Pharrax Uses

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Pharrax indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
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Oral

Primary herpes simplex infections

Adult: 200 mg 5 times daily, usually 4 hrly while awake for 5-10 days. Severely immunocompromised patients: 400 mg 5 times daily for 5 days.

Child: <2 yr Half usual adult dose; ≥2 yr Same as adult dose.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10200 mg 12 hrly.

Oral

Suppression of recurrent herpes simplex

Adult: 800 mg daily in 2-4 divided doses, may reduce to 400-600 mg daily. Treatment is interrupted every 6-12 mth to re-assess condition. Episodic treatment for mild or infrequent recurrences: 200 mg 5 times daily for 5 days, preferably begun during the prodromal period.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10200 mg 12 hrly.

Oral

Prophylaxis of herpes simplex in immunocompromised patients

Adult: 200-400 mg 4 times daily.

Child: <2 yr Half usual adult dose; ≥2 yr Same as adult dose.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10200 mg 12 hrly.

Oral

Varicella zoster

Adult: 800 mg 4 or 5 times daily for 5-7 days.

Child: >2 yr 20 mg/kg (up to max of 800 mg), 4 times daily for 5 days.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10800 mg 12 hrly.
10-25800 mg 8 hrly.

Oral

Herpes zoster (shingles)

Adult: 800 mg 5 times daily for 7-10 days.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10800 mg 12 hrly.
10-25800 mg 8 hrly.

Buccal

Recurrent herpes labialis

Adult: Apply 1 tab (50 mg) as a single dose to the upper gum region w/in 1 hr of onset of prodromal symptoms. Allow the tab to gradually dissolve; do not crush, suck, chew or swallow.

Intravenous

Herpes simplex encephalitis

Adult: 10 mg/kg 8 hrly for 10 days. Dose to be given as IV infusion over 1 hr.

Child: >3 mth to 12 yr 500 mg/m2 8 hrly for 5-10 days. Dose to be given as IV infusion over 1 hr.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10 and patient on peritoneal dialysisHalf the usual dose once daily.
<10 and patient on haemodialysisHalf the usual dose once daily then, additional half-dose after haemodialysis.
10-24Increase dose interval to 24 hr.
25-50Increase dose interval to 12 hr.

Reconstitution: Add 10 mL or 20 mL of sterile water for inj to a vial labeled as containing 500 mg or 1,000 mg of Pharrax, respectively, to provide a soln containing 50 mg/mL. The appropriate dose of reconstituted soln should then be withdrawn from the vial and diluted w/ 50-125 mL of a compatible IV infusion soln.

Incompatibility: Blood products and protein-containing soln. Y-site: Amifostine, amsacrine, aztreonam, caffeine citrate, cefepime, ciclosporin, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondansetron, pantoprazole, piperacillin/tazobactam, sargramostim, TrophAmine®, vinorelbine.

Intravenous

Neonatal herpes simplex virus infections

Child: 0-3 mth 10 mg/kg every 8 hr for 10 days. Dose to be given as IV infusion over 1 hr.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10 and patient on peritoneal dialysisHalf the usual dose once daily.
<10 and patient on haemodialysisHalf the usual dose once daily then, additional half-dose after haemodialysis.
10-24Increase dose interval to 24 hr.
25-50Increase dose interval to 12 hr.

Reconstitution: Add 10 mL or 20 mL of sterile water for inj to a vial labeled as containing 500 mg or 1,000 mg of Pharrax, respectively, to provide a soln containing 50 mg/mL. The appropriate dose of reconstituted soln should then be withdrawn from the vial and diluted w/ 50-125 mL of a compatible IV infusion soln.

Incompatibility: Blood products and protein-containing soln. Y-site: Amifostine, amsacrine, aztreonam, caffeine citrate, cefepime, ciclosporin, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondansetron, pantoprazole, piperacillin/tazobactam, sargramostim, TrophAmine®, vinorelbine.

Intravenous

Varicella zoster

Adult: 5 mg/kg 8 hrly. Immunocompromised patients: 10 mg/kg 8 hrly. Dose to be given as IV infusion over 1 hr.

Child: >3 mth to 12 yr 250 mg/m2 8 hrly for 5-10 days. Immunocompromised patients: 500 mg/m2 8 hrly for 5-10 days. Dose to be given as IV infusion over 1 hr.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10 and patient on peritoneal dialysisHalf the usual dose once daily.
<10 and patient on haemodialysisHalf the usual dose once daily then, additional half-dose after haemodialysis.
10-24Increase dose interval to 24 hr.
25-50Increase dose interval to 12 hr.

Reconstitution: Add 10 mL or 20 mL of sterile water for inj to a vial labeled as containing 500 mg or 1,000 mg of Pharrax, respectively, to provide a soln containing 50 mg/mL. The appropriate dose of reconstituted soln should then be withdrawn from the vial and diluted w/ 50-125 mL of a compatible IV infusion soln.

Incompatibility: Blood products and protein-containing soln. Y-site: Amifostine, amsacrine, aztreonam, caffeine citrate, cefepime, ciclosporin, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondansetron, pantoprazole, piperacillin/tazobactam, sargramostim, TrophAmine®, vinorelbine.

Intravenous

1st episodes of genital herpes

Adult: 5 mg/kg 8 hrly for 5-7 days. Dose to be given as IV infusion over 1 hr.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10 and patient on peritoneal dialysisHalf the usual dose once daily.
<10 and patient on haemodialysisHalf the usual dose once daily then, additional half-dose after haemodialysis.
10-24Increase dose interval to 24 hr.
25-50Increase dose interval to 12 hr.

Reconstitution: Add 10 mL or 20 mL of sterile water for inj to a vial labeled as containing 500 mg or 1,000 mg of Pharrax, respectively, to provide a soln containing 50 mg/mL. The appropriate dose of reconstituted soln should then be withdrawn from the vial and diluted w/ 50-125 mL of a compatible IV infusion soln.

Incompatibility: Blood products and protein-containing soln. Y-site: Amifostine, amsacrine, aztreonam, caffeine citrate, cefepime, ciclosporin, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondansetron, pantoprazole, piperacillin/tazobactam, sargramostim, TrophAmine®, vinorelbine.

Intravenous

Prophylaxis of herpes simplex in immunocompromised patients

Adult: 5 mg/kg 8 hrly for 5-7 days. Dose to be given as IV infusion over 1 hr.

Child: >3 mth to 12 yr 250 mg/m2 8 hrly for 5-10 days. Dose to be given as IV infusion over 1 hr.

Renal impairment:

CrCl (ml/min)Dosage Recommendation
<10 and patient on peritoneal dialysisHalf the usual dose once daily.
<10 and patient on haemodialysisHalf the usual dose once daily then, additional half-dose after haemodialysis.
10-24Increase dose interval to 24 hr.
25-50Increase dose interval to 12 hr.

Reconstitution: Add 10 mL or 20 mL of sterile water for inj to a vial labeled as containing 500 mg or 1,000 mg of Pharrax, respectively, to provide a soln containing 50 mg/mL. The appropriate dose of reconstituted soln should then be withdrawn from the vial and diluted w/ 50-125 mL of a compatible IV infusion soln.

Incompatibility: Blood products and protein-containing soln. Y-site: Amifostine, amsacrine, aztreonam, caffeine citrate, cefepime, ciclosporin, dobutamine, dopamine, fludarabine, foscarnet, gemcitabine, idarubicin, levofloxacin, ondansetron, pantoprazole, piperacillin/tazobactam, sargramostim, TrophAmine®, vinorelbine.

Ophthalmic

Herpes simplex keratitis

Adult: As 3% oint: Apply inside the lower conjunctival sac 5 times daily at approx 4 hrly intervals. Continue treatment for at least 3 days after healing is complete.

Topical/Cutaneous

Herpes simplex infections of skin

Adult: As 5% oint/cream: Apply 5 or 6 times daily for 5-10 days, preferably beginning in the prodromal period.

Special Populations: Critically ill patients receiving renal replacement therapy: Continuous venovenous haemofiltration (CVVH): 5-10 mg/kg 24 hrly. Continuous venovenous haemodialysis (CVVHD) or haemodiafiltration (CVVHDF): 5-10 mg/kg 12-24 hrly.

Pharrax description

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A guanosine analog antiviral drug that acts as an antimetabolite. Pharrax is used for the treatment of herpes simplex virus infections, varicella zoster (chickenpox) and herpes zoster (shingles). Pharrax has also been investigated for the treatment of herpes labialis applied using an iontophoretic device. Currently approved drugs for the treatment of herpes labialis (cold sores) exhibit low levels of efficacy due to the limited ability of the drugs to penetrate the skin to the site where the herpes virus is replicating. Iontophoresis uses electric current to enhance the delivery of drugs through the skin.

Pharrax dosage

Adults: Treatment of Herpes Simplex Infections: 200 mg should be taken 5 times daily at approximately 4-hr intervals omitting the night time dose. Treatment should continue for 5 days, but in severe initial infections this may have to be extended.

In severely immunocompromised patients (eg, after marrow transplant) or in patients with impaired absorption from the gut, the dose can be doubled to 400 mg or alternatively IV dosing could be considered.

Dosing should begin as early as possible after the start of an infection. For recurrent episodes, this should preferably be during the prodromal period when lesions first appear.

Suppression of Herpes Simplex Infections in Immunocompetent Patients: 200 mg should be taken 4 times daily at approximately 6-hr intervals.

Many patients may be conveniently managed on a regimen of 400 mg twice daily at approximately 12-hr intervals.

Dosage titration down to 200 mg taken thrice daily at approximately 8-hr intervals or even twice daily at approximately 12-hr intervals, may prove effective.

Therapy should be interrupted periodically at intervals of 6-12 months in order to observe possible changes in the natural history of the disease.

Prophylaxis of Herpes Simplex Infections in Immunocompromised Patients: 200 mg should be taken 4 times daily at approximately 6-hr intervals.

In severely immunocompromised patients (eg, after marrow transplant) or in patients with impaired absorption from the gut, the dose can be doubled to 400 mg or alternatively IV dosing could be considered.

The duration of prophylactic administration is determined by the duration of the period at risk.

Treatment of Herpes Zoster Infections: 800 mg tablets should be taken 5 times daily at approximately 4-hr intervals omitting the night time dose. Treatment should continue for 7 days.

In severely immunocompromised patients or in patients with impaired absorption from the gut, consideration should be given to IV dosing.

Dosing should begin as early as possible after the start of an infection; treatment yields better results if initiated as a soon as possible after rash onset.

Children >2 years: Treatment of Herpes Simplex Infections and Prophylaxis of Herpes Simplex Infections: Should be given adult dosages, <2 years should be given ½ the adult dose of Pharrax tablet.

Treatment of Chicken Pox in Children up to 2 years: Pharrax tablet is administered 20 mg/kg on the basis of body weight 4 times daily for 5 days. Dosing should begin as early as possible after the start of a chicken pox rash, treatment yields better results if initiated within 24 hrs after rash onset.

Patients with Renal Impairment: Treatment of Herpes Simplex Infections: In the management of herpes simplex infections in patients with impaired renal function, the recommended oral doses will not lead to accumulation of Pharrax tablets above levels that have been established by IV infusion.

For patients with severe renal impairment (CrCl <10 mL/min) of an adjustment of dosage to Pharrax 200 mg tablets twice daily at approximately 12-hr intervals is recommended.

Treatment of Herpes Zoster Infections: For patients with severe renal impairment (CrCl <10 mL/min) an adjustment of dosage to Pharrax 800 mg tab 3-4 times daily at approximately 6-8 hrs intervals is recommended.

Elderly: In elderly, total Pharrax body clearance declines in parallel with CrCl. Adequate hydration of elderly patients taking high oral doses of Pharrax tablets should be maintained.

Special attention should be given to dosage reduction in elderly patients with impaired renal function.

Pharrax interactions

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Probenecid increases the Pharrax mean t½ and area under the plasma concentration curve. Other drugs affecting renal physiology could potentially influence the pharmacokinetics of Pharrax.

Pharrax side effects

Herpes simplex:

Short term administration: the most frequent adverse events reported with Pharrax 200 mg administered orally 5 times daily every 4 hours for 10 days were nausea and/or vomiting.

Long term administration: the most frequent adverse events reported in a clinical trial for the prevention of recurrences with continuous administration of 400 mg 2 times daily for 1 year were nausea (4.8%) and diarrhea (2.4%).

Herpes zoster: the most frequent adverse event reported with 800 mg of oral Pharrax 5 times daily for 7 to 10 days in 323 patients was malaise (11.5%).

Chickenpox: the most frequent adverse event reported with oral Pharrax at doses of 10 to 20 mg/kg 4 times daily for 5 to 7 days was diarrhea (3.2%).

Observed during clinical practice: in addition to adverse events reported from clinical trials, the following events have been identified during post-approval use of Pharrax.

General: anaphylaxis, angioedema, fever, headache, pain, peripheral edema.

Nervous: aggressive behavior, agitation, ataxia, coma, confusion, decreased consciousness, delirium, dizziness, encephalopathy, hallucinations, paresthesia, psychosis, seizure, somnolence, tremors. These symptoms may be marked, particularly in older adults or in patients with renal impairment.

Digestive: diarrhea, gastrointestinal distress, nausea.

Hematologic and lymphatic: anemia, leukocytoclastic vasculitis, leukopenia, lymphadenopathy, thrombocytopenia.

Hepatobiliary tract and pancreas: elevated liver function tests, hepatitis, hyperbilirubinemia, jaundice.

Musculoskeletal: myalgia.

Skin: alopecia, erythema multiforme, photosensitive rash, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.

Skin: alopecia, erythema multiforme, photosensitive rash, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.

Urogenital: renal failure, elevated blood urea nitrogen, elevated creatinine, hematuria.

Pharrax contraindications

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Pharrax Lotion is contraindicated for premature neonates because their skin may be more permeable than full term infants and their liver enzymes may not be sufficiently developed. It is also contraindicated for patients with Norwegian (crusted) scabies due to possible increased absorption. It is also contraindicated for patients with known seizure disorders and for individuals with a known sensitivity to the product or any of its components.

Active ingredient matches for Pharrax:

Aciclovir in Japan.


List of Pharrax substitutes (brand and generic names)

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Unit description / dosage (Manufacturer)Price, USD
Pharmaniaga Aciclovir Tablet tab 400 mg 5 x 10's (Pharmaniaga Manufacturing Berhad)
Polisu 50 mg/1 g x 1 g
Polisu 50 mg/1 g x 5 g
Polisu 50 mg/1 g x 10 g
Polisu 50 mg/1 g x 450 g
Poviral Metronidazole 1%, PovidoneIodine 5%, Dexpanthol 5% CREAM / 15gm (Roemmers)$ 0.76
Poviral 200 mg x 30's (Roemmers)
Poviral 400 mg x 30's (Roemmers)$ 7.44
Tablets; Oral; Acyclovir 200 mg (Roemmers)
Tablets; Oral; Acyclovir 400 mg (Roemmers)
400 mg x 50's (Psycorem)$ 11.11
800 mg x 30's (Psycorem)$ 11.43
Psyvir 400mg TAB / 50 (Psycorem)$ 11.11
Psyvir 800mg TAB / 30 (Psycorem)$ 11.43
PSYVIR 400MG TABLET 1 strip / 10 tablets each (Psycorem)$ 2.19
PSYVIR 5% CREAM 1 tube / 5 GM cream each (Psycorem)$ 1.09
PSYVIR 800MG TABLET 1 strip / 6 tablets each (Psycorem)$ 2.25
PSYVIR tab 400 mg x 10's (Psycorem)$ 2.22
PSYVIR tab 800 mg x 6's (Psycorem)$ 2.29
Psyvir 400mg TAB / 50 (Psycorem)$ 11.11
Psyvir 800mg TAB / 30 (Psycorem)$ 11.43
Psyvir 400mg Tablet (Psycorem)$ 0.22
Psyvir 800mg Tablet (Psycorem)$ 0.38
Psyvir 5% 5% w/w CRM / 5g (Psycorem)$ 1.11
5 % w/w x 5g (Psycorem)$ 1.11
PSYVIR 5% cream 5 % w/w x 5g (Psycorem)$ 1.11
Psyvir 5% Cream (Psycorem)$ 1.09
Qualiclovir 200 mg x 1, 000's (Quality)$ 580.00
Qualiclovir 400 mg x 1, 000's (Quality)$ 1080.00
Qualiclovir Cream 5 % x 500 g$ 360.00
Ranvir 200 mg x 10 x 5's (Ranbaxy)
Ranvir 800 mg x 10 x 5's (Ranbaxy)
Ranvir tab 200 mg 10 x 5's (Ranbaxy)
Ranvir tab 800 mg 10 x 5's (Ranbaxy)
Tablet; Oral; Acyclovir 200 mg
Tablet; Oral; Acyclovir 400 mg
Tablet; Oral; Acyclovir 800 mg

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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