Neurotoxicity associated with acyclovir in end stage renal failure

Aims: To alert practitioners to the danger of acyclovir neurotoxicity occurring in the presence of renal failure. Methods: Two case reports of acyclovir neurotoxicity in the patients on continuous ambulatory peritoneal dialysis. Results: In one case neurotoxicity resulted from the use of a dosage regimen that would be appropriate in patients with normal renal function. In the other case, neurotoxicity occurred even though a reduced dose of acyclovir was given. Supportive management resulted in a complete recovery. Conclusions: In patients with end stage renal failure with varicella zoster infections, when acyclovir is prescribed the loading dose should be 400 mg and the maintenance dose should be 200 mg twice daily.