HEMODIALYSIS REMOVAL OF ACYCLOVIR

A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes tester and begun on 800 mg acyclovir 5 times da ily. Two days later the patient developed visual hallucinations, ataxi a, confusion and memory loss along with focal myoclonus, nausea and vo miting. No fever, elevated WBC count or significant electrolyte imbala nce was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 mu g/ml (normal peak range 0.4-2 mu g/ml ) prior to dialysis. After 3 h of hemodialysis, her post-dialysis. acy clovir level was 1.9 mu g/ml. After a second course of hemodialysis th e next day the patient's mental status improved, and she was discharge d 5 d later. Due to its low volume of distribution (0.6 L/kg), low pro tein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of t he total body amount can be extracted through a 3-h course of hemodial ysis with resultant improvement in symptoms.