How does acyclovir cause renal damage?
Acyclovir-induced nephrotoxicity is typically evident by an increase in the plasma creatinine level, abnormal urine sediment, or acute renal injury [8]. Acyclovir is rapidly excreted in the urine via glomerular filtration and tubular secretion, and reaches high concentrations in the tubular lumen.
What is the mechanism of acyclovir?
Mechanism of Action: Acyclovir is converted to its triphosphate form, acyclovir triphosphate (ACV-TP), which competitively inhibits viral DNA polymerase, incorporates into and terminates the growing viral DNA chain, and inactivates the viral DNA polymerase.
Is oral acyclovir nephrotoxic?
Acyclovir is one of the most common prescribed antiviral drugs. Acyclovir nephrotoxicity occurs in approximately 12–48% of cases. It can present in clinical practice as acute kidney injury (AKI), crystal-induced nephropathy, acute tubulointerstitial nephritis, and rarely, as tubular dysfunction.
How does acyclovir act as an antiviral?
Acyclovir is in a class of antiviral medications called synthetic nucleoside analogues. It works by stopping the spread of the herpes virus in the body. Acyclovir will not cure genital herpes and may not stop the spread of genital herpes to other people.
Why is acyclovir less toxic?
Activation of acyclovir to form the nucleoside triphosphate is dependent upon a promiscuous viral thymidine kinase; the low toxicity of acyclovir is due to the activation of acyclovir only in infected cells and the low inhibition of cellular replication (19).
Is acyclovir bad for liver?
Hepatotoxicity. Despite widespread use, there is little evidence that acyclovir when given orally causes significant liver injury. Serum enzyme levels generally do not change during oral acyclovir therapy.
Can a kidney injury be caused by acyclovir?
The possibility for chronic kidney injury is a strong concern if the renal insufficiency is not rapidly detected [2]. In addition, there is strong evidence that acyclovir/valacyclovir can also cause neurotoxicity in the setting of kidney injury, which could further complicate the patient’s clinical picture [4].
Which is the most common side effect of acyclovir?
Acute kidney injury is a well-described side effect of acyclovir, the most common mechanism being crystal nephropathy. Unfortunately, although the side-effects of acyclovir are well known, they are often underappreciated.
What was the case of acyclovir nephrotoxicity?
P. K. Sodhi and S. K. Ratan, “A case of chronic renal dysfunction following treatment with oral acyclovir,” Scandinavian Journal of Infectious Diseases, vol. 35, no. 10, pp. 770–772, 2003. View at: Publisher Site | Google Scholar
When to use famciclovir instead of acyclovir?
There is limited evidence that famciclovir may be substituted for acyclovir if renal toxicity develops for treatment of certain infections [5]. In patients that develop severe renal failure or do not respond to treatment, hemodialysis is an option to remove the offending drug and support renal function [1].