Morris D J
Department of Pathological Sciences, Medical School, Manchester, England.
Drug Saf. 1994 Apr;10(4):281-91. doi: 10.2165/00002018-199410040-00002.
Most antiviral drugs are nucleoside analogues with potential teratogenic, embryotoxic, carcinogenic and antiproliferative activities. They must be administered with caution during pregnancy, because some are known teratogens (e.g. amantadine) and a similar propensity cannot be entirely excluded for others (e.g. aciclovir). Their adverse effects mostly involve bone marrow depression (e.g. granulocytopenia with ganciclovir, anaemia with zidovudine) or neurotoxicity (e.g. seizures with interferon-alpha, peripheral neuropathy with zalcitabine), although gastrointestinal effects are also seen. Idiosyncratic reactions include didanosine-induced acute pancreatitis. Only inosine pranobex is largely free from toxicity. Idoxuridine must be administered topically, given the severity of its systemic adverse effects. Drug interactions involving antiviral agents mostly reflect shared toxicity with other agents (e.g. neutropenia with ganciclovir and zidovudine, pancreatitis with didanosine and alcohol), although renal excretion or hepatic metabolism may be implicated. Given the possibility of severe adverse reactions and drug interactions, antiviral chemotherapy should only be used for potentially serious virus infections. Topical administration avoids systemic adverse effects but not mutagenic risks, and may result in exposure of individuals other than the patient (e.g. aerosolised ribavirin).
大多数抗病毒药物是核苷类似物，具有潜在的致畸、胚胎毒性、致癌和抗增殖活性。孕期使用时必须谨慎，因为有些药物是已知的致畸剂（如金刚烷胺），其他药物（如阿昔洛韦）也不能完全排除类似风险。它们的不良反应主要包括骨髓抑制（如更昔洛韦导致粒细胞减少、齐多夫定导致贫血）或神经毒性（如α干扰素导致癫痫发作、扎西他滨导致周围神经病变），不过也可见胃肠道反应。特异反应包括去羟肌苷引起的急性胰腺炎。只有异丙肌苷基本无毒性。由于碘苷全身不良反应严重，必须局部给药。涉及抗病毒药物的药物相互作用大多反映出与其他药物有共同毒性（如更昔洛韦和齐多夫定导致中性粒细胞减少、去羟肌苷和酒精导致胰腺炎），不过也可能涉及肾脏排泄或肝脏代谢。鉴于可能出现严重不良反应和药物相互作用，抗病毒化疗仅应用于可能严重的病毒感染。局部给药可避免全身不良反应，但无法避免诱变风险，且可能导致患者以外的其他人接触药物（如雾化的利巴韦林）。
