Brandariz-Nuñez David, Correas-Sanahuja Marcelo, Maya-Gallego Sara, Martín Herranz Isabel
Pharmacy Service, A Coruña University Hospital Complex (CHUAC), A Coruña, Spain.
Pharmacy Service, Sagrat Cor Hospital, Barcelona, Spain.
J Clin Pharm Ther. 2021 Aug;46(4):918-926. doi: 10.1111/jcpt.13464. Epub 2021 Jun 19.
Acyclovir and valacyclovir are commonly used antivirals with good general tolerance. Despite their good safety profile, they can cause systemic adverse effects, such as neurotoxicity, which are less frequent and known. The objective of this review was to collect all the reported cases of neurotoxicity associated with acyclovir and valaciclovir published in the literature and characterize their clinical course and interventions.
A systematic review of cases was carried out following the guidelines established by "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA). The research was carried out using the PubMed-Medline and Embase databases, between July 1984 and March 2021.
A total of 119 cases with neurotoxicity mainly related to acyclovir (n = 88; 73.9%), followed by valaciclovir (n = 35; 29.4%) were analysed. 49.6% (n = 59) were men with a mean age of 59.5 years ± 21.1 (0.5-88). In 83.3% of the cases, renal impairment was documented and 57.1% (n = 68) with end-stage renal disease. The administered dose was higher than the renal adjustment recommendations in 59.7% of the cases. The global mean of onset of symptoms was 3.1 days ± 4.3 (0.2-28) after the start of antivirals. The mean recovery time was 9.8 days ± 21.7 (0.2-180). 74.4% of the patients had a recovery of ≤7 days, 15.9% between 8 and 15 days and 9.8% > 15 days.
The neurotoxicity induced by acyclovir and its derivative valacyclovir is a poorly known and rare adverse effect that can occur mainly in patients with advanced age and impaired renal function. The most characteristic symptoms are confusion, altered level of consciousness, hallucinations, agitation and dysarthria. The basis of treatment is the discontinuation of the antiviral, and in some cases, it may require additional clearance by dialysis.
阿昔洛韦和伐昔洛韦是常用的抗病毒药物，一般耐受性良好。尽管它们具有良好的安全性，但仍可引起全身不良反应，如神经毒性，不过这种情况较为少见且已为人所知。本综述的目的是收集文献中报道的所有与阿昔洛韦和伐昔洛韦相关的神经毒性病例，并描述其临床病程及干预措施。
按照《系统评价和荟萃分析的首选报告项目》（PRISMA）制定的指南对病例进行系统评价。研究于1984年7月至2021年3月期间使用PubMed - Medline和Embase数据库进行。
共分析了119例主要与阿昔洛韦相关的神经毒性病例（n = 88；73.9%），其次是伐昔洛韦（n = 35；29.4%）。49.6%（n = 59）为男性，平均年龄59.5岁±21.1（0.5 - 88岁）。83.3%的病例有肾功能损害记录，57.1%（n = 68）为终末期肾病。59.7%的病例给药剂量高于肾脏调整建议剂量。症状出现的总体平均时间为开始使用抗病毒药物后3.1天±4.3（0.2 - 28天）。平均恢复时间为9.8天±21.7（0.2 - 180天）。74.4%的患者在≤7天内恢复，15.9%在8至15天恢复，9.8%超过15天恢复。
阿昔洛韦及其衍生物伐昔洛韦引起的神经毒性是一种鲜为人知的罕见不良反应，主要发生在老年和肾功能受损的患者中。最典型的症状是意识模糊、意识水平改变、幻觉、躁动和构音障碍。治疗的基础是停用抗病毒药物，在某些情况下，可能需要通过透析进行额外的清除。
