Famciclovir

Indications
 Oral
Herpes zoster (shingles)
Adult: 250 mg tid or 750 mg once daily for 7 days. In immunocompromised patients, 500 mg tid for 10 days.
Renal impairment: For immunocompromised patients: CrCl >40 ml/min: 500 mg tid; 30-39 ml/min: 250 mg tid; 10-29 ml/min: 125 mg tid.
CrCl (ml/min)Dosage Recommendation
30-59For immunocompetent patients: 250 mg bid.
10-29For immunocompetent patients: 250 mg once daily.

Oral
Acute treatment of recurrent episodes of genital herpes
Adult: 125 mg bid for 5 days. In immunocompromised patients, 500 mg bid for 7 days. Initiate treatment in the prodromal period as soon as the first signs or symptoms appear.
CrCl (ml/min)Dosage Recommendation
10-29For immunocompetent patients: 125 mg once daily.

Oral
Suppression of recurrent episodes of genital herpes
Adult: 250 mg bid. For HIV patients, 500 mg bid. Interrupt treatment at every 6-12 mth intervals to observe for possible changes in the natural history of the disease.
CrCl (ml/min)Dosage Recommendation
>30For immunocompetent patients: 250 mg bid.
10-29For immunocompetent patients: 125 mg bid

Oral
Acute treatment of recurrent mucocutaneous herpes in HIV-infected patients
Adult: 500 mg bid for 7 days.
Renal impairment: Dose reduction may be needed.
Oral
Genital herpes
Adult: For first episodes: 250 mg tid for 5 days. In immunocompromised patients, 500 mg bid for 7 days.
CrCl (ml/min)Dosage Recommendation
30-59For immunocompetent patients: 250 mg bid.
10-29For immunocompetent patients: 250 mg once daily.

Oral
Recurrent herpes labialis
Adult: 1.5 g as a single dose, initiate at 1st sign or symptom such as burning or tingling.

Special Populations: Reduce dose in patients with renal impairment.
Contraindications
 Hypersensitivity. Lactation.
Warnings / Precautions
 Renal impairment. Pregnancy.
Adverse Reactions
 Dizziness, headache, diarrhoea, constipation, nausea, vomiting, hallucinations, confusion, pruritus, abdominal pain, fever.
Drug Interactions
 Increase effect/toxicity of cimetidine, probenecid, theophylline.
See Below for More famciclovir Drug Interactions
Mechanism of Actions
 Famciclovir rapidly undergoes biotransformation to penciclovir, which has inhibitory activity against HSV types 1 (HSV-1) and 2 (HSV-2) varicella-zoster virus (VZV). Thymidine kinase then phosphorylates penciclovir to a monophosphate form, which is then converted to penciclovir triphosphate. This inhibits HSV-2 DNA polymerase by competing with deoxyguanosine triphosphate, thus inhibiting herpes viral DNA synthesis and replication.
Absorption: Rapidly absorbed from the GI tract (oral); peak plasma concentrations after 1 hr. Delayed by the presence of food.
Metabolism: Converted to penciclovir.
Excretion: Via urine (as metabolite and 6-deoxypercrosor); reduced in patients with renal impairment.
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 15-30°C.
ATC Classification
 J05AB09 - famciclovir ; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. Used in the systemic treatment of viral infections.
S01AD07 - famciclovir ; Belongs to the class of antiinfectives, antivirals. Used in the treatment of eye infections.
Storage
 Oral: Store at 15-30°C.
Available As
  • Famciclovir 250 mg
  • Famciclovir 500 mg

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