Ernst M E, Franey R J
College of Pharmacy, University of Iowa, Iowa City, USA.
Ann Pharmacother. 1998 Jan;32(1):111-3. doi: 10.1345/aph.17135.
With increasing use of acyclovir and ganciclovir, primarily due to the increased number of AIDS and transplant patients, further cases of neurologic toxicity will undoubtedly be encountered. Discontinuation or dosage reduction of acyclovir and ganciclovir is necessary to manage neurologic toxicity that is directly attributed to either agent. Renal dysfunction is a known risk factor for acyclovir neurotoxicity, and case reports indicate that renal dysfunction may also be a risk factor for ganciclovir neurotoxicity. Since ganciclovir is structurally related to acyclovir, clinicians should monitor for signs and symptoms of neurotoxicity as they would with acyclovir until the risk factors are more clearly defined. Dosage reduction for both agents and increased monitoring should occur when renal dysfunction is present, to minimize the risk of neurotoxicity and other serious adverse effects. Tables 1 and 2 summarize the recommended dosages of acyclovir and ganciclovir, respectively, in the presence of renal dysfunction. However, as a few case reports describe, neurotoxicity from these agents has also occurred in patients with normal renal function. Therefore, clinicians should always remain vigilant in monitoring for signs of neurotoxicity when acyclovir or ganciclovir is administered, and have a high index of suspicion for these agents if neurotoxicity is encountered during therapy.
随着阿昔洛韦和更昔洛韦使用的增加，主要是由于艾滋病患者和移植患者数量的增多，无疑会遇到更多神经毒性病例。对于直接由这两种药物之一引起的神经毒性，必须停用或减少阿昔洛韦和更昔洛韦的剂量。肾功能不全是阿昔洛韦神经毒性的已知危险因素，病例报告表明肾功能不全也可能是更昔洛韦神经毒性的危险因素。由于更昔洛韦在结构上与阿昔洛韦相关，在危险因素更明确之前，临床医生应像监测阿昔洛韦那样监测神经毒性的体征和症状。当存在肾功能不全时，应减少这两种药物的剂量并加强监测，以将神经毒性和其他严重不良反应的风险降至最低。表1和表2分别总结了存在肾功能不全时阿昔洛韦和更昔洛韦的推荐剂量。然而，正如一些病例报告所描述的，这些药物的神经毒性也发生在肾功能正常的患者中。因此，临床医生在使用阿昔洛韦或更昔洛韦时应始终保持警惕，监测神经毒性体征，如果在治疗期间遇到神经毒性，对这些药物要有高度的怀疑指数。
