valacyclovir and Neutropenia

It is common practice to administer acyclovir as prophylaxis to patients with hematologic malignancies during neutropenia; however, effective therapy requires frequent dosing, which is difficult in this setting. Valacyclovir has greater oral bioavailability and requires less frequent dosing.. To evaluate the efficacy and safety of valacyclovir compared with acyclovir.. Patients who had been treated with chemotherapy or stem-cell transplantation were randomized to receive acyclovir 400 mg orally 3 times daily (n = 51), valacyclovir 500 mg orally twice daily (n = 48), or valacyclovir 250 mg orally twice daily (n = 52) during neutropenia.. Clinical success, defined as the absence of an active herpes simplex virus (HSV) lesion or asymptomatic viral shedding, was similar between the 3 groups (acyclovir 96%, valacyclovir 500 mg 95%, valacyclovir 250 mg 100%). The overall rates of adverse events were similar in the 3 groups.. Prophylactic treatment with valacyclovir is an effective and safe alternative to acyclovir for the prevention of HSV reactivation in patients with hematologic malignancies.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antineoplastic Agents; Antiviral Agents; Biological Availability; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hematologic Neoplasms; Herpes Simplex; Humans; Male; Middle Aged; Neutropenia; Single-Blind Method; Stem Cell Transplantation; Valacyclovir; Valine

Posttransplant leukopenia is frequently observed in renal transplant. Granulocyte colony-stimulating factor controls the production of functional neutrophils and their release into peripheral blood. Granulocyte colony-stimulating factor has been widely and frequently used for many conditions and disorders in the field of hematology and oncology.. We present the cases of valacyclovir-related and valganciclovir-related neutropenia in 2 renal transplant recipients.. Both cases had renal transplants from live donors. The first one was an 18-year-old man. Laboratory investigations revealed his leukocyte count as 1.7 x 10(9)/L. The patient was using mycophenolate mofetil, cyclosporine, and valganciclovir. Mycophenolate mofetil was stopped because he had neutropenia, and later, valganciclovir was also stopped because the neutropenia persisted. Because the neutropenia did not recover after we discontinued valganciclovir, the patient was administered granulocyte colony-stimulating factor. The neutrophil count increased to 2.2 x 10(9)/L (leucocyte count to 6.5 x 10(9)/L) after 24 hours. The second case was a 37-year-old man and was using mycophenolic acid, tacrolimus, and valacyclovir. Laboratory investigations revealed his leukocyte count to be 1.3 x 10(9)/L. Mycophenolic acid and valganciclovir were stopped owing to neutropenia. The patient was administered granulocyte colony-stimulating factor, and the neutrophil count increased to 3.8 x 10(9)/L (leucocyte count to 5.8 x 10(9)/L). The kidney functions did not deteriorate in either patient, and the patients' kidney functions were similar to baseline levels 12 months after surgery.. We conclude that granulocyte colony-stimulating factor can be used safely and effectively in renal transplant patients.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cytomegalovirus Infections; Filgrastim; Ganciclovir; Granulocyte Colony-Stimulating Factor; Humans; Kidney Transplantation; Male; Neutropenia; Recombinant Proteins; Treatment Outcome; Valacyclovir; Valganciclovir; Valine

Mycophenolate mofetil (MMF) is a drug which decreases the frequency of renal transplantation rejection. However, cytomegalovirus infections are a common feature of this treatment leading the physicians to prescribe antiviral prophylactic drugs like valacyclovir. During this association, neutropenia occur and the cause of this adverse effect is difficult to define. This report presents a case of neutropenia in a woman treated with MMF and valacyclovir. As the duration of the valacyclovir treatment exactly corresponds to the neutropenia duration, and the mycophenolate trough levels increased with the neutrophil count, the responsibility of this neutropenia was ascribed to valacyclovir. However, an examination of the literature for cases of neutropenia led to the suspicion of an interaction between MMF and valacyclovir. Mycophenolate may increase intracellular concentrations of valacyclovir up to haematotoxic levels. This mechanism may explain the interaction and further research is needed to confirm this interaction.

Topics: Acyclovir; Antiviral Agents; Cytomegalovirus Infections; Drug Interactions; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Neutropenia; Valacyclovir; Valine