Adverse neuropsychiatric effects of cytomegalovirus prophylaxis with valaciclovir in renal transplant recipients
Open Access
- 9 January 2006
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 21 (5), 1395-1401
- https://doi.org/10.1093/ndt/gfk031
Abstract
Background. Valaciclovir (VACV) has been reported to induce adverse neuropsychiatric effects (ANE), especially in patients with renal failure, but few data are available for renal transplant recipients (RTR). Methods. We conducted a retrospective study in RTR given VACV as cytomegalovirus prophylaxis, from January 1999 to December 2000, to define the incidence rate, type and outcome of VACV-induced ANE, and to identify risk factors for ANE. The VACV-induced ANE were defined as neuropsychiatric disorders justifying VACV dose reduction or withdrawal. Patients with and without VACV-induced ANE were compared by univariate and multivariate analysis. Results. In all, 167 RTR were included, of whom 25 (15%) displayed VACV-induced ANE (mainly hallucinations and confusion), which occurred with a mean of 4 days after the start of VACV. ANE were reversible in all cases. Multivariate analysis showed that delayed graft function (DGF) was the main risk factor for VACV-induced ANE [Odds ratio (OR): 12.1; 95% CI = 3.4–43.4; P = 0.0001]. All VACV doses given to patients with ANE were in accordance with the current recommended adaptation to estimated glomerular filtration rate (GFR). Conclusion. In RTR, VACV-induced ANE are significantly frequent but reversible. DGF occurrence is the main risk factor for these ANE. In RTR with DGF, the recommended doses for GFR below 10 ml/min might be too high. Several strategies, in RTR with DGF, might lower the risk of ANE, including reduction of the currently recommended VACV dosage, delayed VACV introduction until improvement of renal function, or use of another anti-cytomegalovirus drug.Keywords
This publication has 17 references indexed in Scilit:
- Evaluation of Pharmacokinetic Interactions After Oral Administration of Mycophenolate Mofetil and Valaciclovir or Aciclovir to Healthy SubjectsClinical Pharmacokinetics, 2004
- Comparative study of prophylactic oral ganciclovir and valacyclovir in high-risk kidney transplant recipientsNephrology Dialysis Transplantation, 2003
- Toxicité neurologique induite par le Zelitrex® (valaciclovir) chez trois patients insuffisants rénaux. Surdosage lié à l’amélioration de la biodisponibilité du produit ?La Revue de Médecine Interne, 2001
- ValaciclovirDrugs, 2000
- Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal TransplantationNew England Journal of Medicine, 1999
- Neurotoxicity Caused by Valacyclovir in a Patient on HemodialysisTherapeutic Drug Monitoring, 1998
- Acyclovir- and Ganciclovir-Induced NeurotoxicityAnnals of Pharmacotherapy, 1998
- Acyclovir Neurotoxicity: Clinical Experience and Review of the LiteratureSouthern Medical Journal, 1994
- Acyclovir-induced neurotoxicity: Concentration-side effect relationship in acyclovir overdoseAmerican Journal Of Medicine, 1993
- Influence of hemodialysis on acyclovir pharmacokinetics in patients with chronic renal failureAmerican Journal Of Medicine, 1982