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Neurotoxic side effects of acyclovir: two case reports
Zoltan Paluch1, Milan Trojánek2, Zuzana Velíšková3
1Department of Pharmacology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Neuro Endocrinology Letters
|October 29, 2021
Summary
Acyclovir, an antiviral, can rarely cause neurotoxic side effects, especially in elderly patients or those with kidney issues. Promptly recognizing and stopping acyclovir therapy can reverse these serious neurological symptoms.
Area of Science:
- Pharmacology
- Neurology
- Infectious Diseases
Background:
- Acyclovir is a widely used antiviral medication for herpes simplex and varicella zoster virus infections.
- While generally safe, acyclovir can rarely cause severe adverse events, including neurotoxicity.
Observation:
- This paper details two cases of patients experiencing neurotoxic side effects during acyclovir treatment for herpes zoster.
- Neurotoxicity onset occurred within 24-48 hours of initiating therapy.
Findings:
- Renal impairment is a significant risk factor for acyclovir-induced neurotoxicity.
- High-risk populations include the elderly, those with renal dysfunction, comorbidities, polypharmacy, or concurrent nephrotoxic drug use.
- Acyclovir can impair renal function, increasing its plasma and central nervous system (CNS) concentrations, leading to neuropsychiatric side effects.
Implications:
- Early identification of neurotoxicity is crucial for patients on acyclovir, particularly in high-risk groups.
- Discontinuation of acyclovir and consideration of enhanced elimination methods (forced diuresis, hemodialysis) are recommended for suspected neurotoxicity.
- Reversible neurotoxic side effects can be managed effectively, improving patient outcomes.
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