Adverse Effects of Aciclovir
Introduction to Adverse Effects
- The American College of Physicians recommends that patients receiving aciclovir should be monitored for nephrotoxicity, which can occur in up to 20% of patients, especially those with compromised renal function 1, 2, 3
- The Centers for Disease Control and Prevention (CDC) suggest that maintaining adequate hydration during intravenous therapy can reduce the risk of crystallization 1, 4
- The CDC also recommends adjusting the dose in patients with pre-existing renal insufficiency, as aciclovir is almost completely excreted by the kidneys 2, 3, 4
Renal Adverse Effects
- The National Kidney Foundation notes that nephropathic obstructive reversible crystaluria is the most important adverse effect, typically occurring after 4 days of intravenous therapy and affecting up to 20% of patients 1, 2, 3
- The CDC recommends monitoring renal function and adjusting the dose as necessary at the start of treatment and one or two times a week during high-dose intravenous aciclovir therapy 5
Hematological Adverse Effects
- The CDC reports that thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) has resulted in death in immunocompromised patients receiving aciclovir therapy 5
- The CDC also recommends monitoring complete blood counts twice a week during induction therapy and once a week thereafter, as neutropenia and thrombocytopenia may occur 6
Gastrointestinal Adverse Effects
- The CDC notes that nausea and vomiting are the most frequent reactions with short-term oral use, and occasionally, nausea or headache may be associated with episodic or suppressive therapy 5
Rare Adverse Effects
- The American College of Physicians reports that hepatitis, bone marrow failure, and encephalopathy are rare adverse events 1
- The CDC suggests that hemodialysis may be beneficial for acute renal failure and anuria until renal function is restored 1