir?
Denavir (penciclovir) requires a prescription from your provider. Currently, the only over-the-counter antiviral medication for cold sores is Abreva (docosanol cream).
How effective is acyclovir cream for cold sores?
Topical medications Creams, gels and ointments containing the drugs aciclovir or penciclovir are available in pharmacies without a prescription. Studies have shown that they can make cold sores go away about one day sooner. They can also reduce the severity of symptoms somewhat.
Is acyclovir topical effective?
Topical acyclovir cream is well tolerated and an effective treatment for first and recurrent episodes of genital herpes.
Is topical acyclovir as effective as oral?
In spite of higher anterior segment levels our study has shown that topical acyclovir is significantly less effective than the oral formulation and this may be due to insufficient drug levels in the posterior segment.
Is acyclovir cream or ointment better?
Conclusions In this model, the efficacy of penciclovir cream was greater than acyclovir cream, acyclovir cream was greater than or equal to acyclovir ointment, and acyclovir ointment was greater than n-docosanol cream.
What type of product is penciclovir?
Penciclovir is a topical nucleoside polymerase inhibitor used in the treatment of recurrent herpes labialis. Penciclovir is a synthetic acyclic guanine derivative with antiviral activity used for the treatment of various herpes simplex virus (HSV) infections.
Is penciclovir a prodrug?
Famciclovir and Penciclovir Famciclovir (Famvir) is a prodrug, the diacetyl ester of 6-deoxy penciclovir, and lacks intrinsic antiviral activity.
How fast does Denavir work?
In a May 1997 study published in the Journal of the American Medical Association, patients treated with Denavir healed only 0.7 days faster than the placebo group, posting an average healing time of 4.8 days, compared with 5.5 days with the placebo.
How to treat herpes labialis on lips?
Apply 1% cream topically to herpes labialis lesions on the lips and surrounding symptomatic skin on the face (e.g., areas with tingling).
Where is penciclovir found?
In vitro study using cadaver skin indicates that penciclovir penetrates the skin after topical application of 1% cream; approximately 3% of the topical dose is found in the stratum corneum and epidermis layers.
What is the metabolite of penciclovir?
Converted in vivo to penciclovir triphosphate, the pharmacologically active metabolite. Intracellular conversion to the triphosphate is necessary for antiviral activity.
What are the symptoms of herpes labialis?
Initiate at the earliest sign or symptom of herpes labialis (i.e., tingling, redness, itching, presence of a bump). If lesions worsen or do not improve, evaluate for secondary bacterial infection. Also consider possibility of resistance to penciclovir.
Is HSV resistant to acyclovir?
HSV clinical isolates resistant to acyclovir because of deficiency in viral thymidine kinase (i.e., thymidine kinase-negative mutants) generally are cross-resistant to penciclovir. Some viral thymidine kinase- or DNA polymerase-altered strains resistant to acyclovir have been susceptible to penciclovir in vitro.
Is penciclovir the same as acyclovir?
Mechanism of action is similar to that of acyclovir. Although penciclovir has higher affinity for HSV thymidine kinase than acyclovir and penciclovir triphosphate is more stable than acyclovir triphosphate in HSV-infected cells, HSV DNA polymerases have higher affinity for acyclovir triphosphate than for penciclovir triphosphate; net effect is that these nucleoside analogs have similar antiviral potencies.
Does penciclovir cause sensitization?
No evidence that topical penciclovir causes sensitization.
Does HSV persist in the host?
After initial infection, HSV persists latently in host neurons with the risk of periodical reactivation over a lifetime. The development of acyclovir, a potent and specific nucleoside inhibitor of the herpes DNA polymerase, was a milestone in the history of antiviral drugs in the late 1970s.
Is Penciclovir cream good for herpes?
Penciclovir cream--improved topical treatment for herpes simplex infections. Human herpesviruses can be found worldwide and cause many viral infections in immunocompetent as well as in immunocompromised patients. Herpes simplex virus (HSV) diseases can be the cause of life-threatening disease, especially in neonates.
Is herpes a virus?
Human herpesviruses can be found worldwide and cause many viral infections in immunocompetent as well as in immunocompromised patients. Herpes simplex virus (HSV) diseases can be the cause of life-threatening disease, especially in neonates. After initial infection, HSV persists latently in host neurons with the risk of periodical reactivation over a lifetime. The development of acyclovir, a potent and specific nucleoside inhibitor of the herpes DNA polymerase, was a milestone in the history of antiviral drugs in the late 1970s. During the last decades a better understanding of the replication and disease-causing state of HSV types 1 and 2 has been achieved enabling the development of new and potent antiviral compounds. In the mid-1990s, for example, valacyclovir and famciclovir were launched as prodrugs of acyclovir with improved bioavailability. Despite the numerous drugs available for the systemic treatment of HSV infections, the topical application of a cream containing an antiviral agent is still the most convenient method of treating herpes simplex labialis/facialis in the general population. For some time, the topical standard treatment for recurrent HSV infections has been acyclovir cream, despite the fact that the evidence for efficacy in recurrent episodes has been equivocal. Penciclovir, a novel acyclic nucleoside analogue, has demonstrated efficacy against HSV types 1 and 2 and seems to have a pharmacological advantage due to a prolonged half-life of its active form in HSV-infected cells. This review discusses and compares the topical treatment modalities available for HSV infections. As a conclusion, different studies are available that have shown that it is possible to reduce viral replication and hasten lesion resolution with 1% penciclovir treatment beyond the prodromal phase of the HSV infection. Comparing data of topical treatment with acyclovir and penciclovir revealed a superiority for penciclovir cream showing a significant decrease in time to lesion healing, lesion area and pain. While systemic acyclovir or valacyclovir may be valid drugs especially for HSV prophylaxis, 1% penciclovir cream should be preferred as topical treatment since there are good therapeutic results independent of the phase of development of herpetic eruptions.
Can HSV be fatal?
Herpes simplex virus (HSV) diseases can be the cause of life-threatening disease, especially in neonates. After initial infection, HSV persists latently in host neu …. Human herpesviruses can be found worldwide and cause many viral infections in immunocompetent as well as in immunocompromised patients. Herpes simplex virus (H SV) ...
When is penciclovir therapy started?
Penciclovir therapy is started at the first sign of a cold sore outbreak.
How long does it take to get rid of MRSA?
Nasal MRSA eradication requires at least four weeks of therapy, with up to eight weeks needed in some patients.
What to take with griseofulvin?
Take the griseofulvin with a high-fat food.
What to do if rash worsens?
If the rash worsens, apply a thicker layer of medication to settle down the infection.
Is it normal to get skin irritation with penciclovir?
Skin irritation is normal with penciclovir and it should resolve.
Can you mix griseofulvin with ice cream?
Mix the griseofulvin with ice cream before administering.
When is penciclovir therapy started?
A) Penciclovir therapy is started at the first sign of a cold sore outbreak.
What chapter is Antiviral Agents I?
Chapter 93: Antiviral Agents I: Drugs for Non-HIV…
Is skin irritation normal with penciclovir?
B) Skin irritation is normal with penciclovir and it should resolve.
Can clopidogrel cause constipation?
C) Clopidogrel can be constipating, use a stool softener if needed.
What is herpes labialis?
Herpes labialis is caused by herpes simplex virus type 1 (HSV-1). Infection with type 2 virus can also lead to (primary) herpes labialis, but this type rarely causes a relapse of the ailment.5The primary infection with HSV-1 usually occurs before the age of 20 years. Antibodies against the virus can be found in about 80% of all adolescents. Probably because of the improved socioeconomic circumstances in industrial countries, individuals are older when first infected than was the case some decades ago. As a result of this epidemiologic shift, it is becoming more common for the primary infection to manifest as genital herpes because of orogenital contact.4,6,7
How common is herpes labialis?
Herpes labialis (cold sore, fever blister) is a commonly occurring ailment. Its average incidence is 1.6 per 1000 patients per year and its prevalence is 2.5 per 1000 patients per year .1Approximately one-third of all infected patients suffer relapses.2Herpes labialis is a rash of the skin and mucous membranes (in particular, the lips) and is characterized by erythema and blisters that are preceded and accompanied by burning pain. It is a harmless but often annoying ailment in immunocompetent patients and it usually heals spontaneously within 10 days. Herpes labialis is contagious for individuals who have not been previously infected by the virus and for those with weakened immune systems (eg, those with HIV infection or undergoing chemotherapy3). In addition, herpes labialis infection can result in genital herpes through orogenital contact.4
How long does it take to recover from herpes labialis?
In a study of 46 herpes labialis patients, time until recovery was shortened (5.0 vs 6.5 days) in those individuals who received prompt treatment with zinc oxide and glycine cream (applied every 2 hours during the day, starting as soon as possible after the first symptoms appeared and continuing until the complaints disappeared).12The effects of zinc sulfate (1%) gel, applied in a similar fashion, were studied in 79 patients.13After 5 days, 50% of the patients in the treatment group were symptom-free, compared with 35% in the placebo group.
What are the side effects of antiviral medication?
The most frequently reported side effects of oral antiviral medication were headache and nausea, irrespective of dosage and duration of treatment.29,30,41,42
What nerves do you use to reactivate a virus?
After primary infection, the virus recedes via the sensory nerve into the respective ganglion (usually the trigeminal ganglion), where it lies latent throughout the individual’s lifetime. Stimuli such as fever, menstruation, sunlight, and upper respiratory infections can reactivate the virus, after which it returns to the epithelial cells via the sensory nerve.8In contrast to the primary infection, during which all oral mucosa can be affected, relapsing infections are limited to the mucosa of the hard palate or, in older children and adults, the lips.9The number of relapses decreases after the age of 35 years.10
Does sunscreen cause herpes?
The prophylactic effect of sunscreens was studied in a crossover trial in which 38 patients were exposed to experimental ultraviolet (UV) light. None of the test subjects using a sunscreen developed herpes labialis compared with 71% of those using a placebo.31In a study of 51 patients, which was performed under natural conditions, use of a sunscreen lotion with a high protective factor did not result in a lower incidence of herpes labialis.32
Can oral therapy help with herpes?
Only prompt topic al or oral therapy will alleviate symptoms of herpes labialis . Both topical and oral treatment can contribute to the prevention of herpes labialis.
When to start penciclovir?
2. Penciclovir therapy is started at the first sign of a cold sore outbreak.
How to apply antibiotics to rash?
Instructions for applying a topical antibiotic or antiviral ointment include: 1. Apply thickly to the infected area, spreading the medication well past the borders of the infection. 2. If the rash worsens, apply a thicker layer of medication to settle down the infection. 3.
What is Erik's golden-crusted lesion?
Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment?
Can griseofulvin be absorbed?
4. Griseofulvin is best absorbed if ingested with a high-fat food.
How often should I take carbamide peroxide?
Instill carbamide peroxide (Debrox) twice daily until canals are clear. Prior to developing a plan for the treatment of asthma, the patient's asthma should be classified according to the NHLBI Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur: 1.
When to start Montelukast twice a day?
1. Montelukast twice a day is started when there is an asthma exacerbation.
Should you rinse your mouth after taking corticosteroid?
3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
When is penciclovir therapy started?
Penciclovir therapy is started at the first sign of a cold sore outbreak.
What is the advantage of prescribing sublingual medication?
An advantage of prescribing a sublingual medication is that the medication is: Absorbed rapidly. Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:
Why would a NP prescribe ibuprofen?
An NP would prescribe the liquid from of ibuprofen for a 6-year-old child because: A 6-year-old child may have problems swallowing a pill. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's: Biological half-life. Passive monitoring of drug effectiveness includes:
What is a prescription for Legend?
A prescription needs to be written for: Legend drugs; most controlled drugs; and medical devices. Once they have been metabolized by the liver, the metabolites may be: More active than the parent drug; less active than the parent drug; and totally "deactivated" so they are excreted without any effect.
Indications and Usage
Dosage and Administration
- Penciclovir Cream should be applied every 2 hours during waking hours for a period of 4 days. Treatment should be started as early as possible (i.e., during the prodrome or when lesions appear).
Dosage Forms and Strengths
- Each gram of Penciclovir Cream contains 10 mg of Penciclovir in a cream base, which is equivalent to 1% (w/w).
Contraindications
- Penciclovir Cream is contraindicated in patients with known hypersensitivity to the product or any of its components.
Adverse Reactions
- 6.1 Clinical Studies
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. In two double-blind, plac… - 6.2 Post-Marketing Experience
The following adverse reactions have been identified during post-approval use of Penciclovir Cream. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to dru…
Drug Interactions
- No drug interaction studies have been performed with Penciclovir Cream. Due to minimal systemic absorption of Penciclovir Cream, systemic drug interactions are unlikely.
Use in Specific Populations
- 8.1 Pregnancy
CategoryB There are no adequate and well-controlled studies in pregnant women. Animal Data No adverse effects on the course and outcome of pregnancy or on fetal development were noted in rats and rabbits following the intravenous administration of Penciclovir at doses of 80 and 60 m… - 8.3 Nursing Mothers
There is no information on whether Penciclovir is excreted in human milk after topical administration. However, following oral administration of famciclovir (the oral prodrug of Penciclovir) to lactating rats, Penciclovir was excreted in breast milk at concentrations higher th…
Overdosage
- Since Penciclovir is poorly absorbed following oral administration, adverse reactions related to Penciclovir ingestion are unlikely. There is no information on overdose.
Description
- Penciclovir Cream, 1% contains Penciclovir, an antiviral agent active against herpes viruses. Penciclovir Cream is available for topical administration as a 1% white cream. Each gram of Penciclovir Cream contains 10 mg of Penciclovir and the following inactive ingredients: cetostearyl alcohol, mineral oil, polyoxyl 20 cetostearyl ether, propylene glycol, purified water an…
Uses For Penciclovir
- Herpes Labialis
Topical treatment of recurrent herpes labialis (orofacial or orolabial herpes, cold sores, fever blisters) in immunocompetent adults and children ≥12 years of age. Efficacy not established in immunocompromised patients. In HIV-infected individuals, oral antivirals (e.g., acyclovir, famcicl…
Penciclovir Dosage and Administration
- Special Populations
No special population dosage recommendations.
Cautions For Penciclovir
- Contraindications
1. Hypersensitivity to penciclovir or any ingredient in the formulation. - Common Adverse Effects
Application site reactions (localized irritation, hypesthesia/local anesthesia).
Interactions For Penciclovir
- No formal drug interaction studies; clinically important interactions unlikely since systemic absorption is minimal after topical application of penciclovir 1% cream to skin.
Actions and Spectrum
- Nucleoside analog antiviral; structurally and pharmacologically related to acyclovir.
- Converted in vivo to a pharmacologically active triphosphate metabolite.
- Active against various Herpesviridae, including HSV-1 and HSV-2 and varicella-zoster virus (VZV). Also has some in vitro activity against Epstein-Barr virus (EBV), but only limited activity in vitr...
- Nucleoside analog antiviral; structurally and pharmacologically related to acyclovir.
- Converted in vivo to a pharmacologically active triphosphate metabolite.
- Active against various Herpesviridae, including HSV-1 and HSV-2 and varicella-zoster virus (VZV). Also has some in vitro activity against Epstein-Barr virus (EBV), but only limited activity in vitr...
- Exerts antiviral effects on HSV and VZV by interfering with DNA synthesis and inhibiting viral replication. Acts as a viral DNA polymerase inhibitor and stops replication of viral DNA by competing...
Advice to Patients
- Importance of using penciclovir cream only for treatment of recurrent herpes labialis (orofacial or orolabial herpes, cold sores, fever blisters) on the lips and surrounding symptomatic skin on the...
- Importance of avoiding application in or near the eyes.
- Advise patients that the cream is not a cure for cold sores and that not all patients respond t…
- Importance of using penciclovir cream only for treatment of recurrent herpes labialis (orofacial or orolabial herpes, cold sores, fever blisters) on the lips and surrounding symptomatic skin on the...
- Importance of avoiding application in or near the eyes.
- Advise patients that the cream is not a cure for cold sores and that not all patients respond to treatment with the cream.
- Importance of starting treatment at the earliest sign of a cold sore (i.e., tingling, redness, itching, bump).
Preparations
- Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Centerfor information on shortages of one or more of these preparations. Show article references Medical Disclaimer