When a Seemingly Harmless Prescription Turns into Toxicity

Azmaiparashvili, Zurab; Lo, Kevin Bryan; Habib, Nawal; Hsieh, Annie L.

doi:10.1155/2018/9724390

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…These authors also found that 24 hours after giving a dose of valacyclovir, 6.5 +/-1.81% of acyclovir was excreted via the peritoneum [8]. This lends support as to why, in instances of severe toxicity, hemodialysis has been initiated to rapidly eliminate valacyclovir [10,11]. Nevertheless, the removal of acyclovir via PD has been done in the past.…”

Section: Discussionmentioning

confidence: 90%

“…Nevertheless, the removal of acyclovir via PD has been done in the past. In reality, there are case reports that document improvement in neurological function after initiating a more aggressive PD regimen [5,6,9,10] (Table 1). Izzedine et al, in another case, report of a single patient on continuous ambulatory peritoneal dialysis (CAPD) who developed VAN despite dose adjustment, found a CAPD clearance of only 5.27 mL/min [13].…”

Section: Discussionmentioning

confidence: 99%

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A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis

Memon

Rose

Akram

et al. 2021

Cureus

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There are a few cases of valacyclovir-associated neurotoxicity (VAN) reported. This case report documents a case of a 55-year-old male presenting with emotional lability or pseudobulbar affect as the predominant or sole manifestation of VAN. A failure to adjust valacyclovir's dose for herpes simplex infection in the setting of dialysis-dependent end-stage renal disease (ESRD) preceded VAN in this patient. The patient presented with involuntary and uncontrollable outbursts of emotion. Computerized tomography (CT) scan identified no underlying cause. A complete neurological examination with cognitive assessment was performed, with no abnormalities. He benefited from the use of aggressive peritoneal dialysis (PD) that was employed to enhance valacyclovir's clearance in this case of intractable VAN. On discharge, the patient was back to baseline mental function.Traumatic brain injury, neoplasm, vascular lesions, metabolic abnormality, neurological disease, herpetic encephalitis, and disorders of mood were ruled out. This led to the hypothesis of encephalopathy due to valacyclovir intoxication. Given that the clinical manifestations were related to ESRD, a dose-adjustment of valacyclovir is imperative in the setting of ESRD to prevent VAN. Our case presents important clinical variations. Firstly, our patient demonstrates that VAN may present with no focal neurological impairment, but pseudobulbar affect. Secondly, aggressive PD was useful in this case for the treatment of VAN as opposed to hemodialysis. We believe that it cleared valacyclovir resulting in the resolution of symptoms.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis

Memon

Rose

Akram

et al. 2021

Cureus

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“…Ninety‐seven of those were included in the analysis, representing a total of 119 independent patients (Figure 1). The cases were extracted from 86 clinical cases 9‐35,37‐48,50‐54,56‐63,65‐71,73,75‐77,80‐83,85‐100,102,103 and 11 case series 36,49,55,64,72,74,78,79,84,101,113 . Figure 1 shows the case selection flow diagram.…”

Section: Resultsmentioning

confidence: 99%

Neurotoxicity associated with acyclovir and valacyclovir: A systematic review of cases

et al. 2021

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What is known and objective Acyclovir and valacyclovir are commonly used antivirals with good general tolerance. Despite their good safety profile, they can cause systemic adverse effects, such as neurotoxicity, which are less frequent and known. The objective of this review was to collect all the reported cases of neurotoxicity associated with acyclovir and valaciclovir published in the literature and characterize their clinical course and interventions. Methods A systematic review of cases was carried out following the guidelines established by “Preferred Reporting Items for Systematic Reviews and Meta‐Analyses” (PRISMA). The research was carried out using the PubMed‐Medline and Embase databases, between July 1984 and March 2021. Results and discussion A total of 119 cases with neurotoxicity mainly related to acyclovir (n = 88; 73.9%), followed by valaciclovir (n = 35; 29.4%) were analysed. 49.6% (n = 59) were men with a mean age of 59.5 years ± 21.1 (0.5–88). In 83.3% of the cases, renal impairment was documented and 57.1% (n = 68) with end‐stage renal disease. The administered dose was higher than the renal adjustment recommendations in 59.7% of the cases. The global mean of onset of symptoms was 3.1 days ± 4.3 (0.2–28) after the start of antivirals. The mean recovery time was 9.8 days ± 21.7 (0.2–180). 74.4% of the patients had a recovery of ≤7 days, 15.9% between 8 and 15 days and 9.8% > 15 days. What is new and conclusion The neurotoxicity induced by acyclovir and its derivative valacyclovir is a poorly known and rare adverse effect that can occur mainly in patients with advanced age and impaired renal function. The most characteristic symptoms are confusion, altered level of consciousness, hallucinations, agitation and dysarthria. The basis of treatment is the discontinuation of the antiviral, and in some cases, it may require additional clearance by dialysis.

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Valaciclovir overdose

2018

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When a Seemingly Harmless Prescription Turns into Toxicity

Cited by 4 publications

References 12 publications

A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis

A Unique Case of Valacyclovir Toxicity and Pseudobulbar Affect in a Patient On Peritoneal Dialysis

Neurotoxicity associated with acyclovir and valacyclovir: A systematic review of cases

Valaciclovir overdose

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