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, N. J. Rhodes, I. A. Echenique, Michael Peter Angarone, M. H. Scheetz*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)350-355
Number of pages6
JournalJournal of Clinical Pharmacy and Therapeutics
Volume42
Issue number3
DOIs
StatePublished - Jun 1 2017

Keywords

  • acyclovir
  • adverse effects
  • pharmacodynamics
  • pharmacokinetics
  • statistical model

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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