Abstract: PUB476
Valacyclovir Toxicity in Patients with ESKD: A Case Series
Session Information
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Eyasu, Nahom, Emory University, Atlanta, Georgia, United States
- Poobalasingham, Sonali, Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
- Feldman, Danielle, Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
- Rajabalan, Ajai S., Wellstar Health System Inc, Marietta, Georgia, United States
- Cobb, Jason, Emory University, Atlanta, Georgia, United States
Background
Valacyclovir (VCV), a cornerstone in managing herpes virus infections, poses unique challenges in ESRD patients. There is sparse literature on VCV toxicity in this population. More data is available regarding acyclovir toxicity, however, VCV has a longer duration of action and is becoming more commonly used.
Methods
We present two cases and a review of literature of VCV toxicity in ESRD patients.
Results
Case 1: A 33-year-old female with ESRD on peritoneal dialysis (PD) with a right-sided rash suspicious for zoster was prescribed oral VCV 1 g TID at an urgent care. Within 24 hours, she exhibited new-onset confusion and involuntary movements. Suspecting VCV toxicity, the medication was discontinued, and continuous PD provided symptom relief.
Case 2: A 54-year-old man with ESRD on hemodialysis (HD) was started on oral VCV 1 g TID for zoster at an urgent care and presented to us with visual and auditory hallucinations. Suspecting VCV neurotoxicity, emergent HD was performed, resulting in symptom resolution after one treatment.
Review:
19 total patients on different dialysis modalities: PD (9) and HD (10). Average age 61.6 years. 50% female (7), some case reports did not report gender. All HD patients appeared to respond to a single HD treatment. We were unable to determine specific treatment regimens for PD patients.
Conclusion
The literature on VCV toxicity in ESRD patients has been confined to only case reports and we are the first to present a literature review. VCV’s longer duration makes it the treatment of choice for herpes zoster, however, the occurrence of VCV toxicity in ESRD patients is likely to rise if not dosed correctly. PD patients comprise 11-12% of ESRD patients but are involved in 47% of VCV toxicity cases. We suspect that PD patients are more susceptible to VCV toxicity, which raises questions about the differential impact of dialysis modalities on its clearance. In addition, the older age of patients may play a role as well. The critical clinical presentation of our patients underscores the importance of both vigilant monitoring and the need to inform primary and urgent care physicians about the dosing of VCV in the setting of renal dysfunction – 1 g oral daily for ESRD patients.