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    Antiviral Drugs: DR Muhammad Sadiq Gul

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    Hasan Ansari
    Antiviral drugs are used to treat viral infections by inhibiting the development of viruses rather than destroying them. There are two main types of antivirals - first generation drugs that are less potent and second generation drugs that are more effective. Some common antiviral drugs used in ophthalmology include trifluridine, acyclovir, valacyclovir, and famciclovir which are used to treat conditions caused by herpes simplex virus and herpes zoster virus like herpetic keratitis. Other antivirals like ganciclovir, foscarnet and cidofovir are used to treat cytomegalovirus retinitis. Antiviral drugs work by different mechanisms of

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    Antiviral Drugs: DR Muhammad Sadiq Gul

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    Hasan Ansari
    120 views21 pages
    Antiviral drugs are used to treat viral infections by inhibiting the development of viruses rather than destroying them. There are two main types of antivirals - first generation drugs that are less potent and second generation drugs that are more effective. Some common antiviral drugs used in ophthalmology include trifluridine, acyclovir, valacyclovir, and famciclovir which are used to treat conditions caused by herpes simplex virus and herpes zoster virus like herpetic keratitis. Other antivirals like ganciclovir, foscarnet and cidofovir are used to treat cytomegalovirus retinitis. Antiviral drugs work by different mechanisms of

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    Antiviral Drugs

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    Antiviral drugs are used to treat viral infections by inhibiting the development of viruses rather than destroying them. There are two main types of antivirals - first generation drugs that are less potent and second generation drugs that are more effective. Some common antiviral drugs used in ophthalmology include trifluridine, acyclovir, valacyclovir, and famciclovir which are used to treat conditions caused by herpes simplex virus and herpes zoster virus like herpetic keratitis. Other antivirals like ganciclovir, foscarnet and cidofovir are used to treat cytomegalovirus retinitis. Antiviral drugs work by different mechanisms of

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    120 views21 pages

    Antiviral Drugs: DR Muhammad Sadiq Gul

    Uploaded by

    Hasan Ansari
    Antiviral drugs are used to treat viral infections by inhibiting the development of viruses rather than destroying them. There are two main types of antivirals - first generation drugs that are less potent and second generation drugs that are more effective. Some common antiviral drugs used in ophthalmology include trifluridine, acyclovir, valacyclovir, and famciclovir which are used to treat conditions caused by herpes simplex virus and herpes zoster virus like herpetic keratitis. Other antivirals like ganciclovir, foscarnet and cidofovir are used to treat cytomegalovirus retinitis. Antiviral drugs work by different mechanisms of

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    © All Rights Reserved
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    Antiviral

    Drugs

    DR MUHAMMAD SADIQ GUL


    Virus
     Smallest living unit
     Nutrition from host
     Difficult to diagnose
     Difficult to treat
    Types of Viruses
    DNA Viruses RNA Viruses
     He r p e s group Picorna viruses
    Herpes Simplex Virus
    Measles
    Herpes Zoster Virus
    Cytomegalo Virus Mumps
     Ad e n o v i r u s e s Rubella
    Va r i o l a & Va c c i n i a
    Human papilloma virus
    Life Cycle
     Adsorption
     Entry
     Uncoating
     Transcription
     Virus component synthesis
    Antiviral Drugs
    • Antiviral drugs are a class of medication used
    specifically for treating viral infections.
    • Like antibiotics for bacteria, specific antivirals
    are used for specific viruses.
    • Unlike most antibiotics, antiviral drugs do not
    destroy their target pathogen; instead they
    inhibit their development.
    Anti Viral drugs

    1 st Generation Drugs 2 n d Generation Drugs


     Acyclovir
     Idoxuridine  Famciclovir
     Vidarabine  Ganciclovir
     Cytarabine  Vabaciclovir
     Trifluorothymidine
     Foscarnet
     Bromo vinyl deoxyuridine
     Interferon
    ACTION SITE
    ANTIVIRAL DRUGS
    • These are more often used locally in the eye.
    • Currently available antiviral agents are virostatic.
    • They are active against DNA viruses; especially herpes simplex virus.
    Antiviral drugs used in ophthalmology can be grouped as below:

    For herpes simplex For Cytomegalo Virus For herpes zoster


    virus infection retinitis virus infection
    • Idoxuridine • Ganciclovir
    • Foscarnet
    • Acyclovir
    • Vidarabine
    • Zidovudin • Famciclovir
    • Trifluridine
    • Non selective • Valaciclovir
    • Acyclovir
    • Interferons • Vidarabine
    • Famciclovir • Immunoglobulins • Sorvudine
    Idoxuridine
    It is a halogenated pyrimidine resembling thymidine.
    Mechanism of action. It inhibits viral metabolism by substituting for
    thymidine in DNA synthesis and thus prevents replication of virus.
    Preparations. It is available as 0.1% eye drops and 0.5% eye
    ointment.
    Indications and doses: Since the intraocular penetration of topically
    applied IDU is very poor, it is not of much value in the treatment of
    chronic stromal herpetic keratitis.
    It is mainly used in acute epithelial herpetic keratitis.
    IDU drops are used one hourly during day and two hourly during
    night and has to be continued till microscopic staining disappears.
    Idoxuridine
    Side-effects
    follicular conjunctivitis,
    lacrimal punctal stenosis and
    irritation with photophobia.
    Contraindications. It is known to inhibit corneal stromal healing,
    hence its use is not advisable during first few weeks after
    keratoplasty.
    Adenine Arobinoside
    It is a purine nucleoside.
    Uses: It has antiviral activity against herpes simplex, cytomegalo,
    vaccinia and zoster viruses.
    It is more potent and less toxic than IDU and is also effective in IDU
    resistant cases.
    It has no cross allergenicity with IDU or TF3 and thus can be used
    with IDU.
    Mechanism of action: It is metabolized to triphosphate form which
    inhibits DNA polymerase and thus the growth of viral DNA is
    arrested.
    Adenine Arobinoside

    Preparations: It is available as 3% ophthalmic ointment.

    Dose: It is used 5 times a day till epithelization occurs and then


    reduced to once or twice daily for 4-5 days to prevent recurrences.

    Side-effects are superificial punctate keratitis and irritation on


    prolonged application.
    Triflurothymidine (TF3)
    • It is a pyrimidine nucleoside.
    • It has the advantage over IDU of higher solubility, greater
    potency, lack of toxicity and allergic reactions. It is also effective
    in IDU-resistant cases.
    • Mechanism of action: It is a DNA inhibitor with same mechanism
    as IDU.
    Preparation: It is available as 1% eye drops.
    • Dose: One drop is instilled 4 hourly. If no improvement occurs in 14
    days, it is better to change to some other antiviral drug.
    • Toxicity: It is least toxic.
    • It may cause mild superficial punctate keratitis on prolonged use.
    Acyclovir (Acycloguanosine)
    It has proved to be an extremely safe and effective agent and
    is effective in most forms of herpes simplex and herpes zoster
    infections.
    Mechanism of action: It inhibits viral DNA, preferentially
    entering the infected cells, with little effect on normal cells.
    It penetrates into deeper layers and thus is very effective in
    stromal keratitis.
    Preparation. It is available as 3 % ophthalmic ointment and
    also as tablet for oral use and injection for intravenous use.
    Acyclovir (Acycloguanosine)
    Indications and doses: (a) Topical 3 % ointment is used 5
    times a day for epithelial as well as stromal herpes simplex
    keratitis
    (b) Oral acyclovir 4 tablets of 200 mg each, 5 times a day for
    5-7 days, may be considered in following situations:
    (i) After penetrating keratoplasty in patients suffering from herpes
    simplex keratitis. (ii) Recalcitrant stromal or uveal disease caused by
    HSV. (iii) To reduce ocular complications of keratitis and uveitis in
    herpes zoster ophthalmicus.
    Side-effects: A few cases show slight punctate epithelial
    keratopathy which ceases once the drug is stopped.
    Valaciclovir
    It is used for treatment of herpes zoster
    ophthalmicus in a dose of 500-700 mg TDS for 7
    days.
    It is as effective as acyclovir in acute disease and
    is more effective in reducing late neuralgia.
    Famciclovir. Its use, dose and affectivity is similar
    to valaciclovir.
    Interferon--(Glycoproteins) These are non-toxic,
    species-specific proteins possessing broad-
    spectrum antiviral activity.
    INDICATIONS DOSE
    Herpes Zoster 30 – 400 million/ml once or
    AIDS related Kaposi’s sarcoma twice a day for 2 weeks

    Immunoglobulins. These preparations may be useful


    in the treatment or prophylaxis of certain viral
    diseases especially in patients with immune
    deficiencies.
    Uses of Anti viral drugs
    • Viral Conjunctivitis

    • Herpetic keratitis

    • Dendritic keratitis

    • Superficial punctate
    keratitis
    Antiviral Agents for Ophthalmic Use
    GENERIC ROUTE OF ADMINISTRATION OCULAR INDICATIONS FOR USE
    NAME TOXICITY

    Trifluridine Topical (1% solution) PK, H -Herpes simplex keratitis


    - Keratoconjuctivitis
    Acyclovir Oral (200 mg capsules, -Herpes zoster ophthalmicus
    800 mg tablets) - Herpes simplex iridocyclitis
    Intravenous

    Valacyclovir Oral (500- & 1000 mg) -Herpes simplex keratitis


    -Herpes zoster ophthalmicus
    Famciclovir Oral (125-,250 mg tablets) -Herpes simplex keratitis
    -Herpes zoster ophthalmicus

    PK – Punctate Keratopathy ; H - Hypersensitivity


    Antiviral Agents for Ophthalmic Use…
    GENERIC NAME ROUTE OF OCULAR INDICATIONS FOR
    ADMINISTRATION TOXICITY USE
    Foscarnet Intravenous ----- Cytomegalovirus
    Intravitreal Retinitis
    Ganciclovir Intravenous, Oral ----- Cytomegalovirus
    Intravitreal implant Retinitis

    Valganciclovir Oral ------- Cytomegalovirus


    Retinitis

    Cidofovir Intravenous ------ Cytomegalovirus


    Retinitis
    Thank you

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