Hemodialysis removal of acyclovir

Vet Hum Toxicol. 1995 Jun;37(3):233-4.


A 59-y-old with a history of chronic renal failure on hemodialysis was diagnosed with herpes zoster and begun on 800 mg acyclovir 5 times daily. Two days later the patient developed visual hallucinations, ataxia, confusion and memory loss along with focal myoclonus, nausea and vomiting. No fever, elevated WBC count or significant electrolyte imbalance was found. CT scan of the brain was unremarkable. The patient was then dialyzed for presumed acyclovir toxicity. Her acyclovir level was later found to have been 3.4 micrograms/ml (normal peak range 0.4-2 micrograms/ml) prior to dialysis. After 3 h of hemodialysis, her post-dialysis acyclovir level was 1.9 micrograms/ml. After a second course of hemodialysis the next day the patient's mental status improved, and she was discharged 5 d later. Due to its low volume of distribution (0.6 L/kg), low protein binding (about 15%) and water solubility, acyclovir is an example of the ideal drug that can be removed by hemodialysis. About 45% of the total body amount can be extracted through a 3-h course of hemodialysis with resultant improvement in symptoms.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / administration & dosage
  • Acyclovir / adverse effects*
  • Acyclovir / therapeutic use
  • Acyclovir / urine
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Antiviral Agents / urine
  • Ataxia / chemically induced
  • Blood Chemical Analysis
  • Female
  • Hallucinations / chemically induced
  • Herpes Zoster / complications
  • Herpes Zoster / drug therapy*
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy
  • Memory / drug effects
  • Middle Aged
  • Myoclonus / chemically induced
  • Nausea / chemically induced
  • Renal Dialysis*
  • Vomiting / chemically induced


  • Antiviral Agents
  • Acyclovir