Valacyclovir/Acyclovir

PD Dialyzability: Likely

Pharmacokinetic Parameters [1] [2]

  Valacyclovir Acyclovir
Molecular Weight (Da) 324.34 225.20
Plasma Protein Binding (%) 13-18 15-30
Volume of Distribution (L/Kg) No Data 0.7
Hepatic Metabolism Valacyclovir is converted to acyclovir by hepatic metabolism Small amounts of acyclovir is metabolized in the liver
Excreted Unchanged (%) <1 40-70
Half-Life; Normal Renal Function (hours) 2.3-3.3 2.1-3.8
Half-Life; ESRD (hours) No Data 20

CAPD Dosing: [2] [3] [4]

  • Valacyclovir 500mg PO Q24H

CCPD Dosing:

  • No literature identified. Extrapolate dosing from CAPD dosing recommendations.

Indication Specific PD Dosing:

  • None identified

Literature Summary:

Title Patient Intervention Outcome Note
Evaluation of valaciclovir dosage reduction in continuous ambulatory peritoneal dialysis patients.
[5]
  • CAPD
  • 12 patients otherwise healthy
 Single dose of valacyclovir 500mg PO.
  • Acyclovir concentration
  • 500mg daily regimen produced therapeutic concentration for herpes zoster (HZV) or varicella zoster (VZV) viruses.
  • 1 patient developed tinnitus and headache.
Intensification of peritoneal dialysis improves valacyclovir neurotoxicity.
[6]
  • CAPD
  • 72 year old female
  • Prescribed valacyclovir for vesicular herpes zoster eruption.
  • Presenting with confusion and visual hallucination, dysesthesia, impaired coordination, and reported experience of nightmares.
 Valacyclovir 3g PO daily.
  • Valacyclovir was discontinued
  • PD schedule was intensified to six, 2L bag exchanges daily.
  • Valacyclovir induced neurotoxicity.
A cloudy bag and genital ulcers.
[7]
  • CCPD
  • 30 year old female
  • Presenting with abdominal pain, a cloudy effluent, and genital ulcers.
  • Diagnosed with peritonitis secondary to genital herpes.
 Valacyclovir 500mg PO once daily x 14 days.
  • Patient recovered and discharged
  • No ADR reported

References

[1]Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(suppl_1):D668–72.
[2](1, 2) American Pharmacist Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals [Internet]. Hudson, Ohio: American Pharmacist association; 2012 [cited 2018 Jan 24]. Available from: http://online.lexi.com.login.ezproxy.library.ualberta.ca/lco/action/home?siteid=1
[3]Aronoff GR. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
[4]Adjusting oral antibiotics to estimated creatinine clearance [Internet]. [cited 2018 Jan 24]. Available from: http://www.vhpharmsci.com/VHFormulary/Tools/ADJUSTING%20ORAL%20ANTIBIOTICS.pdf
[5]Stathoulopoulou F, Dhillon S, Thodis H, Stathakis C, Vargemezis V. Evaluation of valaciclovir dosage reduction in continuous ambulatory peritoneal dialysis patients. Nephron. 2002;91(1):164–166.
[6]Pipili C, Pantelias K, Deda E, Tsiamalos P, Kostis E, Grapsa E. Intensification of peritoneal dialysis improves valacyclovir neurotoxicity. Ren Fail. 2013;35(2):289–290.
[7]Liesker J, van Elsacker-Niele AM, Blanken R, Halma C. A cloudy bag and genital ulcers. Clin Nephrol. 2006;65(5):378–379.