Neurotoxicity Associated with Standard Doses of Valacyclovir in Renal Insufficiency

Autor: William Kernan, Giorgio Tarchini, Kristen M. Boykin, Einar Lurix
Rok vydání: 2011
Předmět:
Zdroj: Hospital Pharmacy. 46:774-778
ISSN: 1945-1253
0018-5787
DOI: 10.1310/hpj4610-774
Popis: Chronic kidney disease is a growing problem in the United States that increases the risk of medication-related complications. The antiviral medication valacyclovir hydrochloride is indicated for the treatment and/or suppression of herpes labialis, genital herpes, and herpes zoster and requires dosage adjustment for renal impairment. Valacyclovir is generally well tolerated, but serious adverse drug reactions have been reported including neurotoxicity and acute renal failure, especially in the elderly and in those with chronic kidney disease. We present 2 cases of neurotoxicity suspected to be secondary to non-renally dose-adjusted valacyclovir therapy. The first is a female hemodialysis patient who developed neuropsychiatric symptoms within 24 hours of initiating valacyclovir therapy; the second is an elderly gentleman with stage 4 chronic kidney disease and symptoms after 2 days of therapy. Both were prescribed valacyclovir 1 g orally 3 times daily despite renal impairment. Use of the Naranjo adverse drug reaction probability scale suggests probable associations between neuropsychiatric symptoms displayed by the patients and valacyclovir (score of 5 in case 1; score of 7 in case 2). These cases highlight the importance of considering renal status when dosing medications that undergo significant renal elimination.
Databáze: OpenAIRE
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