Famciclovir

Pharmacologic Category

Dosing: Adult

Genital herpes simplex virus infection: Oral: Note: Initiate therapy as soon as possible after diagnosis and within 72 hours of rash onset.

Immunocompetent patients:

Initial episode (off-label use): 250 mg 3 times daily for 7 to 10 days. Note: Treatment can be extended if healing is incomplete after 10 days of therapy (CDC [Workowski 2015]).

Recurrence:

125 mg twice daily for 5 days or 500 mg as a single dose, followed by 250 mg twice daily for 2 days (CDC [Workowski 2015]).

Suppressive therapy: 250 mg twice daily. Note: Duration not established, but efficacy/safety have been demonstrated for 1 year (CDC [Workowski 2015]).

Manufacturer’s labeling: Dosing in the prescribing information may not reflect current clinical practice. 1,000 mg twice daily.

Immunocompromised patients (including patients with HIV):

Initial or recurrent episodes: 500 mg twice daily for 5 to 10 days; extend treatment duration if lesions have not healed completely after 10 days (AST-IDCOP [Lee 2019]; HHS [OI adult 2020]).

Chronic suppressive therapy (eg, for severe and/or frequent recurrences) (off-label use): 500 mg twice daily. Note: Reassess need periodically (eg, annually) (AST-IDCOP [Lee 2019]; HHS [OI adult 2020]).

Herpes labialis/orolabial (cold sores): Oral: Note: Initiate therapy as soon as possible after diagnosis and within 72 hours of rash onset.

Immunocompetent patients:

Recurrent episodes: 1,500 mg as a single dose; initiate therapy at first sign or symptom such as tingling, burning, or itching (initiated within 1 hour in clinical studies).

Immunocompromised patients (including patients with HIV): Treatment: 500 mg twice daily for 5 to 10 days; extend treatment duration if lesions have not healed completely after 10 days (AST-IDCOP [Lee 2019]; HHS [OI adult 2020]).

Herpes zoster (shingles): Oral: Note: Initiate therapy as soon as possible after diagnosis and within 1 week of rash onset or any time before full crusting of lesions.

Immunocompetent patients: 500 mg every 8 hours for 7 days.

Immunocompromised patients (including patients with HIV):

Acute localized dermatomal lesion (off-label use): 500 mg 3 times daily for 7 to 10 days; consider longer duration if lesions heal slowly (AST-IDCOP [Pergam 2019]; HHS [OI adult 2020]).

Extensive cutaneous lesion or visceral involvement (off-label use): Initial therapy with acyclovir IV may be switched to famciclovir 500 mg 3 times daily to complete a 10 to 14 day course, when formation of new lesions has ceased and signs and symptoms of visceral VZV infection are improving (HHS [OI adult 2020]).

Varicella infection (chickenpox) in patients with HIV (uncomplicated cases) (off-label use): Oral: 500 mg 3 times daily for 5 to 7 days (HHS [OI adult 2020]).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

Herpes zoster:

CrCl ≥60 mL/minute: No dosage adjustment necessary.

CrCl 40 to 59 mL/minute: Administer 500 mg every 12 hours

CrCl 20 to 39 mL/minute: Administer 500 mg every 24 hours

CrCl <20 mL/minute: Administer 250 mg every 24 hours

Hemodialysis: Administer 250 mg after each dialysis session.

Recurrent genital herpes: Treatment:

Single-day regimen:

CrCl ≥60 mL/minute: No dosage adjustment necessary.

CrCl 40 to 59 mL/minute: Administer 500 mg every 12 hours for 1 day

CrCl 20 to 39 mL/minute: Administer 500 mg as a single dose

CrCl <20 mL/minute: Administer 250 mg as a single dose

Hemodialysis: Administer 250 mg as a single dose after a dialysis session.

Alternatively the following recommendations have been made (Famvir Canadian product labeling):

CrCl >20 mL/minute/1.73 m2: Administer 125 mg every 12 hours

CrCl <20 mL/minute/1.73 m2: Administer 125 mg every 24 hours

Hemodialysis: Administer 125 mg after each dialysis session.

Recurrent genital herpes: Suppression:

CrCl ≥40 mL/minute: No dosage adjustment necessary.

CrCl 20 to 39 mL/minute: Administer 125 mg every 12 hours

CrCl <20 mL/minute: Administer 125 mg every 24 hours

Hemodialysis: Administer 125 mg after each dialysis session.

Recurrent herpes labialis: Treatment (single-dose regimen):

CrCl ≥60 mL/minute: No dosage adjustment necessary.

CrCl 40 to 59 mL/minute: Administer 750 mg as a single dose

CrCl 20 to 39 mL/minute: Administer 500 mg as a single dose

CrCl <20 mL/minute: Administer 250 mg as a single dose

Hemodialysis: Administer 250 mg as a single dose after a dialysis session.

Recurrent orolabial/genital (mucocutaneous) herpes in patients with HIV:

CrCl ≥40 mL/minute: No dosage adjustment necessary.

CrCl 20 to 39 mL/minute: Administer 500 mg every 24 hours

CrCl <20 mL/minute: Administer 250 mg every 24 hours

Hemodialysis: Administer 250 mg after each dialysis session.

Dosing: Hepatic Impairment: Adult

Mild-to-moderate impairment: No dosage adjustment is necessary

Severe impairment: No dosage adjustment provided in manufacturer’s labeling; has not been studied. However, a 44% decrease in the Cmax of penciclovir (active metabolite) was noted in patients with mild-to-moderate impairment; impaired conversion of famciclovir to penciclovir may affect efficacy.

Dosing: Pediatric

Herpes simplex virus (HSV) genital infection: Limited data available:

Immunocompetent patients:

Initial episode: Children weighing ≥45 kg and Adolescents: Oral: 250 mg 3 times daily for 7 to 10 days (CDC [Workowski 2015]; Redbook [AAP 2015]). Note: Treatment can be extended if healing is incomplete after 10 days of therapy (CDC [Workowski 2015]).

Recurrence: Adolescents: Note: Initiate treatment within 1 day of lesion onset or during the prodrome that precedes some outbreaks (CDC [Workowski 2015]).

One-day regimen: Oral: 1,000 mg twice daily for 1 day

Two-day regimen: Oral: 500 mg once as a single dose, followed 12 hours later by 250 mg twice daily for a total of 2 days

Five-day regimen: Oral: 125 mg twice daily for 5 days

Suppressive therapy: Adolescents: Oral: 250 mg twice daily. Note: Duration not established; efficacy/safety have been demonstrated for 1 year (CDC [Workowski 2015]).

HIV-exposed/-positive patients:

Initial or recurrent episodes: Adolescents: Oral: 500 mg twice daily for 5 to 10 days (HHS [OI adult 2016]). Note: Treatment can be extended if healing is incomplete after 10 days of therapy (CDC [Workowski 2015]).

Chronic suppressive therapy: Adolescents: Oral: 500 mg twice daily; suppressive therapy can be continued indefinitely regardless of CD4 count in patients with severe recurrences of genital herpes or in patients who want to minimize frequency of recurrences, or to reduce the risk of genital ulcer disease in patients with CD4 cell counts <250 cells/mm3 who are starting antiretroviral therapy. However, continuation of therapy should be reviewed annually, particularly if immune reconstitution has occurred (HHS [OI adult 2016]).

Herpes labialis/orolabial (cold sores) in HIV-exposed/-positive patients, treatment: Limited data available: Adolescents: Oral: 500 mg twice daily for 5 to 10 days (HHS [OI adult 2016])

Herpes zoster (shingles) in HIV- exposed/-positive patients, treatment (HHS [OI adult 2016]): Limited data available: Adolescents: Oral:

Acute localized dermatomal lesion: 500 mg 3 times daily for 7 to 10 days; consider longer duration if lesions heal slowly

Extensive cutaneous lesion or visceral involvement: Initial therapy with acyclovir IV may be switched to famciclovir 500 mg 3 times daily to complete a 10- to 14-day course, when formation of new lesions has ceased and signs and symptoms of visceral VZV infection are improving

Varicella infection (chickenpox) in HIV-exposed/-positive patients (uncomplicated cases), treatment: Limited data available: Adolescents: Oral: 500 mg 3 times daily for 5 to 7 days (HHS [OI adult 2016])

Dosing: Renal Impairment: Pediatric

There are no pediatric specific recommendations available; based on experience in adult patients; dosage adjustment suggested.

Dosing: Hepatic Impairment: Pediatric

Mild to moderate impairment: There are no pediatric specific recommendations available; experience in adults suggests no dosage adjustment is necessary.

Severe impairment: There are no dosage adjustments provided in the manufacturer’s labeling; has not been studied. However, a 44% decrease in the Cmax of penciclovir (active metabolite) was noted in patients with mild to moderate impairment; impaired conversion of famciclovir to penciclovir may affect efficacy.

Calculations

Use: Labeled Indications

Treatment of acute herpes zoster (shingles) in immunocompetent patients; treatment and suppression of recurrent episodes of genital herpes in immunocompetent patients; treatment of herpes labialis (cold sores) in immunocompetent patients; treatment of recurrent orolabial/genital (mucocutaneous) herpes simplex in adult patients with HIV.

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

Genital herpes simplex virus infectionLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, famciclovir is an effective and recommended agent for initial and recurrent episodes of genital herpes simplex virus in immunocompetent patients Ref.

Herpes simplex virus chronic suppressive therapy in patients with HIVLevel of Evidence [G]

Based on the US Department of Health and Human Services (HHS) Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV, famciclovir is effective and recommended as chronic suppressive therapy of HSV infections in adolescent and adult patients with HIV Ref.

Herpes zoster (shingles) in patients with HIVLevel of Evidence [G]

Based on the HHS Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV, famciclovir is an effective and recommended agent in the management of acute localized herpes zoster (shingles) in adolescent and adult patients with HIV Ref.

Varicella infection (chickenpox) in patients with HIVLevel of Evidence [G]

Based on the HHS Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV, famciclovir is an effective and recommended agent in the management of uncomplicated cases of varicella infection (chickenpox) in adolescent and adult patients with HIV Ref.

Level of Evidence Definitions

Level of Evidence Scale

Clinical Practice Guidelines

Opportunistic Infections:

HHS, "Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV"

Sexually-Transmitted Disease:

CDC, “Sexually Transmitted Diseases Treatment Guidelines,” June 2015

Public Health Agency of Canada, “Canadian Guidelines on Sexually Transmitted Infections," January 2010

Administration: Oral

May be administered without regard to meals.

Administration: Pediatric

Oral: May be administered without regard to meals

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat or prevent herpes infections.

• It is used to treat cold sores.

• It is used to treat shingles.

• It may be given to you for other reasons. Talk with the doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Headache

• Nausea

• Abdominal pain

• Menstrual pain

• Diarrhea

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Medication Safety Issues

Sound-alike/look-alike issues:

Contraindications

Hypersensitivity to famciclovir, penciclovir, or any component of the formulation

Warnings/Precautions

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required. Acute renal failure has been reported with use of inappropriate high doses in patients with underlying renal disease.

Dosage form specific issues:

• Lactose: Tablets contain lactose; do not use with galactose intolerance, severe lactase deficiency, or glucose-galactose malabsorption syndromes.

Other warnings/precautions:

• Appropriate use: Has not been established for use in initial episodes of genital herpes, recurrent episodes of genital herpes in Black and African-American patients, patients with ophthalmic or disseminated zoster, immunocompromised patients (except patients with HIV with orolabial or genital herpes).

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

For herpes zoster (shingles) infections, famciclovir should be started within 72 hours of the appearance of the rash to be effective. Famciclovir has been shown to accelerate healing, reduce the duration of viral shedding, and resolve posthepatic neuralgia faster than placebo. Adjust dose for estimated renal function.

Pregnancy Considerations

Based on available data, use during pregnancy appears to be well tolerated; however, other agents are preferred when treatment is needed (CDC [Workowski 2015]; Werner 2017).

Health care providers are encouraged to enroll women exposed to famciclovir during pregnancy in the Famvir Pregnancy reporting system (888-669-6682).

Breast-Feeding Considerations

It is not known if famciclovir is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. If herpes lesions are on breast, breastfeeding should be avoided in order to avoid transmission to infant (AAP 2012).

Briggs' Drugs in Pregnancy & Lactation

Famciclovir

Adverse Reactions

Frequencies vary with dose and duration.

>10%:

Central nervous system: Headache (9% to 23%)

Gastrointestinal: Nausea (11% to 13%)

1% to 10%:

Central nervous system: Fatigue (≤5%), migraine (≤3%), paresthesia (≤3%)

Dermatologic: Pruritus (2% to 4%), skin rash (3%)

Gastrointestinal: Diarrhea (2% to 8%), flatulence (≤5%), vomiting (≤5%)

Genitourinary: Dysmenorrhea (≤8%)

Hematologic & oncologic: Neutropenia (3%), leukopenia (1%)

Hepatic: Increased serum ALT (3%), increased serum AST (2%), increased serum bilirubin (2%)

<1%, postmarketing, and/or case reports: Abnormal hepatic function tests, anaphylactic shock, anaphylaxis, anemia, angioedema (eyelid edema, facial edema, periorbital edema, pharyngeal edema), cholestatic jaundice, confusion, delirium, disorientation, dizziness, drowsiness, erythema multiforme, hallucination, hypersensitivity angiitis, palpitations, seizure, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, urticaria

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

Antiviral Acyclic Guanine Derivative Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Cladribine: Agents that Undergo Intracellular Phosphorylation may diminish the therapeutic effect of Cladribine. Risk X: Avoid combination

Talimogene Laherparepvec: Antiherpetic Antivirals may diminish the therapeutic effect of Talimogene Laherparepvec. Risk C: Monitor therapy

Varicella Virus Vaccine: Famciclovir may diminish the therapeutic effect of Varicella Virus Vaccine. Management: When possible, avoid use of famciclovir within the 24 hours prior to administration of the varicella vaccine, and avoid use of famciclovir for 14 days after vaccination. Risk X: Avoid combination

Zoster Vaccine (Live/Attenuated): Famciclovir may diminish the therapeutic effect of Zoster Vaccine (Live/Attenuated). Risk X: Avoid combination

Food Interactions

Rate of absorption and/or conversion to penciclovir and peak concentration are reduced with food, but bioavailability is not affected. Management: Administer without regard to meals.

Monitoring Parameters

Periodic CBC during long-term therapy; renal function

Advanced Practitioners Physical Assessment/Monitoring

Obtain periodic CBC during long-term therapy. Assess renal function prior to initiation; dosage adjustment may be needed.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Famvir: 125 mg [DSC], 250 mg [DSC], 500 mg [DSC]

Generic: 125 mg, 250 mg, 500 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Famvir: 125 mg, 250 mg, 500 mg

Generic: 125 mg, 250 mg, 500 mg

Anatomic Therapeutic Chemical (ATC) Classification

J05AB09
S01AD07

Generic Available (US)

Yes

Pricing: US

Tablets (Famciclovir Oral)

125 mg (per each): $5.81 - $6.39

250 mg (per each): $6.32 - $6.95

500 mg (per each): $12.69 - $13.95

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Famciclovir undergoes rapid biotransformation to the active compound, penciclovir (prodrug), which is phosphorylated by viral thymidine kinase in HSV-1, HSV-2, and VZV-infected cells to a monophosphate form; this is then converted to penciclovir triphosphate and competes with deoxyguanosine triphosphate to inhibit HSV-2 polymerase, therefore, herpes viral DNA synthesis/replication is selectively inhibited.

Pharmacodynamics/Kinetics

Absorption: Food decreases maximum peak penciclovir concentration and delays time to penciclovir peak; AUC remains the same

Distribution: Vd: Healthy adults: Penciclovir: 1.08 ± 0.17 L/kg

Protein binding: Penciclovir: <20%

Metabolism: Famciclovir is rapidly deacetylated and oxidized to penciclovir (active prodrug); in vitro data demonstrate that metabolism does not occur via CYP isoenzymes

Bioavailability: Penciclovir: 77% ± 8%

Half-life elimination:

Penciclovir: 2 to 4 hours; Prolonged in renal impairment:

CrCl 40 to 59 mL/minute: ~3.4 hours

CrCl 20 to 39 mL/minute: ~6.2 hours,

CrCl <20 mL/minute: ~13.4 hours

Intracellular penciclovir triphosphate: HSV 1: 10 hours; HSV 2: 20 hours; VZV: 7 hours

Time to peak: Penciclovir: ~1 hour

Excretion: Urine (73% primarily as penciclovir); feces (27%)

Pharmacodynamics/Kinetics: Additional Considerations

Renal function impairment: With CrCl 40 to 59 mL/minute, clearance is approximately 13 L/hour; CrCl 20 to 39 mL/minute, clearance is about approximately 4.2 L/hour; CrCl less than 20 mL/minute, clearance is approximately 1.6 L/hour.

Hepatic function impairment: Penciclovir Cmax decreased 44% and Tmax increased 0.75 hours in patients with hepatic impairment.

Geriatric: Mean penciclovir AUC was 40% higher, and penciclovir renal clearance was 22% lower in elderly volunteers.

Gender: AUC of penciclovir was approximately 9.3 mcg•h/mL and 11.1 mcg•h/mL in male and female volunteers, respectively, after a single 500 mg dose. Penciclovir renal clearance was 28.5 L/h and 21.8 L/h, respectively.

Dental Use

Management of acute herpes zoster (shingles); treatment of recurrent herpes labialis in immunocompetent patients

* See Uses in AHFS Essentials for additional information.

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Dental Usual Dosing

Adults: Oral:

Acute herpes zoster: 500 mg every 8 hours for 7 days (Note: Initiate therapy as soon as possible after diagnosis and within 72 hours of rash onset)

Recurrent herpes labialis (cold sores): 1,500 mg as a single dose; initiate therapy at first sign or symptom such as tingling, burning, or itching (initiated within 1 hour in clinical studies)

Pharmacotherapy Pearls

Most effective for herpes zoster if therapy is initiated within 48 hours of initial lesion. Resistance may occur by alteration of thymidine kinase, resulting in loss of or reduced penciclovir phosphorylation (cross-resistance occurs between acyclovir and famciclovir). When treatment for herpes labialis is initiated within 1 hour of symptom onset, healing time is reduced by ~2 days.

References

Alrabiah FA, Sacks SL. New Antiherpesvirus Agents. Their Targets and Therapeutic Potential. Drugs. 1996; 52(1):17-32.[PubMed 8799682]

American Academy of Pediatrics (AAP). In: Kimberlin DW, Brady MT, Jackson MA, Long SA, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. American Academy of Pediatrics; 2015.

American Academy of Pediatrics (AAP) Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.[PubMed 22371471 ]

Boike SC, Pue MA, Freed MI. Pharmacokinetics of Famciclovir in Subjects With Varying Degrees of Renal Impairment. Clin Pharmacol Ther. 1994;55(4):418-426.[PubMed 8162668]

Boyd MR, Safrin S, Kern ER. Penciclovir: A Review of Its Spectrum of Activity, Selectivity, and Cross Resistance Pattern. Antivir Chem Chemother. 1993;4:3-11.

Daniels S, Schentag JJ. Drug Interaction Studies and Safety of Famciclovir in Healthy Volunteers: A Review. Antivir Chem Chemother. 1993;4:57-64.

De Clercq E. Antivirals for the Treatment of Herpesvirus Infections. J Antimicrob Chemother. 1993;32(suppl A):121-132.[PubMed 8407694]

DHHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. November 2013. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf.

Famvir (famciclovir) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; April 2013.

Famvir (famciclovir) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; December 2018.

Famvir (famciclovir) [product monograph]. Boucherville, Quebec, Canada: Sandoz Canada Inc; February 2020.

Gill KS, Wood MJ. The Clinical Pharmacokinetics of Famciclovir. Clin Pharmacokinet. 1996;31(1):1-8.[PubMed 8827396]

Goffin E, Horsmans Y, Pirson Y, et al. Acute Necrotico-Hemorrhagic Pancreatitis After Famciclovir Prescription. Transplantation. 1995;59(8):1218-1219.[PubMed 7537399]

Hodge RA. Famciclovir and Penciclovir: The Mode of Action of Famciclovir Including Its Conversion to Penciclovir. Antivir Chem Chemother. 1993;4:67-84.

Lee DH, Zuckerman RA; AST Infectious Diseases Community of Practice. Herpes simplex virus infections in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13526. doi:10.1111/ctr.13526[PubMed 30859647]

Luber AD and Flaherty JF Jr, “Famciclovir for Treatment of Herpesvirus Infections,” Ann Pharmacother, 1996, 30(9):978-85.[PubMed 8876860]

Pasternak B, Hviid A. Use of Acyclovir, Valacyclovir, and Famciclovir in the First Trimester of Pregnancy and the Risk of Birth Defects. JAMA. 2010;304(8):859-866.[PubMed 20736469]

Pergam SA, Limaye AP; AST Infectious Diseases Community of Practice. Varicella zoster virus in solid organ transplantation: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13622. doi:10.1111/ctr.13622[PubMed 31162727]

Perry CM, Wagstaff AJ. Famciclovir. A Review of Its Pharmacological Properties and Therapeutic Efficacy in Herpesvirus Infections. Drugs. 1995;50(2):396-415.[PubMed 8521764]

Pue MA, Benet LZ. Pharmacokinetics of Famciclovir in Man. Antivir Chem Chemother. 1993;4(suppl 1):47-55.

Sacks SL. Genital Herpes Simplex Virus and Its Treatment Focus on Famciclovir. Semin Dermatol. 1996;15(2)(suppl 1):32-36.[PubMed 8840414]

Spruance SL, Bodsworth N, Resnick H, et al, “Single-Dose, Patient-Initiated Famciclovir: A Randomized, Double-Blind, Placebo-Controlled Trial for Episodic Treatment of Herpes Labialis,” J Am Acad Dermatol, 2006, 55(1):47-53.[PubMed 16781291]

Tyring SK, Barbarash RA, Nahlik JE, et al. Famciclovir for the Treatment of Acute Herpes Zoster: Effects on Acute Disease and Postherpetic Neuralgia. Ann Intern Med. 1995;123(2):89-96.[PubMed 7778840]

Tyring SK. Efficacy of Famciclovir in the Treatment of Herpes Zoster. Semin Dermatol. 1996;15(2)(suppl 1):27-31.[PubMed 8840413]

US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed November 11, 2016.

Werner RN, Nikkels AF, Marinović B, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), part 2: treatment. J Eur Acad Dermatol Venereol. 2017;31(1):20-29. doi: 10.1111/jdv.13957.[PubMed 27579792]

Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137.[PubMed 26042815 ]

Brand Names: International

Bencavir (LU); Ezovir (AU); Famcicool (KR); Famcino (VN); Famcir (KR); Famcler (KR); Famcro (KR); Famicle (KR); Famtrex (IN); Famvir (AE, AT, AU, BB, BE, BF, BG, BH, BJ, BM, BS, BZ, CH, CI, CY, CZ, DE, DK, EE, ES, ET, FI, GB, GH, GM, GN, GR, GY, HK, HN, HR, HU, ID, IE, IL, IS, IT, JM, JO, JP, KE, KR, KW, LR, LU, MA, ML, MR, MT, MU, MW, NE, NG, NL, NO, NZ, PK, PL, PT, QA, RU, SA, SC, SD, SE, SK, SL, SN, SR, TH, TN, TR, TT, TW, TZ, UA, UG, ZA, ZM, ZW); Fanle (CN); Favic (AU); Fenalabial (IE); Herfam (KR); Oravir (FR); Rivofam (LB); Vectavir (LU); Zosfam (KR)

Last Updated 9/4/20

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