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Acyclovir Disease Interactions

There are 4 disease interactions with acyclovir.

Major

Acyclovir (applies to acyclovir) renal dysfunction

Major Potential Hazard, High plausibility.

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.

References

  1. Laskin OL, Longstreth JA, Whelton A, et al. (1982) "Effect of renal failure on the pharmacokinetics of acyclovir." Am J Med, 73, p. 197-201
  2. Laskin OL, Longstreth JA, Whelton A, et al. (1982) "Acyclovir kinetics in end-stage renal disease." Clin Pharmacol Ther, 31, p. 594-600
  3. Sawyer MH, Webb DE, Balow JE, Straus SE (1988) "Acyclovir-induced renal failure." Am J Med, 84, p. 1067-71
  4. Fletcher CV, Chinnock BJ, Chace B, Balfour HH (1988) "Pharmacokinetics and safety of high-dose oral acyclovir for suppression of cytomegalovirus disease after renal transplantation." Clin Pharmacol Ther, 44, p. 158-63
  5. Rashed A, Asadeh B, Romeh SHA (1990) "Acyclovir-induced acute tubulo-interstitial nephritis." Nephron, 56, p. 436-8
  6. Peterslund NA, Larsen ML, Mygind H (1988) "Acyclovir crystalluria." Scand J Infect Dis, 20, p. 225-8
  7. Gnann JW, Barton NH, Whitley RJ (1983) "Acyclovir: mechanism of action, pharmacokinetics, safety and clinical applications." Pharmacotherapy, 3, p. 275-83
  8. Hernandez E, Praga M, Moreno F, Montoyo C (1991) "Acute renal failure induced by oral acyclovir." Clin Nephrol, 36, p. 155-6
  9. Bianchetti MG, Roduit C, Oetliker OH (1991) "Acyclovir-induced renal failure: course and risk factors." Pediatr Nephrol, 5, p. 238-9
  10. (2017) "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc
  11. Becker BN, Fall P, Hall C, Milam D, Leonard J, Glick A, Schulman G (1993) "Rapidly progressive acute renal failure due to acyclovir: case report and review of the literature." Am J Kidney Dis, 22, p. 611-5
  12. Krieble BF, Rudy DW, Glick MR, Clayman MD (1993) "Case report: acyclovir neurotoxicity and nephrotoxicity--the role for hemodialysis." Am J Med Sci, 305, p. 36-9
  13. Johnson GL, Limon L, Trikha G, Wall H (1994) "Acute renal failure and neurotoxicity following oral acyclovir." Ann Pharmacother, 28, p. 460-3
View all 13 references
Moderate

Acyclovir (applies to acyclovir) dehydration

Moderate Potential Hazard, High plausibility.

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.

References

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

Acyclovir (applies to acyclovir) hemodialysis

Moderate Potential Hazard, High plausibility.

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.

References

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

Acyclovir (applies to acyclovir) neurotoxicity

Moderate Potential Hazard, Low plausibility. Applicable conditions: Liver Disease, Electrolyte Abnormalities, Hypernatremia, Phosphate Imbalance, Magnesium Imbalance, Asphyxia, CNS Disorder, Hyponatremia, Dehydration, Hypocalcemia, Hypercalcemia, Acidosis, Alkalosis

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.

References

  1. Jones PG, Beier-Hanratty SA (1986) "Acyclovir: neurologic and renal toxicity." Ann Intern Med, 104, p. 892
  2. Fletcher CV, Chinnock BJ, Chace B, Balfour HH (1988) "Pharmacokinetics and safety of high-dose oral acyclovir for suppression of cytomegalovirus disease after renal transplantation." Clin Pharmacol Ther, 44, p. 158-63
  3. Feldman S, Rodman J, Gregory B (1988) "Excessive serum concentrations of acyclovir and neurotoxicity." J Infect Dis, 157, p. 385-8
  4. Cohen SM, Minkove JA, Zebley JW, Mulholland JH (1984) "Severe but reversible neurotoxicity from acyclovir." Ann Intern Med, 100, p. 920
  5. Wade JC, Meyers JD (1983) "Neurologic symptoms associated with parenteral acyclovir treatment after marrow transplantation." Ann Intern Med, 98, p. 921-5
  6. Bean B, Aeppli D (1985) "Adverse effects of high-dose intravenous acyclovir in ambulatory patients with acute herpes zoster." J Infect Dis, 151, p. 362-5
  7. Gill MJ, Burgess E (1990) "Neurotoxicity of acyclovir in end stage renal disease." J Antimicrob Chemother, 25, p. 300-1
  8. MacDiarmaid-Gordon AR, O'Connor M, Beaman M, Ackrill P (1992) "Neurotoxicity associated with oral acyclovir in patients undergoing dialysis." Nephron, 62, p. 280-3
  9. (2017) "Product Information. Zovirax (acyclovir)." Mylan Pharmaceuticals Inc
  10. Krieble BF, Rudy DW, Glick MR, Clayman MD (1993) "Case report: acyclovir neurotoxicity and nephrotoxicity--the role for hemodialysis." Am J Med Sci, 305, p. 36-9
  11. Rashiq S, Briewa L, Mooney M, Giancarlo T, Khatib R, Wilson FM (1993) "Distinguishing acyclovir neurotoxicity from encephalomyelitis." J Intern Med, 234, p. 507-11
  12. Johnson GL, Limon L, Trikha G, Wall H (1994) "Acute renal failure and neurotoxicity following oral acyclovir." Ann Pharmacother, 28, p. 460-3
View all 12 references

Acyclovir drug interactions

There are 67 drug interactions with acyclovir.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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