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Hemodialysis removal of acyclovir
J B Leikin1, L Shicker, J Orlowski
1Emergency Services, Rush Poison Control Center, Rush Presbyterian St Luke's Medical Center, Chicago, Illinois 60612, USA.
Veterinary and Human Toxicology
|June 1, 1995
Summary
A patient with chronic renal failure experienced acyclovir toxicity, presenting with neurological symptoms. Hemodialysis effectively removed acyclovir, resolving the toxicity and improving the patient's condition.
Area of Science:
- Nephrology
- Pharmacology
- Neurology
Background:
- Patients with chronic renal failure often require antiviral medications like acyclovir.
- Acyclovir dosing requires careful consideration in patients with impaired kidney function to prevent toxicity.
Observation:
- A 59-year-old patient on hemodialysis developed neurological symptoms including hallucinations and ataxia after initiating acyclovir treatment.
- Elevated acyclovir levels (3.4 mcg/mL) were detected prior to hemodialysis, indicating potential drug toxicity.
Findings:
- Hemodialysis was effective in reducing acyclovir levels, with a 3-hour session lowering the concentration from 3.4 mcg/mL to 1.9 mcg/mL.
- A second hemodialysis session led to significant improvement in the patient's neurological status.
- Acyclovir's pharmacokinetic properties (low volume of distribution, low protein binding, water solubility) make it highly amenable to removal by hemodialysis.
Implications:
- This case highlights the risk of acyclovir neurotoxicity in patients with renal impairment.
- Hemodialysis is a crucial intervention for managing acyclovir toxicity in patients with kidney failure.
- Understanding acyclovir's removal characteristics by hemodialysis is essential for optimizing treatment in vulnerable populations.