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Neurologic sequelae associated with foscarnet therapy

E Lor1, Y Q Liu

  • 1San Francisco General Hospital, CA 94110.

The Annals of Pharmacotherapy
|September 1, 1994
PubMed
Summary

Foscarnet may cause neurologic side effects like seizures and paresthesia, even without typical risk factors. Close electrolyte monitoring and slower infusion rates might mitigate these risks in patients receiving foscarnet therapy.

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Area of Science:

  • Neurology
  • Pharmacology
  • Infectious Diseases

Background:

  • Foscarnet is an antiviral medication used to treat cytomegalovirus and herpes simplex virus infections.
  • Neurologic adverse effects associated with foscarnet have been reported, but the exact mechanisms and risk factors are not fully understood.

Observation:

  • Three cases of possible foscarnet-induced neurologic sequelae are reported: two cases of seizures and one case of hand cramping and finger paresthesia.
  • These adverse events occurred in patients receiving appropriate foscarnet dosages, with no evidence of predisposing risk factors like laboratory abnormalities, renal dysfunction, or pre-existing central nervous system (CNS) involvement.
  • Patients maintained stable laboratory values during foscarnet therapy when the neurologic symptoms manifested.

Findings:

  • A history of CNS lesions, infections, or acquired immunodeficiency syndrome (AIDS) may increase the risk of foscarnet-related neurologic adverse effects.
  • Acute ionized hypocalcemia, which can be transitory and related to infusion rate, is a potential cause of these neurologic events and may not be detected by total serum calcium measurements.
  • Foscarnet administration, potentially at a slower rate than recommended, may be necessary to prevent these neurologic complications.

Implications:

  • Foscarnet's potential to induce neurologic adverse effects necessitates careful patient selection and monitoring.
  • Healthcare providers should consider the possibility of foscarnet-induced neurologic sequelae, particularly in patients with a history of CNS issues or AIDS.
  • While electrolyte monitoring is crucial, neurologic adverse effects may still occur unpredictably, highlighting the need for vigilance during foscarnet treatment.

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