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Acyclovir Injection

[08 May 2014]

Products Affected - Description

Acyclovir lyophilized powder for injection, Bedford Laboratories
1 g vial (NDC 55390-0613-20)

Acyclovir lyophilized powder for injection, Fresenius Kabi (formerly APP)
500 mg vial (NDC 63323-0105-10)

Reason for the Shortage

  • Fresenius Kabi (formerly APP) is not manufacturing acyclovir lyophilized powder to concentrate on supplying the solution for injection.1
  • Ben Venue has stopped production in its plant in Bedford, Ohio and will close in early 2014. Ben Venue supplies multiple sterile injectable products for Bedford Laboratories. Supplies of product that has already been manufactured will continue to be released until inventory is depleted. Bedford Laboratories has a small number of products manufactured elsewhere that are not affected by this closure.2 
  • AuroMedics introduced acyclovir injection in February 2014.3

Available Products

Acyclovir 50 mg/mL solution for injection, AuroMedics
10 mL vial (NDC 55150-0154-10)
20 mL vial (NDC 55150-0155-20)
 
Acyclovir lyophilized powder for injection, Bedford Laboratories
500 mg vial (NDC 55390-0612-10)
 
Acyclovir 50 mg/mL solution for injection, Fresenius Kabi (formerly APP)
10 mL vial (NDC 63323-0325-10)
20 mL vial (NDC 63323-0325-20)

Estimated Resupply Dates

  • Fresenius Kabi (formerly APP) has acyclovir lyophilized powder on long-term back order and the company cannot estimate a release date.1
  • Bedford has acyclovir lyophilized powder for injection 1 gram vials on back order and the company cannot estimate a release date. Ben Venue manufactured acyclovir lyophilized powder for Bedford.2

Implications for Patient Care

Acyclovir injection is labeled for treatment of initial and recurrent herpes simplex (mucosal and cutaneous) in immunocompromised patients, herpes simplex encephalitis, neonatal herpes infections, varicella zoster infection in immunocompromised patients, and severe initial episodes of herpes genitalis in immunocompetent patients.4

Alternative Agents & Management

  • There are no alternative manufacturers of acyclovir injection.
  • Conserve use of current supplies of acyclovir injection for patients with herpes simplex encephalitis and neonatal herpes infections.
  • The table lists potential alternatives for acyclovir injection in selected situations. 

Related Shortages

References

  1. Fresenius Kabi (formerly APP). Customer Service (personal communications). January 12, February 9 and 23, March 2, 9, and 31, April 6, 20, and 27, 2009; March 3, 12, and 17, April 5, 20 and 27, May 19, June 30, July 22, August 12 and 27, September 22, October 28, December 1 and 20, 2010; February 4, March 9, April 12 and 29, May 18, July 11 and 26, August 8, September 16, November 8, December 12, 2011; February 8, April 11, May 14, July 9, August 21, October 15, November 5, 2012; January 15, February 11, March 8, April 16, May 30, June 17, August 5, October 22, November 13, 2013; and February 4, 11, and 18 and May 6, 2014.
  2. Bedford Laboratories. Customer Service (website and personal communications). January 12, February 23, March 2, 9, and 31, April 6, and 27, 2009; March 3 and 12, April 5 and 20, May 19, June 30, August 10 and 30, September 10 and 22, October 28, November 24, December 27, 2010; February 8, March 8, April 12, May 2, 11, and 20, June 1, 16, and 29, July 12 and 27, August 10, September 15, November 7 and 21, December 2, 2011; January 9, April 9, May 11, July 3, August 16, October 15, November 5, 2012; January 15, February 11, March 4, April 16, May 30, June 14, August 7, October 21, 2013; January 22, and February 11 and 18, and April 14, 2014.
  3. Auromedics. Customer Service (personal communications). February 21 and May 8, 2014.
  4. Acyclovir injection [product information]. Bedford, OH: Bedford Laboratories; 2005.
  5. Tunkel AR, Glaser CA, Bloch KC, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Aug 1 2008;47(3):303-327.
  6. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, PA: Elsevier; 2005.
  7. Nucleosides and Nucleotides. In: McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH, eds. AHFS 2008 Drug Information. Bethesda, MD: American Society of Health-System Pharmacists; 2008:791-798.
  8. Ziai WC, Lewin JJ, 3rd. Update in the diagnosis and management of central nervous system infections. Neurol Clin. May 2008;26(2):427-468, viii.
  9. Poscher ME. Successful treatment of varicella zoster virus meningoencephalitis in patients with AIDS: report of four cases and review. AIDS. Aug 1994;8(8):1115-1117.
  10. Segal BH, Freifeld AG, Baden LR, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw. Feb 2008;6(2):122-174.
  11. Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. Jan 1 2007;44 Suppl 1:S1-26.
  12. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-
    1406.
  13. American Academy of Pediatrics. Herpes Simplex. In: Pickering L, Baker CJ, Long SS, McMillan JA,. ed. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:361-371.
  14. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94.
  15. Foscavir (foscarnet injection) [product information]. Wilmington, DE: AstraZeneca; 2006 August.
  16. Mandell LA, Bartlett JG, Dowell SF, File TM, Jr., Musher DM, Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. Dec 1 2003;37(11):1405-1433.
  17. Martinez E, de Diego A, Paradis A, Perpina M, Hernandez M. Herpes simplex pneumonia in a young immunocompetent man. Eur Respir J. Jun 1994;7(6):1185-1188.
  18. Suh J, Sepkowitz K. Opportunistic infections in HIV disease. In: Betts R, Chapman SW, Penn RL, ed. Reese and Betts': A Practical Approach to Infectious Diseases. Philadelphia, PA: Lippincott Williams and Wilkins; 2003:649-718.
  19. Weller S, Blum MR, Doucette M, et al. Pharmacokinetics of the acyclovir pro-drug valaciclovir after escalating single- and multiple-dose administration to normal volunteers. Clin Pharmacol Ther. Dec 1993;54(6):595-605.
  20. Mori T, Shimizu T, Yamazaki R, et al. Varicella-zoster virus infection under administration of ganciclovir after allogeneic bone marrow transplantation. Scand J Infect Dis. 2006;38(3):227-228.
  21. Haake DA, Zakowski PC, Haake DL, Bryson YJ. Early treatment with acyclovir for varicella pneumonia in otherwise healthy adults: retrospective controlled study and review. Rev Infect Dis. Sep-Oct 1990;12(5):788-798.

Updated

Updated May 8, 2014, by Jane Chandramouli, PharmD, Drug Information Service. Created February 3, 2009 by Jane Chandramouli, PharmD, Drug Information Specialist. Edited by M. Christina Beckwith, PharmD, Drug Information Specialist. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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