Antivirais Contra o Vírus Herpes

Descrição Geral

Herpesvírus humano (HHVs, pela sigla em inglês)

• Vírus de DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure (processo de infeção semelhante):
  • Os vírus entram no núcleo da célula hospedeira.
  • O DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure viral é transcrito em mRNA mRNA RNA sequences that serve as templates for protein synthesis. Bacterial mRNAs are generally primary transcripts in that they do not require post-transcriptional processing. Eukaryotic mRNA is synthesized in the nucleus and must be exported to the cytoplasm for translation. Most eukaryotic mRNAs have a sequence of polyadenylic acid at the 3′ end, referred to as the poly(a) tail. The function of this tail is not known for certain, but it may play a role in the export of mature mRNA from the nucleus as well as in helping stabilize some mRNA molecules by retarding their degradation in the cytoplasm. RNA Types and Structure via polimerase da célula hospedeira.
  • Subsequentemente, o mRNA mRNA RNA sequences that serve as templates for protein synthesis. Bacterial mRNAs are generally primary transcripts in that they do not require post-transcriptional processing. Eukaryotic mRNA is synthesized in the nucleus and must be exported to the cytoplasm for translation. Most eukaryotic mRNAs have a sequence of polyadenylic acid at the 3′ end, referred to as the poly(a) tail. The function of this tail is not known for certain, but it may play a role in the export of mature mRNA from the nucleus as well as in helping stabilize some mRNA molecules by retarding their degradation in the cytoplasm. RNA Types and Structure é traduzido em proteínas específicas do vírus.
• Família Herpesviridae Herpesviridae A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. Subfamilies, based on biological characteristics, include: alphaherpesvirinae; betaherpesvirinae; and gammaherpesvirinae. Herpes Simplex Virus 1 and 2:
  • Subfamília: Alphaherpesvirinae Alphaherpesvirinae A subfamily of herpesviridae characterized by a short replication cycle. The genera include: simplexvirus; varicellovirus; marek’s disease-like viruses; and iltovirus. Antivirals for Herpes Virus:
    • Vírus Herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections (VHS)-1 e VHS-2 (lesões mucocutâneas e genitais)
    • Vírus Varicela-zoster (VZV, pela sigla em inglês) (varicela)
  • Subfamília: Betaherpesvirinae Betaherpesvirinae A subfamily of herpesviridae characterized by a relatively long replication cycle. Genera include: cytomegalovirus; muromegalovirus; and roseolovirus. Cytomegalovirus:
    • Citomegalovírus (CMV)
    • HHV-6 HHV-6 Human herpesvirus (HHV)-6 and HHV-7 are similar double-stranded DNA viruses belonging to the Herpesviridae family. Human herpesviruses are ubiquitous and infections are commonly contracted during childhood. Human Herpesvirus 6 and 7 e HHV-7 HHV-7 Human herpesvirus (HHV)-6 and HHV-7 are similar double-stranded DNA viruses belonging to the Herpesviridae family. Human herpesviruses are ubiquitous and infections are commonly contracted during childhood. Human Herpesvirus 6 and 7 (roséola)
  • Subfamília: Gammaherpesvirinae Gammaherpesvirinae A subfamily of herpesviridae characterized by variable reproductive cycles. The genera include: lymphocryptovirus and rhadinovirus. Epstein-Barr Virus :
    • Vírus Epstein-Barr ( EBV EBV Epstein-barr virus (EBV) is a linear, double-stranded DNA virus belonging to the herpesviridae family. This highly prevalent virus is mostly transmitted through contact with oropharyngeal secretions from an infected individual. The virus can infect epithelial cells and B lymphocytes, where it can undergo lytic replication or latency. Epstein-Barr Virus, pela sigla em inglês) (linfoma de Burkitt e mononucleose infeciosa)
    • HHV-4
    • HHV-8 (sarcoma de Kaposi Kaposi A multicentric, malignant neoplastic vascular proliferation characterized by the development of bluish-red cutaneous nodules, usually on the lower extremities, most often on the toes or feet, and slowly increasing in size and number and spreading to more proximal areas. The tumors have endothelium-lined channels and vascular spaces admixed with variably sized aggregates of spindle-shaped cells, and often remain confined to the skin and subcutaneous tissue, but widespread visceral involvement may occur. Hhv-8 is the suspected cause. There is also a high incidence in AIDS patients. AIDS-defining Conditions)

Agentes contra o vírus herpes

• Têm como alvo a síntese do ácido nucleico viral, inibindo a DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase
• Grupos de fármacos:
  • Análogos de nucleosídeos:
    • Aciclovir
    • Valaciclovir
    • Famciclovir Famciclovir An aminopurine derivative and prodrug of penciclovir which is a competitive inhibitor of herpes simplex 2 DNA polymerase. It is used to treat herpes simplex virus infection. Antivirals for Herpes Virus
    • Ganciclovir Ganciclovir An acyclovir analog that is a potent inhibitor of the herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from aids-associated cytomegalovirus infections. Antivirals for Herpes Virus
    • Penciclovir Penciclovir Antivirals for Herpes Virus
  • Análogo nucleótido de citidina: cidofovir Cidofovir An acyclic nucleoside phosphonate that acts as a competitive inhibitor of viral DNA polymerases. It is used in the treatment of retinitis caused by cytomegalovirus infections and may also be useful for treating herpesvirus infections. Antivirals for Herpes Virus
  • Análogo de pirofosfato: foscarnet Foscarnet An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. Antivirals for Herpes Virus

Análogos de Nucleosídeos

Estrutura química

• Aciclovir: análogo de nucleosídeo da guanosina acíclico (o fármaco protótipo do grupo)
• Valaciclovir: pró-fármaco de éster L-valil do aciclovir
• Penciclovir Penciclovir Antivirals for Herpes Virus, fanciclovir e ganciclovir Ganciclovir An acyclovir analog that is a potent inhibitor of the herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from aids-associated cytomegalovirus infections. Antivirals for Herpes Virus são antivirais relacionados.

Farmacodinâmica

Aciclovir:

• A fosforilação sequencial da quinase viral (p. ex., dependente da timidina quinase (TK)) e da quinase hospedeira converte o fármaco num monofosfato e posteriormente numa porção trifosfato.
• Como a etapa inicial requer quinase viral, são apenas afetadas as células infetadas.
• As etapas permitem que o fármaco se torne um inibidor de trifosfato da DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase.
• Inibe a síntese de DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure viral:
  • O trifosfato compete com o trifosfato de desoxiguanosina (dGTP, pela sigla em inglês) pela DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral.
  • O trifosfato incorpora-se no DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure viral.
  • A terminação da cadeia ocorre devido à ausência de um grupo 3′-hidroxilo, impedindo a ligação de nucleosídeos.
• Mecanismo de resistência:
  • Alteração na DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase do vírus
  • Ausência ou comprometimento da TK (causado por mutações virais)

Farmacocinética

• Absorção:
  • Aciclovir:
    • Disponibilidade oral, IV e tópica
    • Baixa biodisponibilidade oral (10%–30% )
  • Valaciclovir: maior biodisponibilidade
  • Penciclovir Penciclovir Antivirals for Herpes Virus: tópico
• Distribuição:
  • Elevada taxa de distribuição (incluindo LCR)
  • Boa penetração nos tecidos e fluidos
  • São necessárias múltiplas doses por dia devido à sua semi-vida curta
• Metabolismo: minimamente metabolizado (> 80% excretado inalterado)
• Excreção:
  • Renal por filtração glomerular e secreção tubular
  • É necessário um ajuste da dose na insuficiência renal.
  • A semi-vida de eliminação varia entre 2 a 4 horas.

Indicações

Aciclovir (e outros agentes relacionados):

• VHS
• VZV
• Prevenção do vírus herpes em indivíduos imunodeprimidos
• Uso off-label: Paralisia de Bell e prevenção de CMV em indivíduos com transplante de células-tronco hematopoiéticas de baixo risco

Efeitos adversos e contraindicações

Aciclovir:

• Efeitos adversos significativos:
  • Lesão renal aguda:
    • Uropatia obstrutiva (formação de cristais de aciclovir)
    • Nefrite intersticial
    • Acidose tubular renal
  • Nefrotoxicidade:
    • Confusão, agitação e alucinação
    • Mioclonias e tremores
  • Púrpura trombocitopénica trombótica (PTT) e síndrome hemolítica-urémica (SHU)
• Contraindicações: hipersensibilidade ao aciclovir

Comparação entre análogos de nucleosídeos

Cidofovir

Estrutura química

O cidofovir Cidofovir An acyclic nucleoside phosphonate that acts as a competitive inhibitor of viral DNA polymerases. It is used in the treatment of retinitis caused by cytomegalovirus infections and may also be useful for treating herpesvirus infections. Antivirals for Herpes Virus é um análogo de nucleótido de citidina.

Farmacodinâmica

• Tem como alvo a replicação viral, inibindo a DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral:
  • Ao contrário dos análogos de nucleosídeos, o cidofovir Cidofovir An acyclic nucleoside phosphonate that acts as a competitive inhibitor of viral DNA polymerases. It is used in the treatment of retinitis caused by cytomegalovirus infections and may also be useful for treating herpesvirus infections. Antivirals for Herpes Virus é fosforilado por enzimas celulares (quinase hospedeira), não virais.
  • Compete com o trifosfato de desoxicitidina (dCTP) pela DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral, para incorporação no DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure viral.
  • Quando o fármaco é incorporado ocorre a interrupção do prolongamento adicional na cadeia.
• O cidofovir Cidofovir An acyclic nucleoside phosphonate that acts as a competitive inhibitor of viral DNA polymerases. It is used in the treatment of retinitis caused by cytomegalovirus infections and may also be useful for treating herpesvirus infections. Antivirals for Herpes Virus tem atividade contra vírus com ausência ou comprometimento da TK, porque as enzimas virais não são necessárias.
• Mecanismo de resistência: mutação na DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral

Farmacocinética

• Absorção:
  • Administração IV
  • Baixa biodisponibilidade oral
• Distribuição:
  • Baixa penetração no LCR
  • O metabolito ativo (difosfato de cidofovir Cidofovir An acyclic nucleoside phosphonate that acts as a competitive inhibitor of viral DNA polymerases. It is used in the treatment of retinitis caused by cytomegalovirus infections and may also be useful for treating herpesvirus infections. Antivirals for Herpes Virus) é eliminado lentamente → longa semi-vida intracelular
• Metabolismo: A maior parte do fármaco é excretado de forma inalterada na urina.
• Excreção:
  • Renal
  • Filtração glomerular e secreção tubular

Indicações

• Retinite por CMV (na SIDA)
• Atividade contra:
  • Herpesvírus
  • Adenovírus
  • Poliomavírus (nefropatia por vírus BK)
  • Papilomavírus (por exemplo, verrugas, molusco contagioso)
  • Poxvírus
• Ativo contra vírus mutantes resistentes ao aciclovir e ganciclovir Ganciclovir An acyclovir analog that is a potent inhibitor of the herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from aids-associated cytomegalovirus infections. Antivirals for Herpes Virus:
  • HSV HSV Herpes simplex virus (HSV) is a double-stranded DNA virus belonging to the family Herpesviridae. Herpes simplex virus commonly causes recurrent infections involving the skin and mucosal surfaces, including the mouth, lips, eyes, and genitals. Herpes Simplex Virus 1 and 2 TK-negativo
  • CMV negativo para fosfotransferase UL97

Efeitos adversos e contraindicações

• Efeitos adversos:
  • Nefrotoxicidade:
    • Efeito adverso mais MAIS Androgen Insensitivity Syndrome importante
    • Diminui quando administrado com solução salina IV e probenecid Probenecid The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. Gout Drugs (bloqueia a secreção tubular renal ativa)
  • Náuseas, vómitos
  • Neutropenia Neutropenia Neutrophils are an important component of the immune system and play a significant role in the eradication of infections. Low numbers of circulating neutrophils, referred to as neutropenia, predispose the body to recurrent infections or sepsis, though patients can also be asymptomatic. Neutropenia
  • Irite aguda e hipotonia ocular
  • Em estudos com animais: hipospermia, carcinogénico e teratogénico
• Contraindicações:
  • Proteinúria ≥ 2+ ou proteína na urina ≥ 100 mg/dL
  • Creatinina sérica basal > 1,5 mg/dL

Foscarnet

Estrutura química

Foscarnet Foscarnet An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. Antivirals for Herpes Virus é um análogo de pirofosfato.

Farmacodinâmica

• Inibe a síntese do ácido nucleico viral:
  • Impede a fosforilação intracelular, necessária para a atividade antiviral Antiviral Antivirals for Hepatitis B
  • Liga-se reversivelmente ao local de ligação do pirofosfato da DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral (ou transcriptase reversa)
  • Inibe a clivagem do pirofosfato pelos desoxinucleotídeos trifosfato → interrompe o alongamento da cadeia de DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure
• Mecanismo de resistência: mutações pontuais na DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase viral

Farmacocinética

• Absorção:
  • Biodisponibilidade oral baixa
  • Formulação IV
• Distribuição:
  • Níveis vítreos semelhantes ao plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products
  • Os níveis do LCR aproximam-se de 66% do plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products.
• Metabolismo: minimamente metabolizado
• Excreção:
  • Secreção tubular e filtração glomerular
  • Aproximadamente 20% do foscarnet Foscarnet An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. Antivirals for Herpes Virus pode ser absorvido pelo osso.
  • Excreção diminuída nos indivíduos com doença renal

Indicações

• Infeções por CMV resistentes ao ganciclovir Ganciclovir An acyclovir analog that is a potent inhibitor of the herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from aids-associated cytomegalovirus infections. Antivirals for Herpes Virus (SIDA ou recetores de transplante)
• Infeções mucocutâneas por VHS resistentes ao aciclovir

Efeitos adversos e contraindicações

• Efeitos adversos:
  • Nefrotoxicidade (atenuada com administração de solução salina IV)
  • Hipocalcemia, hipomagnesemia e hipocaliemia
  • Formação de úlceras genitais
  • Neurológicas:
    • Convulsões
    • Parestesias
    • Irritabilidade
    • Cefaleia
    • Alucinações
  • Prolongamento do intervalo QT
• Contraindicações: hipersensibilidade ao foscarnet Foscarnet An antiviral agent used in the treatment of cytomegalovirus retinitis. Foscarnet also shows activity against human herpesviruses and HIV. Antivirals for Herpes Virus

Agentes Não Sistémicos

Docosanol

• Álcool alifático saturado de 22 carbonos
• Inibe a fusão entre a membrana plasmática da célula hospedeira e o envelope Envelope Bilayer lipid membrane acquired by viral particles during viral morphogenesis. Although the lipids of the viral envelope are host derived, various virus-encoded integral membrane proteins, i.e. Viral envelope proteins are incorporated there. Virology do VHS → impede a entrada do vírus nas células
• Creme tópico de docosanol 10%:
  • Venda livre
  • Reduz o tempo de cicatrização se aplicado dentro de 12 horas desde o início dos sintomas prodrómicos

Trifluridina

• Trifluorotimidina
• Mecanismo de ação:
  • Inibição da síntese do DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure viral (VHS-1, VHS-2, CMV)
  • Sofre fosforilação intracelular por enzimas da célula hospedeira → compete com o trifosfato de timidina pela DNA DNA A deoxyribonucleotide polymer that is the primary genetic material of all cells. Eukaryotic and prokaryotic organisms normally contain DNA in a double-stranded state, yet several important biological processes transiently involve single-stranded regions. DNA, which consists of a polysugar-phosphate backbone possessing projections of purines (adenine and guanine) and pyrimidines (thymine and cytosine), forms a double helix that is held together by hydrogen bonds between these purines and pyrimidines (adenine to thymine and guanine to cytosine). DNA Types and Structure polimerase do vírus
• 1% solução:
  • Tratamento da queratoconjuntivite e queratite epitelial recorrente por VHS-1 ou VHS-2
  • Uso off-label: aplicação tópica em infeções por VHS resistentes ao aciclovir

Comparação de Fármacos