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Review
. 2017 Jun;42(3):350-355.
doi: 10.1111/jcpt.12520. Epub 2017 Mar 29.

Resolution of acyclovir-associated neurotoxicity with the aid of improved clearance estimates using a Bayesian approach: A case report and review of the literature

W A Watson  1 , N J Rhodes  1   2 , I A Echenique  3 , M P Angarone  4 , M H Scheetz  1   2
Affiliations
Review

Resolution of acyclovir-associated neurotoxicity with the aid of improved clearance estimates using a Bayesian approach: A case report and review of the literature

W A Watson et al. J Clin Pharm Ther. 2017 Jun.

Abstract

What is known and objective: Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity.

Case summary: A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours.

What is new and conclusion: Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.

Keywords: acyclovir; adverse effects; pharmacodynamics; pharmacokinetics; statistical model.

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Conflict of interest statement

Conflicts of interest:

All authors: No relevant conflicts of interest.

References

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