Xavier University –Ateneo de Cagayan

College of Nursing
School Year2009 – 2010

Submitted to:
Mrs. Melanie Bustamante, RN

Mrs. Meldrid Pinque,RN

Mrs. Ivy R. Go

Ms. Charisse Raagas

Clinical Instructor

Submitted by:
Mae Shiela Vivares

BSN – 2

April 30, 2010

 Antiviral Agents

Brand names and its photos:

Famciclovir (famvir)

Famciclovir tablet and capsule

 New Antiviral drugs
Nahed Abdel-Haq, Pimpanada Chearskul, Hossam Al-Tatari and Basim Asmar

As intracellular pathogens, viruses depend on the host cells for survival

and replication. Anti viral agents that have been developed interfere with
viral entry into cells, replication, protein synthesis and release with minimal
or acceptable side effects. Actively replicating viruses are the main targets of
antiviral therapy. Therefore, most common employed strategy of antiviral
use is treatment of active viral disease. However, prophylactic and pre-
emptive uses of antivirals have been increasingly recognize especially
among patients at risk of contracting infection such as immunocomprimized
patients and organ transplant recipients.

Acyclovir has been considered as the drug of choice for treating herpes
infections. However, acyclovir has limited oral bioavailability (10%-20%) and
short intracellular half-life (less than one hour). To overcome these limitation
more bioavailable anti- herpes agents such as famciclovir and valaciclovir
were developed.

Famciclovir
Famciclovir is a prodrug (diacetyl 6-deoxy derivative) of penciclovir.
Famciclovir is rapidly absorbed following oral administration with an absolute
bioavailability of 77%. Prolonged intracellular half life has also been
demonstrated in cells infecting with HSV-1, HSV-2 and VZV. Thus famciclovir
has been introduced as anti-herpes virus agent with the much improve
pharmacokinetics and bioavailability profile compared to acyclovir.

Mechanism of Action

Famciclovir is very stable within duodenal contents accounting for its

consistently good absorption. It is converted into active metabolite
penciclovir via two steps of enzymatic hydrolysis and oxidation. The first step
occurs in the intestine and results in removal of one ester group. The second
step of deacetylation and oxidation occurs in the liver. Peak serum
concentrations of penciclovir are achieved in one hour of an oral dose.
penciclovir is only 20% protein bound. No significant metabolism occurs and
approximately 60% of an oral dose of famciclovir is secreted in the urine as
unchanged penciclovir. The elimination half life of penciclovir is 2 hours in
healthy adult volunteers and 3 hours in patients with herpes zoster.
However, prolong intracellular half life has been demonstrated in cells
infected with VZV (9-14 hours), HSV-1 (10 hours) and HSV-2 (20 hours).
Reduction in renal function causes linear decrease in drug clearance and
dosage adjustment is needed. Patients with hepatic insufficiency have 44%
reduction in penciclovir mean plasma concentration and prolongation of the
time to mean plasma concentration compare to controls. Famciclovir
availability is not affected by food and may be taken without regarding to
meals. The pharmacokinetics of famciclovir is being evaluated in children.

Clinical Indication

Famciclovir is indicated for treatment herpes zoster infection

(shingles). Treatment should begin as soon as possible and within 72 hours
of the onset of rash. Compared to placebo, famciclovir reduce the time to full
lesion crusting, loss of vesicles, loss of ulcers and loss of crusts. Famciclovir
also shortened the duration of viral shedding in zoster patients.

Famciclovir is used in the treatment of HSV infections including

recurrent herpes labialis, recurrent genital herpes simplex infection in
immunocompetent patients, recurrent and first episode genital herpes. In
HIV infected adult patients with recurrent mucocutaneous herpes simplex
infection, famciclovir 500mg twice a day for 7 days was comparable oral
acyclovir 400mg 5 times daily for 7 days. The safety and efficacy of oral
famciclovir in children is being evaluated in clinical trials.

Dosage and Administration

Dosage administrations are only available for adults at this point.

Famciclovir 500mg orally every 8 hours for 7days is given to treat herpes
zoster infections. For recurrent genital herpes, the dose is 125mg twice daily
for 7 days. An oral suppressive dose of 250mg twice a day for up to one year
has been used for recurrent genital herpes. For recurrent orolabial or genital
herpes in HIV patients, 500mg twice daily for 7 days may be used. The doses
should be adjusted (decreased) in patients with renal impairment.

Side Effects

Famciclovir was well tolerated in adult clinical trials for HSV and VZV
infections. The most common adverse effect was headache, nausea and
diarrhea. Other reported adverse effects are vomiting and abdominal pain.
These reported effects were not serious and were comparable in incidence of
placebo group. No differences in adverse effects were noted between
acyclovir and famciclovir. Famciclovir is not recommended for use during
pregnancy.
Contraindication/ precaution

Famciclovir is contraindicated in patients who are allergic to

famciclovir and penciclovir.

Reactions

Herpes virus has been spreading in all over the world. Many people
had this virus because it transmits via sexual activity, sharing of things from
the others; contaminated needles etc. herpes simplex viruses are mutated as
the years go by so the viruses obtain resistance to some drugs that can treat
herpes. So the doctors developed new antiviral agents for herpes virus to
enhance its effectiveness and block the replication of viruses in the host.

Famciclovir can be intravenous, oral, systemic or topical in form. This

drug has a half life of 10- 20 hours that is why it’s very effective but it has to
be monitored its dosage because of this; it may lead to renal dysfunction.
Some of the adverse effects are said to be less dangerous but we have also
to prevent the dangerous effect like nephrotoxicity. We have to teach the
significant others or the patient that they have to drink lots of water for them
to rehydrate and to decrease the toxic effect in the kidney. Also to treat the
disease easily, the patient must take the full course of drug so that we can
determine the effectiveness of the drug and prevents the emergence of
resistance of the viruses. Monitor always the intake and output of the patient
so that you can determine if the patient developed renal toxicity.

Reference

Book

• Focus on nursing pharmacology, 4th edition by Amy M. Karch

Websites

• http://www.rxlist.com/famvir-drug.htm