Department of Pharmacology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Infectious Diseases, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Neuro Endocrinol Lett. 2021 Oct;42(6):375-382.
Acyclovir is an antiviral drug frequently used in clinical practice. It is indicated for the treatment of infections caused by herpes simplex virus and varicella zoster virus. The drug has a good safety profile; however, severe side effects may rarely occur during therapy. These include renal failure as a major risk factor for neurotoxic side effects potentially developing within 24-48 hours of therapy initiation. The paper presents the cases of two patients developing neurotoxic side effects while treated for herpes zoster. The aim of the authors is to highlight the potential for developing neurotoxic side effects in high-risk groups such as the elderly, patients with impaired renal function or multiple comorbidities on polypharmacy, or those using nephrotoxic drugs. Acyclovir use could lead to renal impairment and an increase in its plasma and CNS concentrations with severe neuropsychiatric side effects. The neurotoxic side effects are reversible after therapy withdrawal. Thus, in patients developing mental impairment or showing other neurological symptoms during acyclovir therapy, the patient should be promptly assessed for potential drug neurotoxicity, their therapy should be discontinued and drug elimination with forced diuresis or hemodialysis considered. Early recognition of acyclovir neurotoxic side effects can significantly improve a patient's prognosis.
阿昔洛韦是一种常用于临床实践的抗病毒药物。它用于治疗单纯疱疹病毒和水痘带状疱疹病毒引起的感染。该药物具有良好的安全性，但在治疗过程中可能很少发生严重的副作用。这些副作用包括肾功能衰竭，是治疗开始后 24-48 小时内可能发生神经毒性副作用的主要危险因素。本文介绍了两名带状疱疹患者在接受治疗时出现神经毒性副作用的病例。作者的目的是强调在高危人群中可能发生神经毒性副作用的风险，例如老年人、肾功能受损或多种合并症的患者、或正在使用肾毒性药物的患者。阿昔洛韦的使用可能导致肾功能损害和其血浆和中枢神经系统浓度增加，从而导致严重的神经精神副作用。神经毒性副作用在停药后是可逆的。因此，在接受阿昔洛韦治疗的患者出现精神障碍或出现其他神经症状时，应及时评估患者是否存在潜在的药物神经毒性，应停止治疗，并考虑使用强力利尿或血液透析来清除药物。早期识别阿昔洛韦的神经毒性副作用可以显著改善患者的预后。
