Acyclovir Neurotoxicity and Nephrotoxicity-The Role for Hemodialysis

Acute kidney injury due to acyclovir

“…Dialysis may be needed in some severe cases [5]. Accurate diagnosis and effective treatment of AKI secondary to acyclovir is critical for successful management.…”

Acyclovir-induced renal failure in an obese patient

“…3 Numerous case reports and animal studies have described the occurrence and elucidated the mechanism of acyclovir nephrotoxicity for almost three decades. [4][5][6][7][8][9][10][11][12][13][14][15] Although the nephrotoxic potential of acyclovir is well documented, the necessary precautions to prevent acyclovir-associated ARF can easily be neglected. In addition, obese patients have an increased Am J Health-Syst Pharm-Vol 66 Jul 15, 2009 risk of receiving an excessive dose if clinicians do not base the acyclovir dosage for these patients on IBW.…”

Famciclovir substitution for patients with acyclovir-associated renal toxicity

“…In patients with underlying renal insufficiency and volume depletion, the bolus infusion of acyclovir leads to reversible acute renal failure in approximately 5% of patients. 6 In obese patients, doses should be based on ideal body weight (IBW) to avoid potential side effects. Acyclovir-induced renal toxicity generally resolves with discontinuation of the drug and aggressive hydration.…”

“…1e5 A small proportion of patients may develop advanced renal failure requiring hemodialysis. 6 Once renal toxicity develops, it is general clinical practice to discontinue the antiviral therapy and proceed with supportive treatment only. There are no clear recommendations in the published literature addressing the safety of alternative antiviral agents that could be used safely in patients developing nephrotoxicity from acyclovir.…”