Observational studyThe Journal of antimicrobial chemotherapy2019
An unexpectedly high occurrence of aciclovir-induced neuropsychiatric symptoms in patients treated for herpesvirus CNS infection: a prospective observational study.
Observational study in The Journal of antimicrobial chemotherapy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 22 citations in OpenAlex.
- Use of fomepizole as a novel approach for preventing aciclovir-induced neurotoxicity.The Journal of antimicrobial chemotherapy · 2026Article
- The Role of Metabolites in Acyclovir-Induced Neurotoxicity and Nephrotoxicity.Medicines (Basel, Switzerland) · 2026Review
- Marine Derived Natural Products: Emerging Therapeutics Against Herpes Simplex Virus Infection.Biomolecules · 2026Review
- Article
- Distribution of acyclovir in central nervous system compartments: a porcine pharmacokinetic model.Antimicrobial agents and chemotherapy · 2025Article
- Acyclovir Encephalopathy in HSV Encephalitis Elderly With Normal Renal Function.Case reports in neurological medicine · 2025Article
- Continuous flow biocatalysis: synthesis of purine nucleoside esters catalyzed by lipase TL IM fromRSC advances · 2024Article
- Rapid determination of acyclovir, its main metabolite 9-carboxymethoxymethylguanine, ganciclovir, and penciclovir in human serum using LC-MS/MS.Biomedical chromatography : BMC · 2022Article
- Acyclovir Brain Disposition: Interactions with P-gp, Bcrp, Mrp2, and Oat3 at the Blood-Brain Barrier.European journal of drug metabolism and pharmacokinetics · 2022Article
- [Acute nihilistic delusion in a multimorbid patient with zoster ophthalmicus requiring dialysis].Zeitschrift fur Gerontologie und Geriatrie · 2021Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood-brain barrier (BBB) in acute CNS infection may be of interest.
objectivesTo investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS.
methodsWe investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS.
resultsIncreased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration.
conclusionsIn patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS.
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