valacyclovir and Acute-Kidney-Injury

Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases.. An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission.. He was diagnosed with ACV-associated encephalopathy with acute kidney injury.. VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission.. Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.

Topics: Acute Kidney Injury; Aged, 80 and over; Antiviral Agents; Brain Diseases; Creatinine; Guanine; Herpes Zoster; Humans; Kidney; Male; Reference Values; Renal Dialysis; Valacyclovir

An 83-year-old Japanese man had a 29-year history of well-controlled diabetes mellitus. His HbA1c level was approximately 6.0%, with no microalbuminuria and a serum creatinine level seven days before admission of 0.8 mg/dl (eGFR: 69.67 ml/min/1.73 m(2)). Five days before admission, he visited an ophthalmologist with inflammation of the right palpebra and conjunctiva and began taking valacyclovir at a dose of 3,000 mg for the treatment of herpes zoster. Two days before admission, he was prescribed loxoprofen at a dose of 180 mg for a headache. One day prior to admission, he developed dysarthria, wandering and loss of appetite. He was subsequently admitted to our hospital with progressive deterioration of consciousness (Japan Coma Scale: II-20). On admission, he exhibited renal dysfunction, with a serum creatinine level of 5.11 mg/dl (eGFR: 9.16 ml/min/1.73 m(2)). Based on his diverse symptoms and current treatment with valacyclovir, the patient was diagnosed with acyclovir-induced neurotoxicity and his symptoms rapidly improved after hemodialysis. The serum acyclovir level on admission was found to be 9.25 μg/ml. Although acyclovir-induced neurotoxicity is commonly seen in elderly patients with renal dysfunction, there are also reports of this condition in patients with a normal renal function. Valacyclovir is frequently prescribed to the elderly to treat diseases such as herpes zoster. As valacyclovir induces renal dysfunction, which raises the serum acyclovir level to the toxic range, special attention must be paid when administering this drug in elderly subjects.

Topics: Acute Kidney Injury; Acyclovir; Aged, 80 and over; Antiviral Agents; Consciousness Disorders; Diabetes Complications; Diabetes Mellitus, Type 2; Humans; Male; Valacyclovir; Valine

INTRODUCTION. Infection by the Epstein-Barr virus (EBV) -either as a primary infection, a reactivation or an active chronic infection- can give rise to several clinical forms of involvement of the central nervous system. We report a case of encephalitis due to EBV produced by viral reactivation in an immunocompetent patient which initially mimicked, from the clinical and electroencephalographic point of view, encephalitis due to type 1 herpes simplex virus (HSV-1). CASE REPORT. A 51-year-old male who had reported the presence of dorsal herpes zoster some days earlier. The patient visited the emergency department after suffering a holocranial oppressive headache and febricula for seven days; 24 hours before admission to hospital, he was suffering from drowsiness and language disorder. The neurological examination revealed stiffness in the back of the neck and dysphasia. An analysis of the cerebrospinal fluid revealed pleocytosis (422 cells/mm(3)) with 98% of mononuclear cells and normal protein and glucose concentration levels in cerebrospinal fluid. Magnetic resonance imaging of the brain and electroencephalogram readings were normal with periodic lateralised epileptiform discharges in the left temporal region. Intravenous acyclovir treatment was initiated, but renal failure meant it had to be changed to oral valaciclovir with clinical resolution and improvement of the liquoral parameters. Polymerase chain reaction in the cerebrospinal fluid was positive for EBV and negative for the other neurotropic viruses. In blood, the serology test for EBV with IgG was positive, while IgM and heterophile antibody tests were negative. CONCLUSIONS. EBV infection can give rise to acute disseminated encephalomyelitis or affect several locations in the central nervous system, especially the cerebellum. Clinical pictures mimicking HSV-1 are less frequent. When encephalitis is related to viral reactivation, precipitating factors can be detected, as in our case.. Encefalitis por el virus de Epstein-Barr: descripcion de un caso clinico y revision de la bibliografia.. Introduccion. La infeccion por el virus de Epstein-Barr (VEB) puede dar lugar –tanto como primoinfeccion, reactivacion o infeccion cronica activa– a varias formas clinicas de afectacion del sistema nervioso central. Presentamos un caso de encefalitis por VEB producido por reactivacion virica en un paciente inmunocompetente, que inicialmente simulaba, desde el punto de vista clinico y electroencefalografico, una encefalitis por virus herpes simple tipo 1 (VHS-1). Caso clinico. Varon de 51 años con antecedente de herpes zoster dorsal en los dias previos. Acudio a urgencias por un cuadro de siete dias de duracion de cefalea opresiva holocraneal y febricula; 24 horas antes de su ingreso, padecia somnolencia y alteracion del lenguaje. En la exploracion neurologica presentaba rigidez nucal y disfasia. En el liquido cefalorraquideo se evidencio pleocitosis (422 celulas/mm3) con un 98% de mononucleares, y proteinorraquia y glucorraquia normales. Resonancia magnetica cerebral normal y electroencefalograma con descargas epileptiformes lateralizadas periodicas en la region temporal izquierda. Se trato con aciclovir intravenoso; una insuficiencia renal motivo su cambio a valaciclovir oral con resolucion clinica y mejoria de los parametros licuorales. La reaccion en cadena de la polimerasa en el liquido cefalorraquideo fue positiva para VEB y negativa para el resto de virus neurotropos. En sangre, la serologia para VEB con IgG resulto positiva, y negativa con IgM y anticuerpos heterofilos. Conclusiones. La infeccion por VEB puede dar lugar a una encefalitis aguda diseminada o afectar a varias localizaciones del sistema nervioso central, principalmente el cerebelo. Menos frecuentes son los cuadros imitadores de VHS-1. Cuando la encefalitis se relaciona con reactivacion viral pueden detectarse, como en nuestro caso, factores precipitantes.

Topics: Acute Kidney Injury; Acyclovir; Antibodies, Viral; Antiviral Agents; Cerebrospinal Fluid; Drug Substitution; Electroencephalography; Encephalomyelitis, Acute Disseminated; Epilepsy; Epstein-Barr Virus Infections; Herpes Zoster; Herpesvirus 4, Human; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Male; Middle Aged; Valacyclovir; Valine

Valacyclovir (VACV) is used increasingly to treat herpes zoster, although neuropsychiatric symptoms [VACV neurotoxicity (VAN) or acyclovir neurotoxicity], may accompany use of this drug. To promote awareness of this rare condition, we describe here two clinical cases of VAN we previously reported and review 20 cases from the literature. In all cases, chronic or acute renal failure preceded VAN. The symptoms of VAN varied, but disturbances of consciousness and hallucination occurred most commonly. When acute renal failure was due to the drug, recovery from both the disturbance of consciousness and renal failure followed within several days after discontinuation of VACV. Early recognition and diagnosis will ensure effective treatment of VAN.

Topics: Acute Kidney Injury; Acyclovir; Adult; Aged; Antiviral Agents; Consciousness Disorders; Female; Hallucinations; Herpes Zoster; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neurotoxicity Syndromes; Valacyclovir; Valine

A 72-year-old Japanese woman was treated by 3000 mg/day of valacyclovir for the herpes zoster in her left back. She had been treated as hypertension with no renal insufficiency. In two days, she visited an emergency room of a regional stroke care center with dysarthria, dexterity disorder and gait disturbance. Neither head CT nor MRI found intracranial lesions, then, laboratory tests revealed that her serum creatinine level was 4.63 mg/dL. She was transferred and admitted to our hospital on the following day and received hemodialysis under the diagnosis of AKI due to acyclovir accompanied with encephalopathy. Afterward, her serum concentration of acyclovir revealed as 44 μg/mL, which is extremely high. Her neurological symptom disappeared in parallel with the decrease of serum concentration of acyclovir. She received 3 sessions of hemodialysis and discharged on the 8th day of admission with almost normal renal function and no neurological sequela.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Female; Humans; Kidney; Stroke; Valacyclovir

Topics: Acute Kidney Injury; Humans; Valacyclovir

A man in his 70s presented to hospital with an acute kidney injury. He recently had started taking valacyclovir for treatment of shingles. The valacyclovir was stopped and his acute kidney injury improved. Work-up for other causes of acute kidney injury was negative and he was diagnosed with valacyclovir-associated acute kidney injury. He was discharged home after four days in the hospital with improving renal function.

Topics: Acute Kidney Injury; Herpes Zoster; Humans; Male; Valacyclovir

Primary care provides an opportunity to prevent community acquired, medicine or drug-induced acute kidney injury. One of the barriers to proactive prevention of medicine-induced kidney injury in primary care is the lack of a list of nephrotoxic medicines that are most problematic in primary care, particularly one that provides a comparison of risks across medicines.. The aim of this study was to consolidate evidence on the risks associated with medicines and acute kidney injury, with a focus on medicines used in primary care.. We searched the MEDLINE and EMBASE databases to identify published studies of all medicines associated with acute kidney injury identified from spontaneous report data. For each medicine positively associated with acute kidney injury, as identified from spontaneous reports, we implemented a sequence symmetry analysis (SSA) and a case-control design to determine the association between the medicine and hospital admission with a primary diagnosis of acute kidney injury (representing community-acquired acute kidney injury). Administrative claims data held by the Australian Government Department of Veterans' Affairs for the study period 2005-2019 were used.. We identified 89 medicines suspected of causing acute kidney injury based on spontaneous report data and a reporting odds ratio above 2, from Japan, France and the US. Spironolactone had risk estimates of 3 or more based on spontaneous reports, SSA and case-control methods, while furosemide and trimethoprim with sulfamethoxazole had risk estimates of 1.5 or more. Positive association with SSA and spontaneous reports, but not case control, showed zoledronic acid had risk estimates above 2, while candesartan telmisartan, simvastatin, naproxen and ibuprofen all had risk estimates in SSA between 1.5 and 2. Positive associations with case-control and spontaneous reports, but not SSA, were found for amphotericin B, omeprazole, metformin, amlodipine, ramipril, olmesartan, ciprofloxacin, valaciclovir, mycophenolate and diclofenac. All with the exception of metformin and omeprazole had risk estimates above 2.. This research highlights a number of medicines that may contribute to acute injury; however, we had an insufficient sample to confirm associations of some medicines. Spironolactone, furosemide, and trimethoprim with sulfamethoxazole are medicines that, in particular, need to be used carefully and monitored closely in patients in the community at risk of acute kidney injury.

Topics: Acute Kidney Injury; Adverse Drug Reaction Reporting Systems; Amlodipine; Amphotericin B; Australia; Case-Control Studies; Ciprofloxacin; Diclofenac; Furosemide; Humans; Ibuprofen; Metformin; Naproxen; Omeprazole; Primary Health Care; Ramipril; Simvastatin; Spironolactone; Sulfamethoxazole; Telmisartan; Trimethoprim; Valacyclovir; Zoledronic Acid

Topics: Acute Kidney Injury; Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Female; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications; Valacyclovir

Nonsteroidal anti-inflammatory drugs (NSAIDs) are likely to be used concomitantly with acyclovir or valacyclovir in clinical practice, but the study on the safety of such combinations was seldom reported. The objective of the study was to investigate reports of acute kidney injury (AKI) events associated with the concomitant use of oral acyclovir or valacyclovir with an NSAID by using the United States Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) database between January 2004 and June 2012. The frequency of AKI events in patients while simultaneously taking either acyclovir or valacyclovir and an NSAID was compared using the Chi-square test. The effect of concomitant use of acyclovir or valacyclovir and individual NSAIDs on AKI was analyzed by the reporting odds ratio (ROR). The results showed that AKI was reported as the adverse event in 8.6% of the 10923 patients taking valacyclovir compared with 8.7% of the 2556 patients taking acyclovir (p=NS). However, AKI was significantly more frequently reported in patients simultaneously taking valacyclovir and an NSAID (19.4%) than in patients simultaneously taking acyclovir and an NSAID (10.5%) (p<0.01). The results also suggested that increased risk of AKI was likely associated with the concomitant use of valacyclovir and some NSAIDs such as loxoprofen, diclofenac, etodolac, ketorolac, piroxicam or lornoxicam. The case series from the AERS indicated that compared with acyclovir, valacyclovir is more likely to be affected by NSAIDs, and the concomitant use of valacyclovir with some NSAIDs might be associated with increased risk of AKI. The drug interactions with this specific combination of medications are worth exploring further.

Topics: Acute Kidney Injury; Acyclovir; Adult; Adverse Drug Reaction Reporting Systems; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Chi-Square Distribution; Data Mining; Drug Interactions; Female; Humans; Japan; Kidney; Male; Middle Aged; Prodrugs; Risk; United States; United States Food and Drug Administration; Valacyclovir; Valine

Topics: Acute Kidney Injury; Administration, Oral; Aged; Angiotensin II Type 2 Receptor Blockers; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Oliguria; Valacyclovir

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Herpes Genitalis; Humans; Male; Valacyclovir; Valine

Little is known about the effects of drug-drug interactions between valacyclovir and non-steroidal anti-inflammatory drugs (NSAIDs). In this study, we analysed the adverse event 'acute kidney injury (AKI)' resulting from a possible interaction between loxoprofen (a non-selective NSAID) and valacyclovir in reports received by FDA Adverse Event Reporting System (AERS) database between January 2004 and June 2012.. Adverse event reports of elderly patients aged ≥65 years old were included in the study. Exposure categories were divided into three index groups (only valacyclovir or loxoprofen was used, and both drugs were concomitantly used) and a reference group (neither valacyclovir nor loxoprofen were used). Case/non-case AKI reports associated with these drugs were recorded and analysed by the reporting odds ratio (ROR).. In total, 447 002 reports were included in the study. The ROR, adjusted for year of reporting, age and sex, for an AKI in elderly patients who used only valacyclovir or loxoprofen compared with elderly patients who used neither valacyclovir nor loxoprofen was 4.6 (95%CI: 4.1-5.2) and 1.4 (95%CI: 1.2-1.6), respectively, while the adjusted ROR was 26.0 (95%CI: 19.2-35.3) when both drugs were concomitantly used.. Case reports in AERS are suggestive that interactions between valacyclovir and loxoprofen resulting in AKI may occur, while this association needs to be analysed by other methods in more detail in order to determine the real strength of the relationship.

Topics: Acute Kidney Injury; Acyclovir; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Drug Interactions; Female; Humans; Male; Odds Ratio; Phenylpropionates; Valacyclovir; Valine

Valacyclovir induced neurotoxicity is a life-threatening complication, usually starting 24-48 h after drug-peak serum concentrations. The elderly with impaired renal function seem to be the most susceptible group to valacyclovir neurotoxicity. Although hemodialysis is considered the best method for rapid drug removal, our case showed that intensive peritoneal dialysis regimen leads to the recovery of neurotoxicity after 3 days.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Kidney Failure, Chronic; Kidney Function Tests; Peritoneal Dialysis, Continuous Ambulatory; Risk Assessment; Treatment Outcome; Valacyclovir; Valine

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Crystallization; Drug Overdose; Humans; Male; Middle Aged; Uric Acid; Valacyclovir; Valine

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Herpesvirus 3, Human; Humans; Male; Valacyclovir; Valine

Topics: Acute Kidney Injury; Acyclovir; Antiviral Agents; Coma; Confusion; Female; Humans; Middle Aged; Valacyclovir; Valine