Acyclovir During Pregnancy – Is it Safe?

Is It Safe to Take Acyclovir During Pregnancy?

There are certain indications for which acyclovir is given during pregnancy. Acyclovir is an antiviral medication. It is prescribed to the pregnant woman when diagnosed with any maternal viral infections, such as (2)

• Disseminated Herpes simplex, in which the Herpes simplex virus (HSV) is already widespread in the body. 
• Viral pneumonia called Varicella Pneumonia and 
• Primary genital herpes (First outbreak of genital herpes)
• Preventive use in genital herpes during the near term of pregnancy. 
• Chicken pox and shingles

Acyclovir is considered pregnancy Category B by the US FDA, which has no adequate data for using the drug in pregnant women. More than 1% of women are susceptible to the herpes simplex virus in the first trimester, with high chances of recurrence. But most of the studies have inferred that the use of Acyclovir has not increased the chance of any birth defects in the fetus. (3)

The seriousness of these common viral infections like genital herpes and Herpes simplex is that the infection can be transmitted to the neonates if they get into the latter half of their pregnancies.(2a)

If a pregnant woman has a history of herpes, doctors advise taking acyclovir in the last month of pregnancy to prevent herpes recurrences so that it won’t spread to the baby during delivery and reduce the need for C-sections. (4)

 What Is the Dosage of Acyclovir During Pregnancy?

The dose and dosage depend on the condition you are having. Your consulting physician will tell you how much dose, how often, and for how much duration it is needed to take. Mostly,

• Acyclovir is available in tablet, liquid, cream, and ointment forms. Some of the brand names include Zovirax, Acivir,Ocuvir, Herpikind, etc.
• Single doses of 200–800 mg are available. Acyclovir is taken 2–5 times a day, depending on the infection. A single dose of 1000mg has more absorption than the single doses of 200–800 mg.
• For treating a viral infection, it is needed to take at least 5 to 10 days. If it is prescribed for prevention, then it should be taken for a long time, as suggested by the consulting physician.
• Don’t stop taking the medication without finishing the course, as the doctor advised. Otherwise, it may lead to resistance. It is recommended to take lots of water when taking this medication to ensure that the kidneys work well.
• Acyclovir (5%) cream can be used when there are painful blisters or cold sores on the body, especially in and around the oral cavity and in the genital areas in the case of genital herpes. Cream or ointment can be applied as a thin layer 4 to 5 times a day, with even time gaps between each application. Maintain hand hygiene.
• Acyclovir eye ointments are also available to treat infections in the eyes. Wash your hands clean, apply the ointment in the gap between the eyeball and the lower eyelid, and close your eyes for some time for the ointment to dissolve.
• Do not use unclean hands or the tip of the nozzle too close to your eye to prevent secondary infections. Wash your hands before and after the application of eye ointment and use until advised to stop or as per the prescription. (5)

What If You Already Consumed Acyclovir During Pregnancy?

Women having unintended exposure to acyclovir during pregnancy should inform the consulting doctor about the usage, the condition she is prescribed for or if she is using it without a prescription, the dosage, and how long she is taking the medication. The doctor may assess the condition and suggest a treatment plan.

Many studies have suggested that the use of acyclovir in the first trimester was not associated with any major birth defects. (6) It is always advised for pregnant women to present their past medical and medication histories to the doctors. Do not stop or add medications without consulting doctors.

What Are the Possible Side Effects of Using Acyclovir In Pregnancy?

Acyclovir has both some common and serious side effects while being used. (7) Though few side effects are well tolerated, a few adverse effects needs doctors consultation and treatment

The most common type of side effects include:

• Vomiting and diarrhea
• Vision disturbances.
• Agitated behavior
• Dizziness
• Tiredness
• Pain in joints
• Skin sensitivity to sunlight
• Eye irritation in case of acyclovir eye ointments

There are a few serious side effects documented from using Acyclovir that need medical attention and treatment if experienced:

• Decreased urination and blood in urine
• Hives and rashes or blisters on the body
• Difficulty in breathing, swallowing, or speaking
• Hallucinations
• Swelling of different body parts
• Numbness or difficulty moving different body parts, like arms and legs.
• Seizures and chest pain.

There can be any other side effect from the acyclovir, and it should be reported to the doctor if it is prolonged or unusual.

Acyclovir can also have a possible interaction with certain other antiviral medications, medications used for bowel diseases, certain painkillers, probenecids, medications related to osteoporosis treatment, and a few diabetic medications as well(6). Consulting general physicians must make a note of any possible drug interactions and give treatment accordingly.

What Are The Precautions While Taking Acyclovir During Pregnancy?

These are the few general precautions that need to be followed while taking Acyclovir during pregnancy (7). Knowing precautions will always improve the outcome of treatment. There is certain information that needs to be shared with doctors and vice versa.

• Inform your doctor if you have already taken acyclovir previously.
• Please let your doctor know if you got pregnant while using Acyclovir.
• Inform your doctor immediately after the onset of symptoms( such as blisters, cold sores, tingling, rash, or burning) in case of a first-time infection. It is most effective when started within 48 hours of the onset of symptoms.
• Hydrate your body well from time to time to avoid kidney issues.
• If you have Immunity issues or any immunity-related diseases, Electrolyte imbalance due to illness or kidney disease
• Any liver- or nervous system-related diseases
• Inform your doctor if you are allergic to acyclovir or develop any serious side effects while using it.
• Do not discontinue the medication or start the medication without consulting your doctor.
• Finish the intended course completely, even  after the symptoms subside
• If you are given Acyclovir for genital herpes, you should know that herpes can be spread through sexual contact even if you don’t have any blisters or other symptoms, or even if you are taking Acyclovir. Acyclovir cannot prevent the spread of infection through sexual contact.
• Take suggestions from your doctor on how to avoid the spread of infections to your partner and vice versa.

Acyclovir is an antiviral medication used for viral infections such as chicken pox, oral and genital herpes, and varicella pneumonia. Though acyclovir is not recommended in pregnancy, doctors use it as a first-line drug in certain cases when the benefit outweighs the risk. Most of the research confesses that using Acyclovir will not increase the risk of birth defects and is considered safe in the first trimester.  It is used both as a treatment for varicella and herpes viral infections and as a preventive medicine for genital herpes to control the spread of infection to the newborn from the mother during delivery, especially in the last month of pregnancy.  More attention needs to be paid to dose, duration, side effects, interaction with other drugs, and the necessary precautions that must be taken while using Acyclovir.

FAQ’s

1. Who Should Not Take Acyclovir?

Pregnant women who are allergic to acyclovir, have milk protein allergies, have kidney disease, or are in severe dehydrated conditions are not advised to take acyclovir unless suggested by the doctors. It is not advised for immunosuppressed women or pregnant women taking certain drugs that are compatible with acyclovir.

2. Does Acyclovir Cross Placenta?

Yes, Acyclovir crosses the placenta. It can also be found in the cord blood. Acyclovir is unlikely to cause any adverse effects to the newborn exposed to it in utero, as per studies.

References

1. Uses and safety of acyclovir in pregnancy – [https://go.gale.com/ps/i.do id=GALE%7CA14924390&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00943509&p=AONE&sw=w&userGroupName=anon%7E38ed6e96&aty=open-web-entry]
2. ACYCLOVIR THERAPY DURING PREGNANCY – [https://journals.lww.com/greenjournal/abstract/1989/03001/acyclovir_therapy_during_pregnancy.29.aspx]
3. Acyclovir (Zovirax®) / Valacyclovir (Valtrex®) – [https://www.ncbi.nlm.nih.gov/books/NBK582557/]
4. Herpes and Pregnancy – https://www.ashasexualhealth.org/herpes-and-pregnancy/
5. Safety of antiviral medication for the treatment of herpes during pregnancy – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076471/
6. Use of Acyclovir, Valacyclovir, and Famciclovir in the First Trimester of Pregnancy and the Risk of Birth Defects – https://jamanetwork.com/journals/jama/fullarticle/186468
7. Acyclovir – https://medlineplus.gov/druginfo/meds/a681045.html