Neurotoxicity associated with acyclovir in end stage renal failure

Area of Science:

• Nephrology
• Pharmacology
• Infectious Diseases

Background:

• Renal failure significantly alters drug pharmacokinetics.
• Acyclovir is a common antiviral medication requiring dose adjustment in renal impairment.

Observation:

• Two cases of acyclovir neurotoxicity were observed in patients undergoing continuous ambulatory peritoneal dialysis.
• Neurotoxicity occurred despite appropriate dosing in one case and reduced dosing in another.

Findings:

• Acyclovir neurotoxicity is a risk in patients with end-stage renal failure.
• Standard dosing regimens may not prevent neurotoxicity in this population.
• Supportive care led to full recovery in both reported cases.

Implications:

• Clinicians must exercise caution when prescribing acyclovir to patients with severe renal impairment.
• Revised dosing guidelines are necessary to mitigate neurotoxicity risk.
• This highlights the importance of individualized medication management in renal disease.