Acyclovir is an important antiviral agent in the therapy of herpes simplex and varicella zoster virus infections, Drug Med

Acyclovir is an important antiviral agent in the therapy of herpes simplex and varicella zoster virus infections

Acyclovir is an important antiviral agent in the therapy of herpes simplex and varicella zoster virus infections . Although the drug is well tolerated, severe nephrotoxicity, which often leads to acute renal failure, has been observed in patients . Acyclovir-induced renal failure occurs in approximately 12–48 % of cases . The optimal usage of acyclovir is very important in order to avoid its potentially life-threatening complications. Acyclovir-induced nephrotoxicity is typically evident by an increase in the plasma creatinine level, abnormal urine sediment, or acute renal injury . Acyclovir is rapidly excreted in the urine via glomerular filtration and tubular secretion, and reaches high concentrations in the tubular lumen. Renal excretion of unchanged drug reaches approximately 60–90 % . Acyclovir is relatively insoluble in the urine, particularly in the distal tubular lumen . Rapid intravenous administration of high-dose acyclovir is associated with high luminal concentrations of this drug and the intratubular precipitation of crystals can cause renal injury . Typically, crystalluria develops within 24–48 h of the initiation of acyclovir therapy. Severe intraparenchymal precipitation of crystals can cause interstitial congestion and hemorrhage, leading to a decrease of renal blood flow .

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