General Description
Vidarabine (adenine arabinoside) is a purine nucleoside analogue with antiviral activity against DNA viruses, primarily used as a topical ophthalmic preparation for herpes simplex keratitis. It was historically available in intravenous formulation for systemic herpes infections but has been largely replaced by newer agents. The drug is an analogue of deoxyadenosine that interferes with viral DNA synthesis.
Mechanism of Action
Vidarabine is phosphorylated intracellularly to the active triphosphate form, which competitively inhibits viral DNA polymerase more potently than host DNA polymerase. Once incorporated into viral DNA, it acts as a chain terminator due to the absence of a 3'-hydroxyl group on the arabinose sugar. This selective inhibition of viral DNA replication halts the production of new viral particles. The drug also has some inhibitory activity against host DNA synthesis at higher concentrations.
Application
Its current primary indication is the topical treatment of acute keratoconjunctivitis and recurrent epithelial keratitis caused by herpes simplex virus types 1 and 2. Ophthalmic vidarabine ointment is applied five times daily and is effective against acyclovir-resistant strains. Systemic use for herpes encephalitis or neonatal herpes has been superseded by acyclovir due to its superior efficacy, safety, and aqueous solubility. The ophthalmic formulation remains available but is less commonly used than trifluridine.