Oral Acyclovir and Neurotoxicity

Excerpt

To the Editor: Acyclovir (9- [ (2-hydroxyethoxy)methyl] guanine), an acyclic purine nuclease, is the treatment of choice for herpes zoster and varicella in the immunocompromised host. Adverse effects attributed to acyclovir therapy include nausea, vomiting, rash, phlebitis, myelosuppression, and decreased renal function. Neurotoxicity, manifested by vertigo, obtundation, headache, confusion, seizures, and tremor, has been linked to intravenous acyclovir therapy. To our knowledge, neurotoxicity has not been reported after oral acyclovir therapy. We present a case of neurotoxicity following orally administered acyclovir in a patient with end-stage renal disease.

A 76-year-old woman receiving chronic hemodialysis presented with a 2-day history of