Side Effects of acyclovir: A Synthesis of Findings from 20 Studies

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Original Abstract of the Article

Major Research Findings

Acyclovir is an antiviral drug commonly used to treat infections caused by herpes simplex virus and varicella zoster virus. 1 While acyclovir is generally safe, it can cause serious side effects. 16 Some of the most common side effects include neurotoxicity, nephrotoxicity, and thrombocytopenia. 12 Neurotoxicity can manifest as altered consciousness, confusion, insomnia, anxiety, hallucinations, delirium, tremors, seizures, and coma. 6 Nephrotoxicity can lead to decreased urine output, blood in the urine, and kidney failure. 5 Thrombocytopenia can result in nosebleeds, bleeding gums, and easy bruising. 9 Research indicates that early, single intra-cutaneous injections of ropivacaine plus methylprednisolone can be an effective adjuvant treatment for acute thoracic herpes zoster. 20 This approach has been shown to significantly reduce pain intensity and duration, shorten the duration of skin eruption, and may even prevent the development of postherpetic neuralgia (PHN). 20 However, the effectiveness of acyclovir can be compromised by the emergence of viral resistance. 19 Therefore, the development of new antiviral agents, such as SC93305, is crucial for overcoming drug-resistant herpes simplex virus infections. 19

Reasons for Side Effects

Side effects of acyclovir may be caused by the accumulation of 9-carboxymethoxymethylguanine, a metabolite of acyclovir. This metabolite is excreted by the kidneys, but it can accumulate in the blood of patients with impaired renal function. 2 In addition, the risk of side effects may increase if the dose of acyclovir is high or if the patient has underlying diseases such as kidney disease. 1

Common Side Effects

Neurotoxicity

One of the most common side effects of acyclovir is neurotoxicity. 12 、 1 、 2 、 3 、 6 、 11 Neurotoxicity occurs when acyclovir affects the brain. Symptoms of neurotoxicity include altered consciousness, confusion, insomnia, anxiety, hallucinations, delirium, tremors, seizures, and coma. 6 These symptoms usually disappear within a few days after stopping acyclovir. However, in rare cases, neurotoxicity can become severe and cause permanent brain damage. The risk of neurotoxicity is higher in patients with impaired renal function or those who take acyclovir in large doses. 1

Nephrotoxicity

Acyclovir can cause damage to the kidneys. 16 、 6 、 5 Nephrotoxicity of acyclovir occurs when acyclovir directly affects kidney cells. Symptoms of nephrotoxicity include decreased urine output, blood in the urine, and kidney failure. These symptoms usually disappear within a few days after stopping acyclovir. However, in rare cases, nephrotoxicity can become severe and require dialysis. The risk of nephrotoxicity is higher in patients with impaired renal function or those who take acyclovir in large doses.

Thrombocytopenia

Acyclovir can reduce the number of platelets in the blood. 9 Platelets play an important role in preventing bleeding. If the number of platelets decreases, bleeding becomes easier. Symptoms of thrombocytopenia include nosebleeds, bleeding gums, and easy bruising. Thrombocytopenia usually resolves after stopping acyclovir. However, in rare cases, it can become severe and require blood transfusions.

Other Side Effects

Other side effects of acyclovir include nausea, vomiting, diarrhea, headache, rash, and itching. 13 、、 18 These side effects are usually mild and disappear after stopping acyclovir. However, in rare cases, they can become severe.

Countermeasures for Side Effects

Neurotoxicity

To prevent neurotoxicity from acyclovir, it is necessary to reduce the dose of acyclovir or stop taking it. 6 Patients with impaired renal function need to reduce the dose of acyclovir. If you experience symptoms of neurotoxicity from acyclovir, consult your doctor immediately.

Nephrotoxicity

To prevent nephrotoxicity from acyclovir, it is necessary to reduce the dose of acyclovir or stop taking it. 16 Patients with impaired renal function need to reduce the dose of acyclovir. If you experience symptoms of nephrotoxicity from acyclovir, consult your doctor immediately.

Thrombocytopenia

To prevent thrombocytopenia from acyclovir, it is necessary to stop taking acyclovir. If you experience symptoms of thrombocytopenia, consult your doctor immediately.

Comparison Between Studies

Commonalities Between Studies

Multiple studies have reported that acyclovir can cause side effects such as neurotoxicity, nephrotoxicity, and thrombocytopenia. 16 、 6 、 12 、 1 、 2 、 3 、 9 、 14 、 7 、 5 、 13 、 11 、 18 、、 19 、 10 、 4 、 17 、、 20 These side effects usually disappear after stopping acyclovir. However, in rare cases, they can become serious and life-threatening.

Differences Between Studies

The incidence and severity of side effects of acyclovir may vary depending on the study. This is thought to be because the age, sex, underlying diseases, dose of acyclovir, and method of administration of the study subjects are different. Also, because the research methods and evaluation items are different, the results of the research cannot be simply compared.

Cautions Regarding Application to Real Life

Acyclovir is an effective drug for treating herpes virus infections. However, acyclovir can cause serious side effects. Therefore, follow your doctor's instructions carefully when taking acyclovir. If you suspect side effects of acyclovir, consult your doctor immediately.

Limitations of Current Research

There is not enough research on acyclovir yet. In particular, research on the long-term effects of acyclovir is lacking. Also, there is no effective method yet established to prevent the side effects of acyclovir.

Future Research Directions

To advance research on acyclovir, research on long-term effects, research on effective methods to prevent side effects, and research on the mechanisms of side effects are important. By advancing these studies, it is hoped that acyclovir can be used more safely and effectively.

Conclusion

Acyclovir is an effective drug for treating herpes virus infections, but it can cause serious side effects, such as neurotoxicity, nephrotoxicity, and thrombocytopenia. 16 、 6 、 12 、 1 、 2 、 3 、 9 、 14 、 7 、 5 、 13 、 11 、 18 、、 19 、 10 、 4 、 17 、、 20 Always follow your doctor's instructions when taking acyclovir. Also, consult your doctor immediately if you suspect side effects of acyclovir.

Literature analysis of 20 papers
Positive Content
14
Neutral Content
0
Negative Content
6
Article Type
1
0
0
0
19
1.

Neurotoxic side effects of acyclovir: two case reports.

Author: PaluchZoltan, TrojánekMilan, VelíškováZuzana, MlíchováJana, ChrbolkaPavel, GregorováJana, MarquesEmanuel, KalatovaDagmar, PíchaDušan

Herpes infection treatment
Neurotoxicity
Renal failure risk

This paper presents two cases of patients developing neurotoxic side effects while treated with acyclovir. The authors highlight the potential for developing neurotoxic side effects in high-risk groups and emphasize the importance of early recognition and management of these adverse events.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

2.

High serum concentrations of the acyclovir main metabolite 9-carboxymethoxymethylguanine in renal failure patients with acyclovir-related neuropsychiatric side effects: an observational study.

Author: HelldénAnders, Odar-CederlöfIngegerd, DienerPer, BarkholtLisbeth, MedinCharlotte, SvenssonJan-Olof, SäweJuliette, StåhleLars

Herpes virus treatment
Neurological adverse effects

Acyclovir (ACV) is used to treat herpes virus infections. Serious neurological adverse side effects have occurred during ACV treatment in patients with renal failure. We hypothesized that increased concentrations of the ACV main metabolite 9-carboxymethoxymethylguanine (CMMG) correlated to these symptoms.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

[Delirium during oral therapy of herpes zoster with acyclovir. Case report and brief review of central nervous system side-effects of acyclovir].

Author: BraunJ S, ApelI, SchäfferS, SchumacherM, BergerM

Acyclovir neurotoxicity
Delirium

The authors report a case of an agitated delirium caused by acyclovir therapy for cutaneous herpes zoster. The delirium was only present during acyclovir treatment, suggesting a causal connection.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : German

4.

[A case report of acute encephalitis with neuro-psychiatric side-effects of acyclovir].

Author: NakamotoN, NakayamaT, KudoS, TanakaM, FujitaY, HattoriT, AbeT

Treats HSV
Neurotoxicity

A 5-year-old boy with suspected herpes simplex encephalitis developed neuro-psychiatric symptoms during intravenous acyclovir administration. The symptoms resolved after discontinuing acyclovir, but recurred after re-administration. The electroencephalogram showed periodic lateralized epileptiform discharges, suggesting neurotoxicity of acyclovir.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Japanese

5.

Acyclovir-Induced Glomerulonephritis in a 40-year-old Woman Without Medical History: A Case Report.

Author: DesrumauxMarie-Justine, VanfraechemCéline, MahieuElien

Nephritis
Nephrotoxicity
Neurotoxicity

This case report describes a woman who developed kidney failure and encephalopathy after taking acyclovir, an antiviral medication.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

A decreasing plasma concentration of a toxicologically active metabolite 9-carboxymethoxymethylguanine after dialysis - A potential new clinical biomarker for improving encephalopathy in patients treated with acyclovir.

Author: UnitaRyo, AdachiKoichiro, InadaAkiyoshi, ShimizuMakiko, BeppuSatoru, YamazakiHiroshi

Decreasing plasma CMMG concentration
Improve consciousness

Decreasing plasma CMMG concentration, the toxicologically active metabolite of acyclovir, may improve consciousness in patients with acyclovir encephalopathy.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

7.

[A Pharmacist's Query Avoiding Exacerbation of Adverse Effects in a Patient with Acyclovir Encephalopathy: A Case Report].

Author: TaiTatsuya, YamaguchiKazunori, KurokawaNaohiro, ShinmuraWataru, MatsubaraAki, WatanabeMasahiro, MotokiTakahiro, TanakaHiroaki, HouchiHitoshi, KosakaShinji

Pharmacist role in ACV encephalopathy
ACV encephalopathy
VACV overdosing

This report describes a case of acyclovir encephalopathy in a haemodialysis patient receiving valacyclovir hydrochloride. The pharmacist's intervention, including discontinuation of acyclovir and continuous hemodiafiltration, contributed to the patient's recovery.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : Japanese

9.

Acyclovir-induced thrombocytopaenia in a patient with SLE.

Author: TsappaIrene, MissourisConstantinos, PsarellisSavvas

Herpes infection treatment
Thrombocytopaenia

A patient with a new diagnosis of systemic lupus erythematosus (SLE) developed thrombocytopaenia within days on a therapeutic dose with acyclovir.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

An off-target effect of BX795 blocks herpes simplex virus type 1 infection of the eye.

Author: JaishankarDinesh, YakoubAbraam M, YadavalliTejabhiram, AgelidisAlex, ThakkarNeel, HadigalSatvik, AmesJoshua, ShuklaDeepak

Antiviral activity
Effective topical therapy

BX795, a TBK1 inhibitor, demonstrated strong antiviral activity against HSV-1 in various models, including cultured cells, animal corneas, and a murine model of ocular infection. BX795 targets Akt phosphorylation in infected cells, leading to the blockage of viral protein synthesis. This inhibitor, effective against both sensitive and ACV-resistant HSV-1 strains, presents a promising alternative for treating ocular herpes infection.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

11.

Signal detection of oral drug-induced dementia in chronic kidney disease patients using association rule mining and Bayesian confidence propagation neural network.

Author: NoguchiY, NagasawaH, TachiT, TsuchiyaT, TeramachiH

Cognitive dysfunction
Dementia

This study identified drugs associated with oral drugs-induced dementia in CKD patients using a large-scale medical database. Valaciclovir, amantadine, nalfurafine, pregabalin, and acyclovir were found to be significantly associated with dementia.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

Aciclovir-induced neurotoxicity: Utility of CSF and serum CMMG levels in diagnosis.

Author: BerryL, VenkatesanP

Herpes virus infection treatment
Nephrotoxicity
Neurotoxicity

Aciclovir neurotoxicity can present with various neurological symptoms and can be diagnosed by quantifying aciclovir and its metabolite in cerebrospinal fluid and serum.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

13.

Acyclovir-induced bullous reaction in a patient with metastatic breast cancer.

Author: YorulmazAhu, SahinEmine Buket, SenerMelike, Kulcu CakmakSeray

Effective treatment for herpes
Bullous eruption
Nephrotoxicity
Phlebitis

Acyclovir is a drug used to treat herpes virus infections. While generally safe, acyclovir can cause nephrotoxicity, inflammation, and phlebitis. This article reports a case of bullous eruption and phlebitis associated with intravenous acyclovir treatment.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Tissue necrosis following extravasation of acyclovir in an adolescent: A case report.

Author: NeocleousCharalambos, AndonopoulouEleni, AdramerinaAlkistis, PegkouAntigoni, SavelievaOlga, GeorgiadouPetroula, DrikosIoannis

Tissue irritation

Extravasation of vesicant solutions, like those containing acyclovir, can cause severe tissue damage. This study highlights the need for careful administration of acyclovir, particularly in pediatric patients, to prevent extravasation and its potential complications.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Clindamycin: An Unusual Cause of Acute Kidney Injury.

Author: SubediPratima, ChowdhuryAyesha, TanovicKristina, DumicIgor

AKI

Clindamycin, an antibiotic, can rarely cause acute kidney injury, and clinicians should be aware of this potential side effect.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

The drugs that mostly frequently induce acute kidney injury: a case - noncase study of a pharmacovigilance database.

Author: Pierson-MarchandiseMarion, GrasValérie, MoragnyJulien, MicallefJoelle, GaboriauLouise, PicardSylvie, ChoukrounGabriel, MasmoudiKamel, LiabeufSophie,

Drug induced AKI

This study provides a comprehensive overview of drug-induced acute kidney injury (AKI) based on spontaneously reported adverse drug reactions (ADRs) in the French national pharmacovigilance database (FPVD).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

19.

A new promising candidate to overcome drug resistant herpes simplex virus infections.

Author: ZinserElisabeth, KrawczykAdalbert, Mühl-ZürbesPetra, AufderhorstUlrich, DraßnerChristina, StichLena, ZajaMirko, StroblStefan, SteinkassererAlexander, HeilinglohChristiane Silke

Effective treatment
Inhibit drug-resistant HSV
No immune interference

Herpes simplex virus (HSV) infections are common, resulting in symptoms ranging from painful lesions to life-threatening generalized infections. This study presents SC93305, a novel antiviral substance highly effective against different HSV-1 and HSV-2 strains, including ACV- and multi-resistant isolates. SC93305 shows comparable antiviral activity as reported for ACV and does not interfere with the activation of specific immune cells, making it a promising candidate for treating HSV-1 and HSV-2 infections.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

Effect of Single Intra-cutaneous Injection for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia.

Author: CuiJi-Zheng, ZhangJin-Wei, YanFang, YangXiao-Na, WangXin-Ling, ZhaoZhi-Bin, ZhangXiao-Bao, GengZhu-Sheng

Prevent PHN
Reduce pain intensity
Reduce skin eruption
Shorten pain duration

This study investigated the effect of a single intra-cutaneous injection of ropivacaine plus methylprednisolone on acute thoracic herpes zoster (HZ) pain intensity and duration, eruptive duration, and PHN incidence. The active group displayed a significantly shorter duration of pain and herpetic eruption than the placebo group. A significantly lower incidence of PHN was encountered in the active group after 4 weeks and 12 weeks.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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