Generic Name: Penciclovir
Class: Antivirals
VA Class: DE103
Molecular Formula: C10H15N5O3
CAS Number: 39809-25-1
Introduction
Antiviral; acyclic purine nucleoside analog of guanine.1 2 3 5 9 10 11 12 14
Uses for Denavir
Herpes Labialis
Treatment of recurrent herpes labialis (oral and perioral herpes, cold sores, fever blisters) in adults.1 2 6 7 8 20
Efficacy not established in immunocompromised patients or children.1 20
Denavir Dosage and Administration
Administration
Topical Administration
Appy topically to lesions of the lips and surrounding skin as a 1% cream.1 2 7 12 21
Do not apply in or near the eyes since irritation may occur.1 Application to mucous membranes not recommended.1
Dosage
Adults
Herpes Labialis
Topical
Rub 1% cream gently into the affected area every 2 hours while awake (about 9, but at least 6, times daily) for 4 days.1 2 12 Use sufficient quantity to adequately cover all lesions of the lips and surrounding skin.21
Initiate at the earliest sign or symptom (i.e., within 1 hour of the prodrome or appearance of the first lesion) of herpes labialis.1 2 12
Cautions for Denavir
Contraindications
Hypersensitivity to penciclovir or any ingredient in the formulation.1
Warnings/Precautions
Specific Populations
Pregnancy
Category B.1
Lactation
Not known whether distributed into human milk after topical application.1 Penciclovir is distributed into milk in rats following oral administration of famciclovir (the oral prodrug of penciclovir).1 Discontinue nursing or the drug.1
Pediatric Use
Safety and efficacy not established in children <18 years of age.1
Geriatric Use
Adverse effects profile in adults ≥65 years of age is similar to that in younger adults.1
Common Adverse Effects
Headache.1
Denavir Pharmacokinetics
Absorption
Bioavailability
Not appreciably absorbed into systemic circulation following topical application to the skin.1 2 5 7 12
Not detected in plasma or urine of adults following single or repeated application of 1% penciclovir cream at a dosage of 180 mg daily (about 67 times the estimated usual topical dosage).1 2 5 7 12 Systemic absorption not evaluated in children <18 years of age.1
Elimination
Metabolism
Converted in vivo to the pharmacologically active triphosphate metabolite.1 2 5 7 9 10 11 12 13 14
Stability
Storage
Topical
Cream
20°–25°C.1
Actions and SpectrumActions
Converted in vivo to the pharmacologically active triphosphate metabolite.1 2 5 7 9 10 11 12 13 14
Exerts its antiviral effect by interfering with DNA synthesis and inhibiting viral replication.1 2 3 9 12
Active against various Herpesviridae,1 2 5 7 9 10 11 12 13 14 including herpes simplex virus types 1 and 2 (HSV-1 and HSV-2),1 2 3 5 10 12 14 varicella-zoster virus (VZV),2 5 10 12 13 14 and Epstein-Barr virus (EBV).5 9 10 11 Only limited activity in vitro against cytomegalovirus (CMV).5 11
In vitro, penciclovir triphosphate is 10–20 times more stable than acyclovir triphosphate within HSV-infected cells, resulting in more prolonged antiviral activity.2 5 8 9 14
Resistance to penciclovir reported in HSV and VZV.1 4 5 8 12 14 15
Most (but not all) acyclovir-resistant HSV and VZV are cross-resistant to penciclovir.1 4 5 8 12 13 14 15
Advice to Patients
Importance of avoiding contact with eyes.1 If contact with the eye(s) occurs, the affected eye(s) should be washed with large amounts of water; patients should consult a clinician if ocular irritation persists.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of advising patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Cream | 1% | Denavir (with propylene glycol) | Novartis |
Comparative Pricing
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Denavir 1% Cream (NEW AMERICAN THERAPEUTICS): 1/$95.99 or 4/$275.97
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com 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, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions September 2005. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
References
1. Novartis. Denavir (penciclovir) topical cream 1% prescribing information. East Hanover, NJ; 2001 Jan.
2. Spruance SL, Rea TL, Thoming C et al. Penciclovir cream for the treatment of herpes simplex labialis. JAMA. 1997; 277:1374-79. [IDIS 384117] [PubMed 9134943]
3. Wiltink EH. New promising antiviral drugs. Drugs of Today. 1995; 31:273-82.
4. Chatis PA, Crumpacker CS. Resistance of herpesviruses to antiviral drugs. Antimicrob Agents Chemother. 1992; 36:1589-95. [IDIS 299816] [PubMed 1416838]
5. Alrabiah FA, Sacks SL. New antiherpesvirus agents. Drugs. 1996; 52:17-32. [PubMed 8799682]
6. Ackerman B (SmithKline Beecham, Philadelphia, PA): Personal communication; 1997 July 10.
7. Raborn GW for the Penciclovir Topical Collaborative Study Group. Penciclovir cream for recurrent herpes simplex labialis: an effective new treatment. Proceedings of ICAAC New Orleans 1996. Abstract No. H81.
8. Boyd MR, Safrin S, Kern ER. Penciclovir: a review of its spectrum of activity, selectivity and cross-resistance patterns. Antiviral Chem Chemother. 1993; 4(Suppl 1): 3-11.
9. Bacon TH, Boyd MR. Activity of penciclovir against Epstein-Barr virus. Antimicrob Agents Chemother. 1995; 39:1599-1602. [IDIS 350501] [PubMed 7492112]
10. Gnann JW Jr. New antivirals with activity against varicella-zoster virus. Ann Neurol. 1994; 34:S69-72.
11. Kulikowski T. Structure-activity relationships and conformational features of antiherpetic pyrimidine and purine nucleoside analogues: a review. Pharm World Sci. 1994; 16:127-138. [IDIS 331981] [PubMed 8032338]
12. Anon. Topical penciclovir for herpes labialis. Med Lett Drugs Ther. 1997; 39:57-8. [PubMed 9205430]
13. Hasegawa T, Kurokawa M, Yukawa TA et al. Inhibitory action of acyclovir (ACV) and penciclovir (PCV) on plaque formation and partial cross-resistance of ACV-resistant varicella-zoster virus to PCV. Antiviral Res. 1995; 27:271-9. [PubMed 8540749]
14. Safrin S, Phan L. In vitro activity of penciclovir against clinical isolates of acyclovir-resistant and foscarnet-resistant herpes simplex virus. Antimicrob Agents Chemother. 1993; 37:2241-3. [IDIS 320621] [PubMed 8257152]
15. Talarico CL, Phelps WC, Biron KK. Analysis of the thymidine kinase genes from acyclovir-resistant mutants of varicella-zoster virus isolated from patients with AIDS. J Virol. 1993; 67:1024-33. [PubMed 8380452]
16. Centers for Disease Control and Prevention. 1993 Sexually transmitted diseases guidelines. 1993; 42(Suppl RR-14):22-5.
17. Shaw M, King M, Best JM et al. Failure of acyclovir cream in treatment of recurrent herpes labialis. BMJ. 1985; 291:7-9. [IDIS 202407] [PubMed 3926067]
18. Spruance SL, Crumpacker CS, Schnipper LE et al. Early, patient-initiated treatment of herpes labialis with topical 10% acyclovir. Antimicrob Agents Chemother. 1984; 25: 553-5. [IDIS 185372] [PubMed 6732224]
19. Spruance SL, Schnipper LE, Overall JC et al. Treatment of herpes simplex labialis with topical acyclovir in polyethylene glycol. J Infect Dis. 1982; 146:85-90. [IDIS 153489] [PubMed 7045255]
20. FDA summary basis of approval.
21. SmithKline Beecham, Philadelphia, PA: Personal communication.
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