IV acyclovir drug shortage – Adding ID consult to order approval

Situation:  Injectable Acyclovir is on national drug shortage due to unavailable raw supply causing manufacturing delays.  The shortage is anticipated to last until early 2020 and conservations measures are needed to preserve supply.

Background: At the present time, IV Acyclovir order holds no restrictions and is available for all prescribers to order. The IV formulation should be reserved for severe infections where treatment is concentration-dependent such as HSV or VSV encephalitis, neonatal herpes simplex infections, varicella pneumonia, disseminated herpes simplex viral infection or esophageal herpes simplex infections. Although there are alternative treatments, they are considered to be significantly more toxic and we typically try to avoid such medications if possible.

Assessment: Due to unknown duration of IV acyclovir drug shortage, conservation and proper dosing (especially for obese patients) is imperative to preserve the limited supply. IV acyclovir is the drug of choice for: neonates with proven herpes simplex virus (HSV) disease, pregnant women with HSV or varicella-zoster virus (VZV) infection, and individuals with herpes simplex encephalitis.

Recommendation: During this shortage, we are recommending that IV acyclovir be reserved for patients with severe infections only and Infectious Disease consult will be required, except for the treatment of neonatal/PEDS patients. ID pharmacists will review all orders for IV acyclovir on a daily basis to ensure appropriate dosing and therapy duration (including NICU and PEDS).  As supply information becomes available, Pharmacy will provide status updates on this drug shortage.

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