[On the mailing list: use of acyclovir in patients on hemodialysis]

In the SIN Mailing List a message published in May 2004 gave rise to an interesting debate as to the use and dosage of acyclovir in dialysis patients for the treatment of varicella-zoster infection, considering the side effects (mainly neurological) reported in patients affected by renal insufficiency. In this issue, we summarised the main pharmacological characteristics of acyclovir and the clinical indications for using this drug. Finally, we analysed the literature data concerning acyclovir side effects in the setting of renal insufficiency. As they indicate that acyclovir-induced neurotoxicity in renal insufficiency patients may be unpredictable even at reduced dosages, this should discourage the use of acyclovir when severe renal insufficiency is present, unless severe herpes infection is present and after evaluating carefully the risk-benefit. In this case, the patient has to be kept under strict medical control to detect the acyclovir-induced side effects early. The use of new antiviral drugs, such as famciclovir or brivudine, to treat herpes virus infections in patients with renal insufficiency is currently not supported by sufficient data for a critical review.