Incidence, patterns, risk factors and clinical outcomes of intravenous acyclovir induced nephrotoxicity

Alawi, Abdullah M Al; Al-Maqbali, Juhaina Salim; Al-Adawi, Maria; Al-Jabri, Anan; Falhammar, Henrik

doi:10.1016/j.jsps.2022.03.013

Cited by 2 publications

(3 citation statements)

References 19 publications

(34 reference statements)

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“…Acyclovir is an antiviral commonly used for the treatment of viral infections, such as HSV 1 and 2 and VZV; but it is potentially nephrotoxic when given intravenously. D-AKI from acyclovir is reported to occur in 18-21% of patients [80,81,82]. Recently, Al-Alawi et al [81] noted an incidence rate of 20% for acyclovir D-AKI, with the most relevant modifiable risk factors being concomitant vancomycin and duration of treatment.…”

Section: Acyclovirmentioning

confidence: 99%

“…D-AKI from acyclovir is reported to occur in 18-21% of patients [80,81,82]. Recently, Al-Alawi et al [81] noted an incidence rate of 20% for acyclovir D-AKI, with the most relevant modifiable risk factors being concomitant vancomycin and duration of treatment.…”

Section: Acyclovirmentioning

confidence: 99%

“…Clinically, the use of intravenous hydration with isotonic solutions (sodium chloride 0.9% at a rate of 125 ml/h, starting one hour prior to administration and continuing for six hours post infusion to achieve a urine output >75 ml/h) reduces acyclovir D-AKI, and is therefore recommended [81,83,84]. The investigation of herbal remedies to mitigate antiviral drug nephrotoxicity is ongoing.…”

Section: Acyclovirmentioning

confidence: 99%

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Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights

Karimzadeh,

Strader,

Kane-Gill

et al. 2023

Current Opinion in Critical Care

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Purpose of review Drug associated kidney injury (D-AKI) occurs in 19–26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important. Recent findings Artificial intelligence is showcasing its capabilities in early recognition of at-risk patients for acquiring AKI. Furthermore, novel synthetic medications and formulations have demonstrated reduced nephrotoxicity compared to their traditional counterparts in animal models and/or limited clinical evaluations, offering promise in the prevention of D-AKI. Nephroprotective antioxidant agents have had limited translation from animal studies to clinical practice. The control of modifiable risk factors remains pivotal in avoiding D-AKI. Summary The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.

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Section: Acyclovirmentioning

confidence: 99%

Section: Acyclovirmentioning

confidence: 99%

Section: Acyclovirmentioning

confidence: 99%

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Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights

Karimzadeh,

Strader,

Kane-Gill

et al. 2023

Current Opinion in Critical Care

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The importance of therapeutic drug monitoring in acyclovir dosage optimization

Kacířová¹,

Urinovska²,

Sagan³

2023

Klin Farmakol Farm

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Acyclovir je antivirotikum používané k prevenci a léčbě infekcí způsobených herpetickými viry, jako je virus herpes simplex a virus varicella-zoster. Je intracelulárně fosforylován na trifosfátové nukleotidy, které inhibují virovou DNA polymerázu. Přibližně 5-15 % acykloviru je metabolizováno na hlavní metabolit 9-(karboxymethoxymethyl)guanin (CMMG), hlavní cestou eliminace acykloviru je renální exkrece, která zahrnuje glomerulární filtraci a aktivní tubulární sekreci. U pacientů s poruchou funkce ledvin může dojít ke kumulaci acykloviru a CMMG. Acyclovir se často používá a je obecně dobře tolerován, může však způsobit systémové nežádoucí účinky, jako je nefrotoxicita a neurotoxicita. Preexistující onemocnění ledvin, vyšší věk, obezita, hypertenze, delší trvání léčby a současné užívání nefrotoxických léčiv jsou spojeny se zvýšeným rizikem nefrotoxicity vyvolané acyklovirem. Nejcharakterističtějšími příznaky neurotoxicity jsou zmatenost, somnolence a halucinace. Příznaky neurotoxicity způsobené léčbou acyklovirem mohou být chybně interpretovány jako příznaky herpetické encefalitidy. Přesné rozlišení mezi těmito dvěma příčinami neuropsychiatrických symptomů je zvláště důležité vzhledem k různým léčebným strategiím. Stanovení sérových koncentrací CMMG může pomoci odlišit neuropsychiatrické vedlejší účinky acykloviru od symptomů jakékoli formy encefalitidy. Široká interindividuální variabilita farmakokinetiky acykloviru může vést nejen k toxicitě, ale také k suboptimálním terapeutickým koncentracím acykloviru u závažných infekcí herpetickými viry. Terapeutické monitorování acykloviru a CMMG může být užitečným nástrojem pro optimalizaci farmakoterapie tímto antivirotikem, zejména u pacientů se závažnými klinickými stavy.

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Incidence, patterns, risk factors and clinical outcomes of intravenous acyclovir induced nephrotoxicity

Cited by 2 publications

References 19 publications

Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights

Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights

The importance of therapeutic drug monitoring in acyclovir dosage optimization

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