From the Guidelines
To prevent crystalline nephropathy from acyclovir, it is recommended to ensure adequate hydration by administering intravenous fluids, such as 0.9% sodium chloride, at a rate of 1 mL/kg/h for at least 2 hours before and after acyclovir administration 1.
Key Recommendations
- The dose of acyclovir should not exceed 20 mg/kg per dose, and the infusion rate should not exceed 10 mg/kg/h 1.
- For patients with pre-existing renal impairment, the dose of acyclovir should be adjusted according to creatinine clearance 1.
- Monitoring of urine output, serum creatinine, and acyclovir trough levels is also recommended to minimize the risk of nephropathy 1.
Additional Considerations
- Patients with pre-existing renal impairment are at higher risk of developing crystalline nephropathy, and therefore require closer monitoring and dose adjustment 1.
- The use of lipid-associated formulations of amphotericin B may be considered in patients who develop nephrotoxicity with conventional amphotericin B 1.
- Cidofovir should be used with caution in patients with pre-existing renal impairment, and the dose should be adjusted according to creatinine clearance 1.
From the FDA Drug Label
Administration of acyclovir by intravenous infusion must be accompanied by adequate hydration. To prevent crystalline nephropathy caused by Acyclovir, adequate hydration is recommended when administering the drug by intravenous infusion 2.
From the Research
Prophylaxis for Crystalline Nephropathy Caused by Acyclovir
To prevent crystalline nephropathy caused by Acyclovir, the following prophylaxis is recommended:
- Adequate hydration of the patient 3, 4, 5, 6, 7
- Slow intravenous infusion of Acyclovir over one hour 3
- Adjustment of dosage in patients with preexisting impaired renal function 3
- Ensuring hydration, frequent evaluations of renal function, and corresponding dose adjustment of intravenous Acyclovir treatment 6
- Administering Acyclovir in a sufficient volume of fluid, with a median volume of 250 mL or more 4
- Hydration volume of more than 2 L/day 5
Key Considerations
- Hypertension is a predictive factor associated with nephrotoxicity 6
- The absence of co-morbidities is protective against nephrotoxicity 6
- Nephrotoxicity is reversible following rehydration and dose reduction or discontinuation of the drug 6
- Crystalluria and obstructive nephropathy are mechanisms of Acyclovir-induced renal failure in humans 7