Obat anti virus

Anti herpesvirus

Acyclovir
Famciclovir
Valaciclovir
Ganciclovir
Idoxuridine,trifluridine
Foscarnet,sidofovir,brivudine,fomivirxene

Mechanism of action
Antiviralmonophosphatediphosphate
triphosphate(active form)
Triphosphate incorporated into viral
DNA chain termination stop DNA
synthesis
TP form competitive inhibitor of DNA
polymerase

Acyclovir
Active: acyclovir triphosphate
Ind: HSV-1& HSV-2 incl labial,genital,
neonatal, encephalitis, keratitis, and VZV
SP : pregnancy,lactation,renal function
AR : GI disturb, skin rash, headache,
neurological effect(IV)
DI: probenecid
Dosage: prophylaxis/treatment

 Prophylaxis/immunocompromised patient:
200 mg 4x daily 400 mg
HSV inf: 200mg 5x daily5-10 days
Herpes zoster inf: 5x800mg/day7 days
Herpes encephalitis(IV): 10mg/kg, 3x daily10 days
ResistanceDNA polymerase/thymidine kinase
mutation

Valaciclovir
Ind: zoster, simplex inf of the skin,mucous
membrane,initial/recurrent genital herpes
AR: rarely nausea, headache
SP: pregnancy, lactation, renal failure
Dose: zoster inf3x1gr for 7 days
simplex inf 2x500mg(5-10days)
DI: cimetidine

Famciclovir
Acute herpes zoster and acute genital
herpes infections(HSV-1&2)
CI: pregnancy, lactation
SP: impaired renal function
AR: nausea, headache
Dose: 3x250 mg for 7 days(zoster)

Ganciclovir
Ind: life/sight-threatening CMV infection in
immunocompromised patient(AIDS)
Prevention of CMV inf in patient with
organ transplant
CI: pregnancy, lactation, severe
neutropenia
AR: fever, rash, leucopenia,anemia,
thrombositopenia

 Dose: 5 mg/kg infused 12 hrly 14 days

maintenance: orally 3 gr/day(3x4
caps)

Brivudine
Ind: HSV-1& VZV infection
Inhibiting competitively viral DNA
polimerase & alternative substract.
Mechanism action specific
phosphorylation by timidine kinase HSV-1
and VZV
Dose: 125mg/day(1x) herpes zoster
keratitis&labialis herpetictopical

Sidofovir
Inhibiting viral DNA synthesis by stopping
chain elongation
Active form: sidofovir diphosphate
competitive inhibitor & alternative
substract of viral DNA polymerase
Ind: CMV retinitis in AIDS patients,
acyclovir-resistant HSV, CIN-III,
papillomatosis lesion, m. contagiosum.

 Dose: -IV 5mg/kgBW/ week (2x)

5mg/BW/ 2 week
-Topical: cream, gel 1%

Penggunaan klinis

Asiklovir, valasiklovir dan famciclovir

IV asiklovir
Kehamilan dng H. genitalis asiklovir
R/ suppressive asiklovir
Asiklovir IV h. neonetal, ensefalitis,
imunocompromised patient
Cegah PHN

Antiretrovirus

NRTI(nucleoside RT inhibitor)
NNRTI(non nucleoside RT inhibitor)
NtRTI(nucleotide RT inhibitor) tenofovir
Protease inhibitor(PI)
Entry inhibitor(enfuvirtid)
Integrase inhibitor(raltegravir)

Antiretrovirus

Zidovudine
Lamivudin, emtrisitabin
Stavudine
Didanosine
Abacavir
Tenovovir
Nevirapine, delavirdine, efavirenz,etravirin
Ritonavir, nelfinavir, saquinavir,
amprenavir,lopinavir,indinavir,

zidovudine
Ind: asymptomatic and symptomatic HIV
inf, advanced inf w/ AIDS or AIDS
related complex, CD4< 350/mm3
CI : neutrophil< 750/mm3 or Hb < 7,5 g%
SP: myelosupression, pregnancy, lactation
AR: anemia, netropenia,etc
D : Start with 200 mg/ 4 hrly

Didanosine
Nucleoside Reverse Transcriptase
Inhibitor(NRTI)
Ind: advanced HIV inf (prolonged prior
ZDV therapy)
Resistance: mutation on reverse transcript
AR: diarrhea,pancreatitis, neuropathy
Dose: 400mg daily, single or in divided
doses

Stavudine

Ind : HIV infected patient

AR : headace, neuropathy,SGOT/SGPT
SP: pregnancy, laktation, elderly, renal
Dose: adult > 60 kg 40 mg, < 60 kg 30
mg,
taken 2 times daily
child(< 30 kg) : 2 mg/kg/day

Nevirapine
Ind : HIV-1 inf in combination w/ other
anti retroviral agents, prevention motherto-child HIV transmission in pregnant
women
Dose : prevention 200mg during labour,
neonate: 2 mg/kg within 72 hr
after birth
200 mg14 days, then 2x200 mg
AR: GI effect, skin rash, fatigue, liver!

Other antiviral agents

Lamivudine
Telbivudine
Adefovir
Tenofovir
Interferon/pegylated interferon.
ribavirin
Zanamivir,oseltamivir
Amantadine,rimantadine

lamivudine

Indication: HIV and HBV

Inhibit RT & DNA polimerase activity
SP: liver,renal dis,pregnancy, lactation
AR: headache, GI disturb
Tab 150 mg(3TC) & 100 mg( 3TC-HBV)
Used in combination w/ zidovudine(HIV),
dose: 2x150 mg(adult) ,child: 4 mg/kgbw
DI: trimetoprim

Ribavirin

Ind : RSV(pneumonia), chronic hep C

Inhibits replication of DNA&RNA virus
AR : hemolysis,anemia,rigor
Dose: - RSVaerosol(nebulizer)
20 mg/ml
1,4 mg/kgbw/hour,12-18 hr/day
for 3-7 days
- HEP viral : < 75 kg: 1000 mg/day
> 75 kg: 1200mg/day

Interferon/peginterferon
Ind : chronic hep B and C
Inhibiting RNA transcript, protein synthesis, and
assembly of the virus
AR : fever, headache, fatigue, GI disturb,
alopecia
D : peginterf alfa 2a: 180mcg/wk---- 6-12
mth( + ribavirin for hep C)
peginterf alfa 2b: 1-1,5mcg/kg/wk
6-12 mth(+ ribavirin for hep C)

Penggunaan klinis
Terapi HIV clinical stage/CD4 count
Kombinasi obat(triple): AZT+3TC+NVP,
dT4+3TC+NVP, dll
Kehamilan dng HIV segera terapi
Coinfection HIV1& HIV2 NRTI

Anthelmintic drugs

Piperazine
Pyrantel pamoate
Mebendazole
Albendazole
Tiabendazole
Praziquantel
Diethylcarbamazine

piperazin
Ind: ascariasis & E. vermicularis
Memblokade respon otot cacing thd
asetillolin paralisis
Absorpsi sal cerna baik
ES: ggn sal cerna,alergi, skt kepala,
pusing me kejang pd epilepsi
KI: epilepsi, ggn hati&ginjal

pirantel pamoat

Ind: ascaris, ankilostomiasis, enterobiasis

MK: me frekwensi impuls otot cacing
Kombinasi dng oksantel pamoat
Absorpsi sal cerna tidak baik
ES: sal cerna,demam, skt kepala,ggn hati
SGPT/SGOT
Dose: 10 mg/kgbb single dose

mebendazol
Spektrum antelmintik plg luas
MK: -hambat glucosa uptake pd cacing
- hambat sekresi kolinesterase
- sterilisasi telur cacing
Absorpsi oral buruk
ES: ringan(skt kpla,mual,diare, skt perut)
Dosis: 2x100 mg selama 3 hr/ 500 mg SD

Albendazol
MK: blokade ambilan glukosa cacing
Ind: cutan larv migrans, kremi, gelang,
trikuris, tambang, dan S. stercoralis
Pilihan u/ peny hidatid & sistiserkosis
Dosis: SD 400 mg inf berat: 2-3 hr
Peny hidatid: 800mg/hr 30 hr, diulang
2-3x interval 2 mg
Sistiserkosis: 15mg/kgbb/hr 1 bln

Tiabendazol
Drug of choice: S. stercoralis
Efektif utk cutaneus/visceral larva migrans
Mek kerja: hambat asetilkolinesterase
cacing
Ada efek imunostimulant/restoratif
Efek samping: ringan(anoreksia,mual)
Dosis: 2x25mg/kgbb
Tab 500 dan sirup 100mg/ml

Dietilkarbamazin
Drug of choice u/ filariasis
MK: - me aktivitas otot paralisis
- membranolitik efek
Absorpsi oral baik
ES: skt kpla,pusing,anorexia,malaise, nyeri
sendi, papular rash,demam,batuk, ggn
visus
SP: hipertensi, ggn ginjal, hati, kehamilan

 Dosis: 2mg/kgbb, 3x sehari2 minggu

Prazikuantel
Efektif pd cestoda dan trematoda
MK: vakuolisasi dan vesikulasi tegumen
cacing isi cacing keluar hancur oleh
mek pertahanan tbh hospes
Absorpsi oral baik
ES: skt kepala, pusing, sedasi, fatigue
Schistosomiasis: 30-40mg/kgbb,
Taeniasis: 10 mg/kgbb, dosis tunggal

Indication
Mechanism of action
Presentation/packing
Dose