Acyclovir (Injection) interactions

Conditions

Conditions in which Acyclovir (Injection) needs care, as documented in this source.

• Kidney Diseases

  Major

  Acyclovir is primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for neuro- and nephrotoxicity (including further deterioration in renal function, tubular damage and acute renal failure) from acyclovir due to decreased drug clearance. Therapy with acyclovir should be administered cautiously in patients with renal impairment. Dosage adjustments are recommended in patients with moderate to severe renal dysfunction.

  13 sources

  1. Laskin OL, Longstreth JA, Whelton A, et al. "Effect of renal failure on the pharmacokinetics of acyclovir." Am J Med 73 (1982): 197-201
  2. Laskin OL, Longstreth JA, Whelton A, et al. "Acyclovir kinetics in end-stage renal disease." Clin Pharmacol Ther 31 (1982): 594-600
  3. Sawyer MH, Webb DE, Balow JE, Straus SE "Acyclovir-induced renal failure." Am J Med 84 (1988): 1067-71
  4. Fletcher CV, Chinnock BJ, Chace B, Balfour HH "Pharmacokinetics and safety of high-dose oral acyclovir for suppression of cytomegalovirus disease after renal transplantation." Clin Pharmacol Ther 44 (1988): 158-63
  5. Rashed A, Asadeh B, Romeh SHA "Acyclovir-induced acute tubulo-interstitial nephritis." Nephron 56 (1990): 436-8
  6. Peterslund NA, Larsen ML, Mygind H "Acyclovir crystalluria." Scand J Infect Dis 20 (1988): 225-8
  7. Gnann JW, Barton NH, Whitley RJ "Acyclovir: mechanism of action, pharmacokinetics, safety and clinical applications." Pharmacotherapy 3 (1983): 275-83
  8. Hernandez E, Praga M, Moreno F, Montoyo C "Acute renal failure induced by oral acyclovir." Clin Nephrol 36 (1991): 155-6

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  9. Bianchetti MG, Roduit C, Oetliker OH "Acyclovir-induced renal failure: course and risk factors." Pediatr Nephrol 5 (1991): 238-9
  10. "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc (2017):
  11. Becker BN, Fall P, Hall C, Milam D, Leonard J, Glick A, Schulman G "Rapidly progressive acute renal failure due to acyclovir: case report and review of the literature." Am J Kidney Dis 22 (1993): 611-5
  12. Krieble BF, Rudy DW, Glick MR, Clayman MD "Case report: acyclovir neurotoxicity and nephrotoxicity--the role for hemodialysis." Am J Med Sci 305 (1993): 36-9
  13. Johnson GL, Limon L, Trikha G, Wall H "Acute renal failure and neurotoxicity following oral acyclovir." Ann Pharmacother 28 (1994): 460-3

• Dehydration

  Moderate

  Acyclovir crystals may precipitate in the renal tubules, particularly when the drug is injected intravenously as a bolus. Abnormal renal function may occur, which is usually reversible but may infrequently progress to tubular damage and acute renal failure. Patients who are dehydrated may be at increased risk for nephrotoxicity from acyclovir administration. Intravenous acyclovir should be administered over a one-hour period accompanied by adequate hydration. The urine flow should be monitored, especially within the first two hours following infusion when maximum urine concentration occurs. The recommended urine output is a minimum of 500 mL per gram of drug infused.

  1 source

  1. "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc (2017):

• Diseases requiring hemodialysis

  Moderate

  Acyclovir is substantially removed by hemodialysis. Plasma levels of acyclovir have been shown to reduce by 60% following 6 hours of dialysis. Acyclovir should be administered after hemodialysis. Otherwise, an additional dose may be given after each hemodialysis session.

  2 sources

  1. Krasny HC, Liao SH, de Miranda P, Laskin OL, Whelton A, Lietman PS "Influence of hemodialysis on acyclovir pharmacokinetics in patients with chronic renal failure." Am J Med 73 (1982): 202-4
  2. "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc (2017):

• Neurotoxicity Syndromes

  Moderate

  Acyclovir, particularly when administered intravenously in higher dosages, may occasionally produce neurotoxicity characterized by lethargy, obtundation, tremors, confusion, hallucinations, agitation, seizures, or coma. Therapy with acyclovir should be administered cautiously in the elderly and in patients with underlying neurologic abnormalities, severe renal or liver disease, or significant electrolyte abnormalities or hypoxia.

  12 sources

  1. Jones PG, Beier-Hanratty SA "Acyclovir: neurologic and renal toxicity." Ann Intern Med 104 (1986): 892
  2. Fletcher CV, Chinnock BJ, Chace B, Balfour HH "Pharmacokinetics and safety of high-dose oral acyclovir for suppression of cytomegalovirus disease after renal transplantation." Clin Pharmacol Ther 44 (1988): 158-63
  3. Feldman S, Rodman J, Gregory B "Excessive serum concentrations of acyclovir and neurotoxicity." J Infect Dis 157 (1988): 385-8
  4. Cohen SM, Minkove JA, Zebley JW, Mulholland JH "Severe but reversible neurotoxicity from acyclovir." Ann Intern Med 100 (1984): 920
  5. Wade JC, Meyers JD "Neurologic symptoms associated with parenteral acyclovir treatment after marrow transplantation." Ann Intern Med 98 (1983): 921-5
  6. Bean B, Aeppli D "Adverse effects of high-dose intravenous acyclovir in ambulatory patients with acute herpes zoster." J Infect Dis 151 (1985): 362-5
  7. Gill MJ, Burgess E "Neurotoxicity of acyclovir in end stage renal disease." J Antimicrob Chemother 25 (1990): 300-1
  8. MacDiarmaid-Gordon AR, O'Connor M, Beaman M, Ackrill P "Neurotoxicity associated with oral acyclovir in patients undergoing dialysis." Nephron 62 (1992): 280-3

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  9. "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc (2017):
  10. Krieble BF, Rudy DW, Glick MR, Clayman MD "Case report: acyclovir neurotoxicity and nephrotoxicity--the role for hemodialysis." Am J Med Sci 305 (1993): 36-9
  11. Rashiq S, Briewa L, Mooney M, Giancarlo T, Khatib R, Wilson FM "Distinguishing acyclovir neurotoxicity from encephalomyelitis." J Intern Med 234 (1993): 507-11
  12. Johnson GL, Limon L, Trikha G, Wall H "Acute renal failure and neurotoxicity following oral acyclovir." Ann Pharmacother 28 (1994): 460-3